Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States

Abstract

Objective HIV-infected people have elevated risk for some cancers. Changing incidence of these cancers over time may reflect changes in three factors: HIV population demographic structure (e.g. age distribution), general population (background) cancer rates, and HIV-associated relative risks. We assessed the contributions of these factors to time trends for 10 cancers during 1996–2010. Design Population-based registry linkage study. Methods We applied Poisson models to data from the U.S. HIV/AIDS Cancer Match Study to estimate annual percent changes (APCs) in incidence rates of AIDS-defining cancers (ADCs: Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL), and cervical cancer) and 7 non-AIDS-defining cancers (NADCs). We evaluated HIV-infected cancer trends with and without adjustment for demographics, trends in background rates, and trends in standardized incidence ratios (SIRs, to capture relative risk). Results Cancer rates among HIV-infected people rose over time for anal (APC 3.8%), liver (8.5%), and prostate (9.8%) cancers, but declined for KS (1996–2000: −29.3%; 2000–2010: −7.8%), NHL (1996–2003: −15.7%; 2003–2010: −5.5%), cervical cancer (−11.1%), Hodgkin lymphoma (HL, −4.0%), and lung cancer (−2.8%). Breast and colorectal cancer incidence did not change over time. Based on comparison to adjusted models, changing demographics contributed to trends for KS and breast, colorectal, liver, lung, and prostate cancers (all p<0.01). Trends in background rates were notable for liver (APC 5.6%) and lung (−3.2%) cancers. SIRs declined for ADCs, HL (APC −3.2%), and lung cancer (−4.4%). Conclusions Demographic shifts influenced several cancer trends among HIV-infected individuals. Falling relative risks largely explained ADC declines, while background incidence contributed to some NADC trends.

Anal Human Papillomavirus (HPV) Prevalences and Factors Associated with Abnormal Anal Cytology in HIV-Infected Women in an Urban Cohort from Rio de Janeiro, Brazil

“…[4][5][6] Additionally, recent estimates of the incidence of anal SCC among HIV-infected women 6 are higher than the current ICC rate among HIVinfected women 7 (30/100,000 vs. 26/100,000 person-years, respectively), with evidence of increasing risk of anal SCC among both the aging HIV-infected male and female populations in the past two decades. 6,8,9 In comparison to cervical cytologic abnormalities, less is known about anal HPV genotype prevalences and the timeframe of progression from HPV-induced anal pre-cancerous lesions to anal SCC among HIV-infected men and women. 10 While HPV strains 16 and 18 account for more than 70% of ICC worldwide, 11,12 the disease burden of the remaining oncogenic or high-risk HPV (HR-HPV) genotypes (31,33,33,35,39,45,51,52,56,58,59,68,73, and 82) remains high 11 and varies by geographic location.…”

HIV Infection and Survival of Lymphoma Patients in the Era of Highly Active Antiretroviral Therapy

“…HIV infection is the strongest risk factor for lymphoma with a 77-fold associated risk for non-Hodgkin lymphoma (NHL) and an 11-fold risk for Hodgkin lymphoma (5)(6)(7). In the HAART era, the incidence of AIDS-defining NHL subtypes decreased in HIV-infected patients (8)(9)(10), and changes in the HIV-associated relative risks partly contributed to the decrease (10), whereas the incidence of Hodgkin lymphoma remained stable and even increased in some HIV/ AIDS cohorts (10)(11)(12). As a result, lymphoma is currently one of the most common cancers and a leading cause of cancer death among people with HIV/AIDS (7,13,14).…”

HIV-Associated Urogenital Malignancies

“…This was mainly due to infectious complications and to a lower dose intensity of the chemotherapy as dose reductions and prolonged time intervals between chemotherapy cycles were often necessary [23,25,26]. The British study reported a 5-year survival rate of 79% and a cancer-free survival rate of 89% [34]. Notably, HIV was responsible for 70% of the mortality in this cohort, each of which occurred in the pre-cART era.…”