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HIV increases risk for death from common cancers
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Patients with cancer who are HIV-infected experienced significantly higher cancer mortality rates compared with patients without HIV, according to study results.
Mortality remained higher among patients with HIV regardless of cancer stage or treatment receipt, results also showed.
“Infection with HIV increases the risk of cancer,” Anna E. Coghill, PhD, MPH, postdoctoral research fellow at the NCI, and colleagues wrote. “Relatively few data exist regarding the association between HIV and patient survival after a cancer diagnosis. Such a link is biologically plausible if an intact immune system helps control cancer after treatment to prevent relapse.”
Anna E. Coghill
The researchers identified fourteen common cancers and used data from the HIV/AIDS Cancer Match study to collect data from six participating states — Colorado, Connecticut, Georgia, Michigan, New Jersey and Texas — that provided information on the date and cause of death.
Among patients diagnosed with multiple cancers, the researchers considered only the first diagnosed cancer. Further, they excluded patients with Kaposi sarcoma due to its high prevalence among patients with HIV.
The incidence of death resulting from cancer following a cancer diagnosis served as the primary endpoint.
The analysis included data from 1,816,461 patients with cancer, of whom 0.36% (n = 6,459) were HIV-infected. Over 90% of patients contracted HIV prior to their cancer diagnoses.
The most common cancers among patients with HIV included diffuse large B-cell lymphoma (DLBCL, 25%), lung cancer (16.4%) and anal cancer (10.3%). The most common cancers among patients without HIV included prostate cancer (22.8%), breast cancer (21.3%) and lung cancer (18.1%).
Patients with HIV tended to be diagnosed with cancer at a more advanced stage than patients without HIV (32% vs. 17%; P < .01). Further, first-course cancer treatment occurred less frequently among patients with HIV (68.8% vs. 74.6%; P < .01).
Cox regression models examined the association between HIV status and death from cancer, adjusting for age, sex, race or ethnicity, year of cancer diagnosis and cancer stage.
The researchers observed significantly higher incidence of cancer-specific mortality among patients with HIV in seven cancers: colorectal cancer (HR = 1.49; 95% CI, 1.21-1.84), pancreatic cancer (HR = 1.71; 95% CI, 1.35-2.18), laryngeal cancer (HR = 1.62; 95% CI, 1.06-2.47), lung cancer (HR = 1.28; 95% CI, 1.17-1.39), melanoma (HR = 1.72; 95% CI, 1.09-2.7), breast cancer (HR = 2.61; 95% CI, 2.06-3.31) and prostate cancer (HR = 1.57; 95% CI, 1.02-2.41).
Further, patients with HIV experienced elevated rates of cancer-specific mortality from oral cavity cancer, liver cancer and cervical cancer; however, these associations did not reach statistical significance.
Patients with HIV and anal cancer, Hodgkin's lymphoma and DLBCL did not experience higher rates of cancer-specific mortality compared with patients with these cancers without HIV.
After adjusting for cancer treatment, patients with HIV continued to experience a higher risk for cancer-specific mortality from non–AIDS-defining cancers, including colorectal cancer (HR = 1.4; 95% CI, 1.09-1.8), lung cancer (HR = 1.28; 95% CI, 1.14-1.44), melanoma (HR = 1.93; 95% CI, 1.14-3.27) and breast cancer (HR = 2.64; 95% CI, 1.86-3.73).
The association between mortality risk and HIV persisted among patients with local disease who received standard treatment therapies for breast cancer (HR = 3.02; 95% CI, 1.5-6.05) and non–small cell lung cancer (HR = 1.88; 95% CI, 1.11-3.18).
The researchers identified the possibility for incomplete data in treatment registries and lack of immunosuppression-related data as limitations of their study.
“HIV-infected patients with cancer are more likely to die as a result of their cancer than patients without HIV,” Coghill and colleagues concluded. “Our results suggest that this difference not only is related to advanced tumor stage or lack of cancer treatment but also reflects an effect of immunosuppression on cancer outcomes. Despite the biologic plausibility of a role for immunosuppression in influencing tumor outcome, future clinical and laboratory studies are needed to formally evaluate this hypothesis.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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