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Kaposi’s sarcoma, lymphoma highest during first year of ART
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Rates of Kaposi’s sarcoma and lymphoma were highest within the first year of antiretroviral treatment, but after the first year, other non–AIDS-defining cancers comprised most of the cancer burden for those with HIV, researchers reported in Clinical Infectious Diseases.
“It was surprising to see that cancer incidence after ART initiation was relatively constant across calendar years, after accounting for changing demographics and the effects of patients initiating ART at higher CD4+ counts,” Elizabeth Yanik, PhD, ScM, of the department of epidemiology at the University of North Carolina, Chapel Hill, told Infectious Disease News. “This finding may indicate that the improvements in potency and durability of ART regimens from 1996 to 2011 have had little impact on cancer incidence.”
Elizabeth Yanik
Yanik and colleagues studied the incidence and timing of cancer among 11,485 patients who initiated ART from 1996 to 2011, using data from the Centers for AIDS Research Network of Integrated Clinical Systems. At ART initiation, the median age of the patients was 38 years and the median CD4+ count was 202 cells/mm3. The median length of follow-up was 3.1 years after ART initiation.
The study included 46,318 person-years of follow-up, and there were 457 cancer diagnoses, for an incidence rate of 987 cases per 100,000 person-years. The rates of AIDS-defining cancers and non–AIDS-defining cancers were similar. The most common AIDS-defining cancer was Kaposi’s sarcoma, and the most common non–AIDS-defining cancer was anal cancer.
The incidence of Kaposi’s sarcoma was highest during the first 6 months of ART treatment, but then decreased. Lymphoma incidence also was highest during the first 6 months of treatment, then decreased. However, the incidence rates for other cancers increased by 7% each year after ART initiation. In year 1, the incidence rate for other cancers was 416 cases per 100,000 person-years, and in year 10, the incidence rate was 615 cases per 100,000 person-years.
In multivariable analyses, older age increased the risk for all cancers but Kaposi’s sarcoma, and a lower CD4+ count also was associated with a higher incidence of all cancers except for non-lymphoma, HPV-unrelated non–AIDS-defining cancers.
“These results can be used to inform decisions about prioritizing cancer screening after patients initiate ART,” Yanik said. “For instance, Kaposi’s sarcoma and lymphomas account for the majority of the cancer burden during the first year of ART, but after that time, other non–AIDS-defining cancers are more common. As a result, screening for malignancies such as HPV-related cancer could be prioritized after the first year of ART.”
Yanik said additional studies are being conducted in this cohort to examine the effects of immunologic and virologic response to ART on subsequent cancer incidence.
For more information:
Elizabeth Yanik, PhD, ScM, can be reached at elizabeth_yanik@med.unc.edu.
Disclosure: Yanik reports no relevant financial disclosures.
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