Increased incidence of certain cancers in HIV-positive individuals

1. From a cohort study, HIV-infected people had significantly increased incidence of Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL), lung cancer, anal cancer and liver cancer.

2. Over the course of the study from 1996-2009, HIV-infected individuals experienced decreasing crude mortality rate and increasing CD4+ cell counts.

Evidence Rating Level: 2 (Good)

Study Rundown: Antiretroviral therapies are prolonging the lives of people with HIV; however, HIV-infected people also have a higher burden of cancer, which may be due to reduced immunity, higher prevalence of smoking and viral co-infection. The authors of this large multicenter, cohort study explored the incidence of cancers by types between 1996 and 2009 in HIV-infected adults and uninfected adults belonging to the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Most of the cohort was male, less than half were white and the median age was 42 years. The crude mortality rate for HIV-infected decreased from 5140 to 2844 deaths per 100,000 person-years over the study period. Similarly, the median CD4+ count increased from 0.309 to 0.382 x 10⁹ cells/L. Despite the drastic reduction in mortality for HIV-infected people, the crude mortality rate at the end of the study period from 2005 to 2009 was still three-fold greater than in uninfected people. During the entire study period, the cumulative incidence of cancer by age 65 or 75 years was greater in HIV-infected people, particularly for KS, NHL, lung cancer and anal cancer, compared to uninfected people. Overall, it is clear that cancer remains an important public health concern for HIV-positive individuals.

Click to read the study published today in the Annals of Internal Medicine

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

In-Depth [cohort study]: This study followed the incidence of nine cancer types in 86 620 HIV-infected persons (475 660 person-years) and 196 987 uninfected persons (1 847 932 person-years) from 16 centers as part of the NA-ACCORD cohort. The study was divided into three periods 1996-1999, 2000-2004 and 2005-2009. The prevalence of hepatitis B among HIV-infected people was 3-4% and was 20-22% for hepatitis C. The highest incidence rates among HIV-infected people compared to uninfected people were KS (100.4 vs 0.2 per 100 000 person-years), NHL (153.5 vs 12.6 per 100 000 person-years), and anal cancer (60.1 vs 1.2 per 100 000 person-years). The cumulative incidence rate by 75 years of age for people with and without HIV were as follows: 4.4% and 0.01% for KS, 4.5% and 0.7% for NHL, 3.4% and 2.8% for lung cancer, 1.5% and 0.05% for anal cancer, 1.0% and 1.5% for liver cancer, 0.9% and 0.09% for Hodgkin lymphoma, 0.5% and 0.6% for melanoma, and 0.8% and 0.8% for pharyngeal cancers.

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