Cutaneous Malignancies Among HIV-Infected Persons

Abstract

Background As life expectancy of HIV-infected persons increases, cancers have become an important cause of morbidity and mortality. Although cutaneous neoplasms are the most common malignancies in the general population, little data exist among HIV-positive persons especially regarding the impact of HIV-specific factors. Methods We evaluated the incidence rates and factors associated with the development of cutaneous malignancies among HIV-infected persons by examining prospectively collected data from a large HIV Natural History Study composed of 4,490 persons (1986 to 2006). Poisson regression and Cox proportional hazards models were performed. Results Six percent (n=254) of HIV-infected persons developed a cutaneous malignancy during 33,760 person-years of follow-up (mean 7.5 years). Since the advent of highly active antiretroviral therapy (HAART), incidence rates of cutaneous non-AIDS defining cancers (NADCs), in particular basal cell carcinoma, have exceeded rates of cutaneous AIDS-defining cancers such as Kaposi’s sarcoma. Factors associated with the development of cutaneous NADCs in the multivariate models included increasing age (hazard ratio (HR) 2.1; 95% CI 1.7–2.6) and race. Compared to white/non-Hispanic race, African Americans (HR 0.03, 95% CI 0.01–0.14) and other races (HR 0.14, 95% CI 0.03, 0.57) had a lower risk of cutaneous NADCs. There were no significant associations between cutaneous NADCs and time-updated CD4 counts, HIV RNA levels, or HAART receipt. Conclusions NADCs are now the most common cutaneous malignancies among HIV-infected persons. Cutaneous NADCs do not appear to be significantly associated with immune function or HAART, but rather are related to traditional factors, such as aging and skin color.

Non-AIDS definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era

“…The development of cutaneous NADCs was also showed to be not related to the CD4+ T lymphocites count and receipt of HAART, but HIVinfected subjects are characterized by an high likelihood of developing subsequent cutaneous malignancies at novel sites. In the aforementioned study of Crum-Cianflone et al [82] , 24% of the participants, who initially presented with a BCC, developed a subsequent BCC, and 8% developed a second type of cutaneous cancer.…”

“…Since the early phase of HIV epidemic, Kaposi sarcoma was the most common malignancy with cutaneous involvement [2] , whereas the incidence and risk factors associated with cutaneous nonADCs (NADCs) among HIVinfected persons are less defined. In a large American cohort of 4490 HIVpositive patients retrieved from 1986 to 2006, there were 254 (5.7%) patients who developed skin cancers, and basal cell carcinoma (BCC) was the most frequent nonADCs, with a ratio of BCC to squamous cell carcinoma (SCC) of 6:1, that differs from transplant recipients who develop SCC in the majority of cases [82] . Similarly in the period between 1985 and 2002 analyzed by an aforementioned Swiss study, BCC were more frequent than SCC, and the overall incidence of nonmelanomatous skin cancer was threefold higher than in the general population (Standardized Incidence Ratio, SIRs = 3.2, 95%CI: 2.24.5) in this large national cohort study [83] .…”

“…In a recent metaanalysis that analyzed 13 studies in the postHAART and 8 in the preHAART era, also the risk of melanoma was showed to be increased among HIV/ AIDS population [84] . Even if KS was the most frequent cutaneous cancer, its incidence significantly decreased after 1995, while the ageadjusted incidence rates of cutaneous NADCs remained stable [82] . The factors associated with the development of cutaneous NADCs in this study were aging and the withe/nonHispanic race, similarly to what has been showed in other HIV positive cohort and in the general population [85,86] .…”

Long-term results of treatment for benign cervical epithelial changes associated with human papillomavirus

“…Типы ВПЧ высокого риска -16, 18, 31, 35 и 45 -связаны с развитием до 99 % всех карцином шейки матки и аногенитальной области [11]. Начальные по-вреждения эпителия, ассоциированные с этими виру-сами, при определенных условиях могут регрессиро-вать даже без лечения.…”

Melanoma in Immunosuppressed Patients

“…91,95 Thus, the relationship is still unclear among CD4 count, HAART, HIV RNA viral load, and melanoma incidence, as well as disease course. [94][95][96] HIV and Immune Modulation Although the mechanism of HIV's impact on melanoma is still unclear, some evidence suggests the role of immune modulation. Specifically, a 2007 study found a similarity in the pattern of increased cancer risk when evaluating both patients with HIV infection and OTRs.…”