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Cancer Rates in HIV+ in Atlanta: 'Non-AIDS Cancers Found 10 to 15 Years Earlier in People With HIV'
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XVIII International AIDS Conference, July 18-23, 2010, Vienna
Mark Mascolini
HIV-infected adults get diagnosed with certain non-AIDS cancers at an age 10 to 15 years younger than people in the general population, according to results of a single-center study at Emory University in Atlanta [1]. These findings add to the evidence that immune suppression, coinfection with cancer-causing viruses, and other factors could make HIV-infected people vulnerable to cancer at an earlier age than people without HIV. (from Jules: Eric Engels from the CDC went to the microphone and said the earlier age in HIV+ developing cancers in this study is a false finding because since HIV+ individuals are younger than the general population the age at which they develop cancers would be lower, he said to do a proper comparison you need to match by age, and he said he has reported data previously that in 2 cancers, I recall anal & lung, HIV+ develop it at earlier ages but in other cancers they didn't).
The study involved 8300 HIV-infected people seen at an Atlanta HIV clinic from 2000 to 2007. Follow-up continued from January 1, 2000 to cancer diagnosis, death, loss to follow-up, or December 31, 2007. Men comprised 75% of the cohort, and age averaged 39.6 among men and 38.7 among women. Almost three quarters of men and 88% of women were black. Average person-years attending the clinic were 2.66 for men and 2.94 for women.
The investigators identified HIV-infected 512 people with cancer and compared their age at cancer diagnosis with the age of cancer patients in the general population of the Atlanta area. There were 320 AIDS cancers and 192 non-AIDS cancers. Among non-AIDS cancers, lung cancer accounted for 40% of diagnoses, anorectal cancer for 24%, head and neck cancer for 22%, prostate cancer for 18%, Hodgkin lymphoma for 16%, breast cancer for 11%, and liver cancer for 10%.
Lowest-ever CD4 count in HIV-infected men with cancer averaged 129 and CD4 count at cancer diagnosis averaged 263. For HIV-infected women with cancer, those CD4 numbers were 214 and 344. High percentages of these men (44%) and women (60%) were not taking antiretrovirals when they got diagnosed with cancer. Only 17% of men and 11% of women had an undetectable viral load at cancer diagnosis.
HIV-positive men got diagnosed with cancer at an average age of 46.9 years and HIV-positive women at an average age of 48.1 years. Seven non-AIDS cancers got diagnosed in people with HIV at a younger age than in people without HIV. In the following list, only the age difference for Hodgkin lymphoma lacks statistical significance:
Average age at cancer diagnosis
-- Anorectal cancer: 40.9 years with HIV versus 55.1 years without HIV
-- Hodgkin lymphoma: 39.7 years with HIV versus 41.7 years without HIV
-- Hepatocellular carcinoma: 43.7 years with HIV versus 59.5 years without HIV
-- Head and neck cancer: 50.7 years with HIV versus 60.7 years without HIV
-- Lung cancer: 51.6 years with HIV versus 66.3 years without HIV
-- Breast cancer: 44.9 years with HIV versus 57.7 years without HIV
-- Prostate cancer: 53.4 years with HIV versus 64.4 years without HIV
In this study the standardized incidence ratio represents the number of observed cancers at the HIV clinic divided by the number of expected cancers in the general Atlanta population standardized by age, race, and gender. A standardized incidence ratio above 1.0 means the incidence (new diagnosis rate) is higher in the HIV group:
Standardized incidence ratio (HIV versus general population)
-- Anorectal cancer: 67.6 (P < 0.001)
-- Hodgkin lymphoma: 19.7 (P < 0.001)
-- Hepatocellular (liver) carcinoma: 9.5 (P < 0.001)
-- Head and neck cancer: 8.7 (P < 0.001)
-- Lung cancer: 4.5 (P < 0.001)
-- Breast cancer: 1.1 (not significant)
-- Prostate cancer: 0.55 (P = 0.02)
The researchers noted that the retrospective nature of their study means some data are missing. In particular, risk factors like smoking, CD4 count, and viral load could not be factored into the statistical analysis. They suggested that numbers of cancers in these people with HIV may be underestimated because cancers would not be counted if they got diagnosed outside the health system that includes the clinic.
Reference
1. Nguyen ML, Sumbry A, Reddy D, et al. Earlier age at cancer diagnosis and increased incidence of non-AIDS defining cancers in patients with advanced HIV infection. International AIDS Conference. July 18-23, 2010. Vienna. Abstract WEAB0105.
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