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Higher nonmelanoma skin cancer rate found in HIV-positive patients
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Patients who are HIV-positive had a twofold higher incidence rate of nonmelanoma skin cancers compared with patients who were HIV-negative, according to study results.
Squamous cell carcinomas were associated with immunodeficiency, but basal cell carcinomas were not.
Previous studies have indicated that HIV-positive patients may be especially vulnerable to nonmelanoma skin cancers, given the established significant risk of nonmelanoma skin cancers in other immunocompromised populations, such as solid organ transplant recipients and patients with a previous cancer history.
Michael J. Silverberg
“It is also possible that the predominant group at risk of HIV in the United Sates — men who have sex with men — may tend to engage in behaviors, including recreational sun exposure and/or use of tanning beds, that increase their risk for [nonmelanoma skin cancers],” Michael J. Silverberg, PhD, MPH, a research scientist in the division of research at Kaiser Permanente, and colleagues wrote. “Given the increasing longevity for HIV-positive individuals during the antiretroviral therapy era, the burden of many age-related non–AIDS-defining cancers, including [nonmelanoma skin cancers], will only continue to increase.”
To evaluate the role of HIV-specific factors such as immunodeficiency or tumor-specific factors in patients with nonmelanoma skin cancers, Silverberg and colleagues assessed incidence rates in a large cohort of HIV-positive (n=6,560) and HIV-negative (n=36,821) patients who received care in the same health care system. The researchers also compared squamous cell carcinoma and basal cell carcinoma rates by HIV status with adjustment for several skin cancer risk factors.
In addition, the researchers examined links between HIV infection and tumor characteristics, including invasiveness, differentiation and tumor location.
According to study results, HIV-positive patients exhibited a 2.1-fold higher incidence rate of basal cell carcinoma (95% CI, 1.8-2.3) and a 2.6-fold higher incidence rate of squamous cell carcinoma (95% CI, 2.1-3.2) compared with HIV-negative patients in the same health care system.
The increased incidence rate of basal cell carcinomas for HIV-positive patients appeared to be limited to men, whereas the increased incidence rate of squamous cell carcinomas was observed for women, HIV-positive men who have sex with men and other HIV-positive men. Additionally, lower recent CD4 counts among HIV-positive patients presented a higher incidence rate for squamous cell carcinoma but not for basal cell carcinoma.
“Routine skin cancer screening is warranted for HIV-positive individuals, particularly those with more advanced HIV/AIDS,” Silverberg and colleagues wrote. “HIV-positive individuals should also be advised to reduce behaviors that may further increase their risk of [nonmelanoma skin cancer], such as excessive sun exposure. Earlier initiation of [antiretroviral therapy] to maintain higher CD4 counts, as emphasized in recent [antiretroviral therapy] guidelines, may also help reduce the burden of [nonmelanoma skin cancers] in this population.”
Disclosure: The researchers report research funding from Merck and Pfizer.
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