Incidence of Types of Cancer among HIV-Infected Persons Compared with the General Population in the United States, 1992–2003

Patel, Pragna; Hanson, Debra L.; Sullivan, Patrick S.; Novak, Richard M.; Moorman, Anne C.; Tong, Tony C.; Holmberg, Scott D.; Brooks, John T.

doi:10.7326/0003-4819-148-10-200805200-00005

Cited by 859 publications

(737 citation statements)

References 70 publications

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“…Person years of follow-up accrued within current CD4 count strata, and person years of follow-up were censored when the most recent CD4 count was >6 months old. Poisson regression analysis was used to determine the factors associated with the development of non-AIDS-defining malignancies; appropriate adjustments were made to (12) Prostate (15) Brain (4) Pharynx (2) Rectal (12) Multiple myeloma (4) Larynx (8) Colon (11) Myeloid leukemia (3) Vulval (5) Pancreas (7) Leukemia (3) Penile (2) Stomach (7) Liposarcoma ( 21 ; therefore, an additional subgroup analysis focused on these 3 cancers combined. All analysis was performed using SAS 9.1 (SAS institute, Cary, NC).…”

Section: Methodsmentioning

confidence: 99%

“…[3][4][5] Many non-AIDS defining malignancies have been found at a higher incidence in HIV patients than in the general population. 6,7 The incidences of Hodgkin lymphoma (HL) and malignancy of liver, lung, anus, and oral cavity/pharynx have all been found to be higher among the HIV-infected population than the general population, 8,9 as well as melanoma, leukemia, and vaginal, colon, rectal, and kidney cancer in some studies. 8 Several oncogenic viruses are thought to cause AIDS-defining malignancies; human herpesvirus 8 is associated with KS, Epstein-Barr virus (EBV) is associated with the 2 most common NHL subtypes, and the human papillomavirus (HPV) is associated with cervical cancer.…”

mentioning

confidence: 99%

“…6,7 The incidences of Hodgkin lymphoma (HL) and malignancy of liver, lung, anus, and oral cavity/pharynx have all been found to be higher among the HIV-infected population than the general population, 8,9 as well as melanoma, leukemia, and vaginal, colon, rectal, and kidney cancer in some studies. 8 Several oncogenic viruses are thought to cause AIDS-defining malignancies; human herpesvirus 8 is associated with KS, Epstein-Barr virus (EBV) is associated with the 2 most common NHL subtypes, and the human papillomavirus (HPV) is associated with cervical cancer. [10][11][12] Also, several non-AIDS-defining malignancies have been associated with viruses, including HL, 13,14 anal cancer, 15 and hepatocellular carcinoma (HCC).…”

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confidence: 99%

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Relationship between current level of immunodeficiency and non‐acquired immunodeficiency syndrome‐defining malignancies

Reekie

Kósa

Engsig

et al. 2010

Cancer

129

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BACKGROUND:In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency syndrome (AIDS)-defining malignancies account for more morbidity and mortality in human immunodeficiency virus-infected patients than AIDS-defining malignancies. However, conflicting data have been reported on the relationship between immunodeficiency and the development of some non-AIDS-defining malignancies. METHODS: A total of 14,453 patients from the prospective, multinational EuroSIDA cohort were included. Malignancies were classified as virusrelated, non-virus-related epithelial, and other. The incidence of non-AIDS-defining malignancies was calculated stratified by current CD4 count. Poisson regression was used to investigate factors associated with the development of non-AIDS-defining malignancies. RESULTS: A total of 356 non-AIDS-defining malignancies occurred, with an incidence rate of 4.3 per 1000 person years of follow-up (95% confidence interval [CI], 3.8-4.7); 172 (48.3%) were virusrelated, 135 (37.9%) were non-virus-related epithelial, and 49 (13.7%) were classified as other. Anal (69 cases), lung (31 cases), and melanoma (13 cases), respectively, were the most common non-AIDS-defining malignancies within each group. After adjustment, current CD4 was associated with virus-related non-AIDS-defining malignancies (incidence rate ratio [IRR], 0.81 per doubling; 95% CI, 0.75-0.88; P < .0001) and non-virus-related epithelial non-AIDSdefining malignancies (IRR, 0.84; 95% CI, 0.75-0.95; P ¼ .004), but not with other non-AIDS-defining malignancies (IRR, 1.04; 95% CI, 0.83-1.31; P ¼ .73). Current CD4 count was also associated with anal cancer (IRR, 0.86; 95% CI, 0.75-0.99; P ¼ .03), Hodgkin lymphoma (n ¼ 52; IRR, 0.83; 95% CI, 0.73-0.95; P ¼ .005), and lung cancer (IRR, 0.76; 95% CI, 0.64-0.90; P ¼ .0002). CONCLUSIONS: A low current CD4 count was associated with an increased incidence of certain non-AIDS-defining malignancies. Starting cART earlier to reduce the proportion of patients with a low CD4 count may decrease the rate of developing many common non-AIDS-related malignancies. A randomized trial to explore this strategy is urgently needed. Cancer 2010;116:5306-15.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Relationship between current level of immunodeficiency and non‐acquired immunodeficiency syndrome‐defining malignancies

Reekie

Kósa

Engsig

et al. 2010

Cancer

129

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“…6 Todavia, esse esquema terapêutico não está associado com a regressão das NIAs 7 e, contrário ao esperado, a incidência do carcinoma anal vem crescendo na era pós-HAART. 8 Nos Estados Unidos, a expectativa de diagnóstico desse tumor aumentou de 19/100.000, na época pré-HAART (1992-1995), para 48,3/100.000 no período pós-HAART imediato (1996-1999) e para 78,2/100.000 pessoas por ano, nos anos mais recentes (2000)(2001)(2002)(2003). 8 Entretanto, o CEC anal foi mais diagnosticado entre aqueles que possuem contagens de linfócitos T CD4 abaixo de 200/mm 3 , mesmo com carga viral baixa, 5 sugerindo associação entre o aumento da sobrevivência proporcionado pelo HAART, a imunodepressão prolongada e a persistência da infecção pelo HPV, aumentando o risco da doença neoplásica.…”

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“…8 Nos Estados Unidos, a expectativa de diagnóstico desse tumor aumentou de 19/100.000, na época pré-HAART (1992-1995), para 48,3/100.000 no período pós-HAART imediato (1996-1999) e para 78,2/100.000 pessoas por ano, nos anos mais recentes (2000)(2001)(2002)(2003). 8 Entretanto, o CEC anal foi mais diagnosticado entre aqueles que possuem contagens de linfócitos T CD4 abaixo de 200/mm 3 , mesmo com carga viral baixa, 5 sugerindo associação entre o aumento da sobrevivência proporcionado pelo HAART, a imunodepressão prolongada e a persistência da infecção pelo HPV, aumentando o risco da doença neoplásica. 2,5,6,9 Esses fatos induzem a que o HIV seja o co-fator que o HPV necessita para predispor o aparecimento das lesões precursoras e sua progressão para o tumor anal.…”

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Seguimento dos doentes soropositivos e soronegativos para o HIV com carcinoma espinocelular do canal anal

Nadal

Cruz²

2009

Rev bras. colo-proctol.

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RESUMO: A incidência do carcinoma espinocelular (CEC) anal e das neoplasias intra-epiteliais anais (NIA) é maior nos pacientes infectados pelo papilomavírus humano (HPV), e está relacionada à imunidade e à infecção pelo vírus da imunodeficiência humana (HIV). A associação com viroses de transmissão sexual indica que seja tumor sexualmente transmitido. A infecção pelo HIV mudou o perfil dos portadores do CEC anal. A doença que anteriormente acometia mulheres na 6 a década de vida, hoje atinge preferencialmente homens na 3ª e 4 a décadas. Nos Estados Unidos, a expectativa de diagnóstico desse tumor aumentou de 19/ 100.000, na época pré-HAART (1992-1995), para 48,3/100.000 no período pós-HAART imediato (1996-1999) e para 78,2/100.000 pessoas por ano, nos anos mais recentes (2000-2003). O tratamento do CEC anal, descrito por Nigro em 1974, combina radio e quimioterapia. Operações de resgate estão indicadas caso haja persistência ou recidiva da doença. Estudos comparando, respectivamente, doentes imunodeprimidos e imunocompetentes vêm mostrado envolvimento linfonodal em 60% e 17%, recidivas em 75% e 6%, boa resposta à radio e quimioterapia em 62% e 85%, toxicidade a esse tratamento em 80% e 30%, e sobrevivên-cia global de 1,4 e 5,3 anos. A contagem sérica baixa de linfócitos T CD4 prediz mau prognóstico. Quando acima de 200/mm 3 , os resultados são comparáveis aos observados entre os imunocompetentes.

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Cutaneous Malignancies Among HIV-Infected Persons

Crum-Cianflone

Hullsiek²,

Satter

et al. 2009

Arch Intern Med

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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.

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Incidence of Types of Cancer among HIV-Infected Persons Compared with the General Population in the United States, 1992–2003

Abstract: The incidence of many types of non-AIDS-defining cancer was higher among HIV-infected persons than among the general population from 1992 to 2003.

Cited by 859 publications

References 70 publications

Relationship between current level of immunodeficiency and non‐acquired immunodeficiency syndrome‐defining malignancies

Relationship between current level of immunodeficiency and non‐acquired immunodeficiency syndrome‐defining malignancies

Seguimento dos doentes soropositivos e soronegativos para o HIV com carcinoma espinocelular do canal anal

Cutaneous Malignancies Among HIV-Infected Persons

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