Cancers in HIV
from Jules: how much of the findings of increased cancers in HIV+ is due to increased screening, and increased deaths due to other causes (survivor bias), and in some of these studies the cancer rates appear low. A number of studies have found increasing risk for non-AIDS cancers (NADCs), however this recent study immediately below from the large US/Canada based NA-ACCORD study looked at KS, Non-Hodgkins Lymphoma, anal, lung, liver, malignant melanomas, colorectal cancers, oral/pharynx cancers and concluded: "With the exception of declines for KS and NHL as a result of ART, and an increase for liver cancer, cancer risk did not change significantly over time. However, risk for KS, NHL, HL, malignant melanoma, and anal, lung and liver cancers varied significantly by sex, race, and/or HIV exposure risk."
Cancer Rates in Large Patient Cohort NA-ACCORD (46,000) in US/Canada
Risk of common cancers by age 60 for HIV-infected patients in the United States and Canada
North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA
Presented at the XIX International AIDS Conference
July 22-27, 2012
"With the exception of declines for KS and NHL as a result of ART, and an increase for liver cancer, cancer risk did not change significantly over time.
However, risk for KS, NHL, HL, malignant melanoma, and anal, lung and liver cancers varied significantly by sex, race, and/or HIV exposure risk."
CDC Study Confirms Rising Non-AIDS Cancer Rate in With HIV
XVIII International AIDS Conference, July 18-23, 2010, Vienna
Centers for Disease Control (CDC) investigators attributed the spike in non-AIDS cancers to the aging US AIDS population and to longer survival of people with HIV/AIDS because of improving antiretroviral regimens [and perhaps merely due to increased screening in part?]
Federal Prevention Message -
National Cancer Institute press release (Jan 17, 2012). Cancer Among Minorities with HIV/AIDS: most common non-AIDS-defining cancers in patients with HIV are anal, lung, and liver cancers and Hodgkin lymphoma.....prevention efforts are especially important for racial and ethnic minorities
"Preventing cancers that are increasing among the HIV-infected population is now a major focus of people who treat those with HIV. This effort includes trying to combat viral co-infections that cause cancer through prevention, screening, and treatment and avoiding exposure to other risk factors, such as smoking. Both men and women who are infected with HIV should discuss screening options for cancer with their medical providers. The risk of lung cancer can be reduced by quitting smoking. Because HIV-infected people have a higher risk of lung cancer, it is especially important that they do not smoke. Also, determining a patient's hepatitis status can sometimes lead to effective early intervention that may be able to reduce the risk of liver cancer.......since many HIV-related cancers are caused by HPV, it is important for male and female children to be vaccinated against HPV infection before they are sexually active.......These prevention efforts are especially important for racial and ethnic minorities, who make up more than half of all HIV patients. Nearly four in five women with HIV/AIDS are from these groups, and an even greater number of children with the disease are also from these groups."
Skin Cancer in HIV: Doubled Rate of Nonmelanoma Skin Cancer With HIV in California Comparison
6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, July 17-20, 2011, Rome
"The investigators suggested that higher risk of both nonmelanoma cancers in people with HIV may reflect more intense cancer screening of the HIV group or their greater sun exposure. The higher squamous cell carcinoma risk in people with HIV, they added, may partly reflect their immunodeficiency. The Kaiser team noted that viral load and antiretroviral therapy had no measurable impact on risk of these two nonmelanoma skin cancers."
HIV as an independent risk factor for incident lung cancer
AIDS: 15 May 2012
"we find that smoking conveys a much greater magnitude of risk for lung cancer than HIV infection.......Lung cancer is the most common non-AIDS-defining cancer (NADC) and leading source of NADC mortality among HIV-infected individuals [1,2]. Increased rates of lung cancer in HIV-infected patients, compared with uninfected patients, have been demonstrated in multiple prior studies [3-10]. This increased incidence has not been clearly explained and could potentially be attributed to higher smoking rates or increased healthcare surveillance in the HIV-infected population compared with uninfected populations.......The relative contribution of smoking to the increased risk of lung cancer associated with HIV infection remains a major question.......
.........In our cART era cohort of more than 110 000 Veterans, we found that HIV-infected Veterans had a significantly higher incidence of lung cancer than uninfected Veterans, and that HIV infection was an independent risk factor for lung cancer after controlling for potential confounders including smoking. This is the largest cohort study with both HIV-infected and uninfected individuals and individual-level smoking data to evaluate lung cancer incidence. Our analysis includes 457 cases of incident lung cancer among HIV-infected patients, more than eight times that of any previous analysis with individual-level smoking data."
Non-AIDS Cancer Incidence Remains the
Same Over 2004-2010 in D:A:D Study Group
13th European AIDS Conference, October 12-15, 2011, Belgrade
The rising challenge of Non-AIDS Defining Cancers in HIV-infected patients
Clinical Infectious Diseases Advance Access published July 9, 2012
"Even more than screening, cancer prevention should be a key goal for practitioners caring for HIV-infected patients. This includes smoking cessation
Prevention and/or treatment for viral coinfections of Hepatitis B and C should be routine....."
Trends and Predictors of Non AIDS-Defining Cancers in Men and Women With Hiv-Infection. A Single-Institution Retrospective Study Before and After the Introduction of Haart
JAIDS Journal of Acquired Immune Deficiency Syndromes: POST ACCEPTANCE, 28 December 2012
"our findings confirm the increasing incidence and broadening spectrum of NADCs......HIV-infected women show an excess risk of virus-related cancers..... age, an AIDS diagnosis and a nadir CD4 count of <200 cells/mL were independently associated with the risk of developing NADC "