Cancer Trends in HIV-Infected People During the Era of Effective Antiretroviral Therapy

 

The rates of AIDS-defining cancers have decreased, whereas those of several non–AIDS-defining cancers have increased, due in part to aging of the HIV-infected population.

 

Cancer trends in HIV-infected people may be influenced by changes in group demographics (e.g., aging), in background rates of cancer in the general population, and in the relative risk for cancer in HIV-infected individuals compared with the general population. Now, investigators have used data from the HIV/AIDS Cancer Match Study, which links HIV and cancer registries in seven states, to examine how these factors have influenced time trends for 10 cancers in HIV-infected patients.

Data were evaluated for approximately 275,000 HIV-infected patients (~1,472,000 person-years of follow-up) for 1996 through 2010. During this period, the proportion of follow-up time contributed by people aged ≥50 increased from 13% in 1996–2000 to 27% in 2006–2010. The main cancer trends were:

  • Increases in the rates of anal, liver, and prostate cancers

  • Decreases in the rates of Kaposi sarcoma (KS), cervical cancer, non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), and lung cancer

  • Stable rates of breast and colorectal cancers

The trends for breast, colorectal, liver, lung, and prostate cancers were influenced by aging and other demographic shifts in the HIV-infected population. Liver and lung cancer trends were particularly affected by changes in the background rates in the general population. The decline in KS, NHL, cervical cancer, HL, and lung cancer rates reflected decreases in the relative risks for these malignancies in the HIV-infected population.

COMMENT

This study suggests that increased rates of several important non–AIDS-defining cancers in HIV-infected people reflect demographic changes, especially the “graying” of the epidemic. What do these recent cancer trends mean for the practicing clinician? The rise in anal cancer rates supports recentrecommendations to screen many HIV-infected people for precancerous lesions and to increase human papillomavirus (HPV) vaccination rates. (Perhaps the decline in cervical cancer — another HPV-related malignancy — reflects the effect of long-standing screening practices.) More-effective treatment of viral hepatitis, which is finally at hand, should reduce liver cancer rates. And, perhaps most important, these findings highlight the fact that optimal care for HIV-infected people must include age-appropriate screening for common cancers, just as is done in the general population, as well as smoking-cessation counseling to address the leading preventable cause of cancer.

CITATION(S):

  1. Robbins HA et al. Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States. AIDS 2014 Mar 2728:881. (http://dx.doi.org/10.1097/QAD.0000000000000163)