Cancer Risk Increased for Older Patients Living With HIV

Cancer risk was found to be elevated in people living with HIV (PLWH), according to research published in Clinical Infectious Diseases.

In the United States, the proportion of PLWH aged ≥50 years reached 44% in 2014. Cancer risk normally increases with age, and several factors could exacerbate this in PLWH. To investigate, data from the US HIV/AIDS Cancer Match (HACM) study, between the years 2001 to 2012, were used to identify 10,371 cancers among 183,542 older PLWH. Cancer rates were compared with those of the general population using standardized incidence ratios (SIRs) and excess absolute risks (EARs) measures.

Risk was significantly increased for the AIDS-defining cancers: Kaposi sarcoma (SIR=103.34), non-Hodgkin lymphoma (SIR=3.05), and cervical cancers (SIR=2.02), as well as non-AIDS defining cancers: Hodgkin lymphoma (SIR=7.61), anal (SIR=14.00), lung (SIR=1.71), liver (SIR=2.91), and oral cavity/pharyngeal (SIR=1.66) cancers. Risk was reduced for breast (SIR=0.61), prostate (SIR=0.47), and colon (SIR=0.63) cancers.

The risk of most cancers was highest within 5 years of HIV diagnosis and then gradually decreased. All SIRs declined with age while EARs for anal, lung, liver, and oral cavity/pharyngeal cancers increased with age. The increase in EARs reflects the excess numbers of cancers occurring in PLWH compared with the general population.

Information concerning highly active antiretroviral therapy use, CD4⁺ T-cell count, and HIV viral load were unavailable; therefore, definitive interpretation of trends in time from HIV diagnosis are not possible. Further, data on cofactors such as smoking and oncogenic virus coinfections were also unavailable. The data reflect a need for continued cancer prevention and early detection in this group; plus, the increased risk within 5 years of diagnosis highlights the importance of early detection and initiation of treatment.

Reference

Mahale P, Engels EA, Coghill AE, Kahn AR, Shiels MS. Cancer risk in older people living with human immunodeficiency virus infection in the United States [published online January 8, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy012