Incidence and survival for oropharynx and non‐oropharynx head and neck cancers among veterans living with HIV

Mazul, Angela L.; Hartman, Christine; Kramer, Jennifer R.; White, Donna L.; Royse, Kathryn E.; Raychaudhury, Suchismita; Sandulache, Vlad C.; Ahmed, Sarah T.; Richardson, Peter; Sikora, Andrew G.; Chiao, Elizabeth Y.

doi:10.1002/cam4.3539

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…It is estimated, for example, that the risk of HNSCC is between 1.4 and 4 times greater in PLWH, with the risk of laryngeal SCC being between 2-and 11-fold higher. [3][4][5][6][7][8] PLWH are also diagnosed at a younger age, by about 7-10 years for all HNSCC and 15-20 years for LSCC specifically. 3,5,7,14 Here, we found only a 6-year difference in age of LC diagnosis between PLWH and controls, though among PLWH, the median age of 56 was about 15 years older than in other reports.…”

Section: Discussionmentioning

confidence: 99%

“…2 In fact, the rate of LSCC in PLWH has significantly exceeded, by between 1.4 and 11 times, that of uninfected individuals. [3][4][5][6][7][8] PLWH have multiple unique risk factors-for example, immunosuppression, inflammation, oncogenic virus infection, cART toxicity, and HIV itself-that could potentially modify risk, clinical course, and outcomes of their laryngeal cancer (LC) compared to the general population. 9 So, as the incidence of LSCC increases among PLWH, it becomes increasingly important to fully characterize disease outcomes and compare them to HIV À LSCC in order to assist in prognostication and clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

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Impact of human immunodeficiency virus status on laryngeal cancer survival and locoregional control

Weinreb

Piersiala

Dhar

et al. 2022

Laryngoscope Investig Oto

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Objectives: To compare long-term outcomes of laryngeal cancer (LC) in people living with HIV (PLWH) versus uninfected individuals and determine how clinical and viral factors-such as demographics, cancer stage, HIV viral load, and CD4 nadircontribute to these outcomes. Methods: This was a retrospective case-control study of 749 patients seen for LC at a single tertiary care center between 2003 and 2017. Of these, 22 had HIV at the time of LC diagnosis, and they were matched in a 1:4 ratio to uninfected controls based on sex, presence of smoking history, and age at cancer diagnosis. Kaplan-Meier survival curves and Cox proportional hazards models were constructed to identify overall and disease-free survival differences based on HIV status, as well as other clinical and viral factors.Results: Compared to all uninfected individuals, PLWH were diagnosed with LC approximately 6 years younger (p = .013). 1-, 2-, and 5-year overall survival for PLWH were 86.4% (63.4%-95.4%), 77.3% (53.7%-89.9%), and 65.8% (40.8%-82.2%), respectively following LC diagnosis, and HIV was not significantly associated with overall (HR = 3.34 [0.59-18.79]) or disease-free survival (HR = 2.12 [0.71-6.36]). The incidence rate of locoregional recurrence among PLWH was 541 compared to 371 per 10,000 person-years in controls, which were not significantly different (p = .420). Furthermore, among PLWH, peak viral load and CD4 nadir were not associated with overall or disease-free survival. Conclusion:While previous work has shown that HIV is associated with elevated risk of LC, survival did not differ significantly between PLWH and uninfected individuals in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of human immunodeficiency virus status on laryngeal cancer survival and locoregional control

Weinreb

Piersiala

Dhar

et al. 2022

Laryngoscope Investig Oto

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“…All CD4 measurements must have occurred before the HNSCC diagnosis. We selected nadir (lowest recorded) CD4 count rather than CD4 count at the time of cancer or censor because nadir CD4 was the only factor associated with head and neck cancer risk in our previous study, 12 and incident cancer may be associated with decreasing overall lymphocyte and CD4 counts.…”

Section: Methodsmentioning

confidence: 99%

Risk and incidence of head and neck cancers in veterans living with HIV and matched HIV‐negative veterans

Mazul

Hartman

Mowery

et al. 2022

Cancer

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BACKGROUND:Persons living with HIV/AIDS have a higher incidence of virus-related and tobacco/alcohol-related cancers. This study is the first to estimate the effect of HIV versus HIV-negative veterans on the risk of head and neck squamous cell carcinoma incidence in a large retrospective cohort study. METHODS: The authors constructed a retrospective cohort study using patient data from 1999 to 2016 from the National Veterans Administration Corporate Data Warehouse and the VA Central Cancer Registry. This cohort study included 45,052 veterans living with HIV/AIDS and 162,486 HIV-negative patients matched by age, sex, and index visit (i.e., HIV diagnosis date or clinic visit date). The age-standardized incidence rates and estimated adjusted hazard ratios were calculated with a Cox proportional hazards regression for oropharyngeal and nonoropharyngeal head and neck cancer squamous cell carcinoma (HNSCC). The authors also abstracted human papillomavirus (HPV) status from oropharyngeal HNSCC diagnosed after 2010. RESULTS: Veterans living with HIV/AIDS (VLWH) have 1.71 (95% confidence interval [CI], 1.36, 2.14) times the risk of oropharyngeal cancer and 2.06 (95% CI, 1.76, 2.42) times the hazard of nonoropharyngeal cancer compared with HIV-negative veterans. VLWH with oropharyngeal squamous cell carcinoma (OPSCC) were more likely to be HPV-positive (N = 30 [81.1%]) than the HIV-negative veterans with OPSCC (N = 50 [67.6%]), although this difference was not significant (p = .135). For nonoropharyngeal cancer, the increased risk of oral cavity cancer among VLWH drove the increased risk. CONCLUSIONS:The study results suggest that HIV may play a role in virally mediated and nonvirally mediated HNSCC. As the HIV prevalence rises in the United States due to better survival and the incidence of HPV-positive oropharyngeal HNSCC increases, the interaction between HPV and HIV becomes increasingly relevant.

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“…Furthermore, the incidence of several other HPV-related cancers, including oropharynx, vagina, vulva, and penis cancers was increased in PLWH [ 51 ]. A low CD4+ lymphocyte count could also be related to a poorer outcome in some HPV-associated neoplasms [ 52 ]. The incidence of penile SCC is extremely low, although it is higher in PLWH than in those without HIV [ 53 ].…”

Section: Relationship Between Hiv and Hpvmentioning

confidence: 99%

“…HPV-driven OPSCC tends to affect younger people with no significant smoking or alcohol consumption, with HPV-16 being the genotype most commonly linked to the disease [ 69 ]. Finally, the incidence of HPV-related OPSCC is roughly fivefold higher in PLWH than in those without HIV (50.6 cases per 100,000 person years) [ 52 , 70 ].…”

Section: Relationship Between Hiv and Hpvmentioning

confidence: 99%

Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection

2022

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Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Although most HPV infections will spontaneously resolve, a considerable proportion of them will persist, increasing the risk of anogenital dysplasia, especially within certain populations, such as patients infected with human immunodeficiency virus (HIV). Furthermore, high-risk oncogenic HPV types (HR-HPV) are the main cause of cervix and other anogenital cancers, such as cancer of the vagina, vulva, penis, or anus. HIV and HPV coinfection is common among people living with HIV (PLWH) but disproportionally affects men who have sex with men (MSM) for whom the rate of persistent HPV infection and reinfection is noteworthy. The molecular interactions between HIV and HPV, as well as the interplay between both viruses and the immune system, are increasingly being understood. The immune dysfunction induced by HIV infection impairs the rate of HPV clearance and increases its oncogenic risk. Despite the availability of effective antiretroviral therapy (ART), the incidence of several HPV-related cancers is higher in PLWH, and the burden of persistent HPV-related disease has become a significant concern in an aging HIV population. Several public health strategies have been developed to reduce the transmission of HIV and HPV and mitigate the consequences of this type of coinfection. Universal HPV vaccination is the most effective preventive tool to reduce the incidence of HPV disease. In addition, screening programs for HPV-related cervical and vulvovaginal diseases in women are well-recognized strategies to prevent cervical cancer. Similarly, anal dysplasia screening programs are being implemented worldwide for the prevention of anal cancer among PLWH. Herein, the main epidemiological features and clinical implications of HIV and HPV coinfection are reviewed, focusing mainly on the relationship between HIV immune status and HPV-related diseases and the current strategies used to reduce the burden of HPV-related disease.

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Incidence and survival for oropharynx and non‐oropharynx head and neck cancers among veterans living with HIV

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 8 publications

References 37 publications

Impact of human immunodeficiency virus status on laryngeal cancer survival and locoregional control

Impact of human immunodeficiency virus status on laryngeal cancer survival and locoregional control

Risk and incidence of head and neck cancers in veterans living with HIV and matched HIV‐negative veterans

Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection

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