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

Abstract

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.

Head and neck squamous cell carcinoma in HIV patients

“…Due to the rise of HPV-related oropharyngeal SCC, an increased HNSCC incidence has been reported in the general population [12]. This trend was also observed in PLWH, with the incidence of oropharyngeal tumor increasing from 6.8 cases per 100 000 person-year in 1996–2000 to 11.4 in 2006–2009 [12,13 ▪▪ ].…”

“…The increased incidence and presentation in young age and advanced stages of HNSCC in PLWH is part of a multifactorial equation [5,10,13 && ,20]. Tobacco and alcohol abuses, notorious risk factors for HNSCC, are higher in PLWH than in the general population [5].…”

Association of hepatitis B virus infection with head and neck cancer: a propensity-matched study

“…Recently, it is reported that HBV, HCV and HIV can lead to an increased HNC risk [17][18][19]. However, the association of HBV infection with HNC remains to be fully understood and few previous epidemiological investigation studies related to HBV and malignancy have conducted 1:4 propensity-matched controlled studies to control biases.…”