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Incidence of AIDS-defining cancers continues to decline
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Researchers in France have learned that the incidence of three AIDS-defining cancers — Kaposi’s sarcoma, non-Hodgkin’s lymphoma and cervical cancer — has continued to decline, but the risk still remains higher than in the general population.
“Previous studies on the trend of the incidence of AIDS-defining cancers showed a decrease for Kaposi’s sarcoma and non-Hodgkin’s lymphoma and heterogeneous results for cervical cancer,” Mira Hleyhel, PhD, of the Institut national de la santé et de la recherche médicale (INSERM) in Paris, told Infectious Disease News. “These studies did not extend beyond the year 2006, and some of them involved only patients with AIDS, rather than all patients living with HIV. Therefore, updated data were needed to examine the trends of AIDS-defining cancers in a large cohort of HIV-infected patients with a lengthy follow-up to 2009.”
The study included 99,309 patients who were enrolled in the French Hospital Database on HIV cohort from 1992 to 2009. The study was divided into four time periods: pre-combined antiretroviral therapy (1992-1996), early combined ART (1997-2000), intermediate combined ART (2001-2004) and late combined ART (2005-2009).
During the entire period, there were 5,890 incidents of AIDS-defining cancers, including 3,366 cases of Kaposi’s sarcoma, 2,344 cases of non-Hodgkin’s lymphoma and 180 cases of cervical cancer. Fifty-five percent of cases occurred in the pre-ART era, 17% occurred in the early-ART era, 14% occurred in the immediate ART era and 14% occurred in the late ART era.
For Kaposi’s sarcoma, the incidence fell significantly between the pre-ART and ART eras, and continued to fall throughout the ART era. For non-Hodgkin’s lymphoma, the incidence rate also declined significantly from the pre-ART era to the ART era and continued to decline through the ART era. The rates of cervical cancer also fell significantly, but the incidence was still higher among women with HIV compared with women in the general population.
The incidence of Kaposi’s sarcoma and non-Hodgkin’s lymphoma also was higher among people with HIV, compared with the general population. Among patients on combined ART who had CD4 counts of ≥500/mm3 for at least 2 years, and HIV RNA ≤500 copies/mL, however, there was still a higher risk for Kaposi’s sarcoma compared with the general population, but not a higher risk for non-Hodgkin’s lymphoma. In addition, those with non-Hodgkin’s lymphoma developed the disease at a significantly younger age compared to the general population.
“An earlier diagnosis of HIV infection and an earlier treatment initiation leading to a restored or maintained CD4 count above 500/mm3 would be most beneficial to prevent cancer risk,” Hleyhel said. “It might also eliminate the excess risk of non-Hodgkin lymphoma.”
Hleyhel said that research is needed to understand the earlier age at diagnosis of non-Hodgkin’s lymphoma in HIV-infected patients, and the remaining excess risk of Kaposi’s sarcoma in patients with controlled viral load a restored immunity.
Mira Hleyhel, PhD, can be reached at: INSERM U 943, 56 Bd Vincent Auriol, BP 335, 75625 Paris cedex 13, France; email: mhleyhel@ccde.chups.jussieu.fr.
Disclosure: Hleyhel reports no relevant financial disclosures.
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