Incidence of certain cancers expected to decline among HIV–positive individuals

The burden of cancer in HIV–positive patients is projected to decrease by 2030, mostly driven by declines in non-Hodgkin lymphoma and Kaposi sarcoma, according to data presented at the American Association for Cancer Research Annual Meeting.

Perspective from Paul A. Volberding, MD

Although these HIV–associated cancers are expected to decline, incidence of prostate and lung cancers is expected to increase among HIV–positive individuals as this population ages.

Jessica Y. Islam

“Declines in cancer incidence rates, particularly AIDS–defining cancers, are likely driven by widespread treatment with modern antiretroviral therapies, which reduce immune suppression and decrease risk for some cancers,” Jessica Y. Islam, MPH, doctoral student in the UNC Gillings School of Global Public Health, said in a press release.

Islam and colleagues, including Meredith S. Shiels, PhD, investigator from the division of cancer epidemiology and genetic, infections and immunoepidemiology at NCI, estimated future cancer risk and burden among HIV–positive individuals using age-specific cancer incidence data from the NCI HIV/AIDS Cancer Match Study from 2000 to 2012 and projected HIV prevalence data from the CDC.

The researchers used Poisson regression to estimate incidence rates among people living with HIV divided by age and risk group for certain cancers between 2013 and 2030.

The researchers estimated that the total cancer burden in people with HIV will decrease from 7,908 cases in 2010 to 6,495 cases by 2030, based on strong decreases in three AIDS–defining cancers: Kaposi sarcoma, non-Hodgkin lymphoma and cervical cancer (2,719 in 2010 vs. 701 in 2030). Researchers also estimated a small increase would occur in all non–AIDS-defining cancers (5,190 vs. 5,794).

Based on declines that occurred from 2000 and 2012, age-specific cancer incidence rates are expected to decrease across age groups for non-Hodgkin lymphoma, cervical cancer and lung cancer, as well as for some age groups for Kaposi sarcoma, Hodgkin lymphoma and colon cancer. Prostate cancer rates are expected to increase, whereas all other age-specific cancer rates are not expected to change significantly.

The most common cancers for this population in 2010 were Kaposi sarcoma and non-Hodgkin lymphoma, whereas the most common cancers in 2030 will be prostate, lung, liver and anal.

In addition, the number of people living with HIV aged 65 years or older in the United States is expected to increase from 4.1% in 2006 to 21.4% in 2030.

“It is crucial to understand both incidence rates and burden over time, as rates capture changes in risk, and burden quantifies the actual number of cancer cases expected to occur... lung cancer rates are expected to decrease in the future, but the burden is expected to increase due to the growing number of older people living with HIV,” Shiels said in a press release.

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The widespread use of modern antiretroviral therapies for the treatment of HIV has decreased risk for some cancers and increased life expectancy, Islam said. She further said that more effort through targeted cancer prevention and early detection and control is needed to monitor cancer risk.

“These include smoking cessation, treating hepatitis B and C viruses, cancer screening at appropriate age and widespread treatment with antiretroviral therapy,” Islam said. “It is critical that we continue to monitor cancer risk in the HIV–infected population.” – by Melinda Stevens

Reference:

Islam JY, et al. Abstract 5302. Presented at: American Association for Cancer Research Annual Meeting; April 1-5, 2017; Washington, D.C.

Disclosures: Islam reports no relevant financial disclosures.

Perspective

Paul A. Volberding, MD

Cancers have played a central role in the HIV/AIDS epidemic from its earliest outbreak. Unusual cancers, particularly Kaposi sarcoma and aggressive non-Hodgkin lymphomas — termed AIDS–defining cancers — were among the initial common manifestations of HIV disease. With the now 35-year evolution of the epidemic and with dramatic advances in antiretroviral therapy, it is not surprising that the role of cancers in AIDS has changed. The AACR presentation by Islam and colleagues from University of Carolina is a useful summary of some of these changes. They identify several moving parts in this unfolding picture.

First, immune preservation and recovery associated with effective HIV therapy has decreased the incidence of AIDS–defining cancers dramatically. Second, as the HIV–infected population ages, life span may actually approach normal in well-treated HIV infection, and cancers common in the broader population are now increasingly common as well in persons living with HIV.

Finally, those with HIV infection are more likely to smoke than the general population and to be co-infected with HBV and/or HCV — other viruses associated with cancer risk. Therefore, the researchers conclude, HIV care providers still need to be vigilant in considering cancers in infected persons. Screening for the full spectrum of age-associated cancers is critically important as are cancer prevention efforts, including smoking cessation.

The story of progress in the HIV/AIDS epidemic is incredibly gratifying. Treatments have changed the face of the HIV/AIDS epidemic, but cancers remain a major concern and must be considered in all HIV treatment programs.

Paul A. Volberding, MD

University of California, San Francisco

Disclosures: Volberding reports chairing a DSMB for Merck.