This article is more than 5 years old. Information may no longer be current.
Older patients with HIV at higher risk for cancer
Click Here to Manage Email Alerts
Older people living with HIV remain at an elevated risk for cancer, according to findings published in Clinical Infectious Diseases.
Although the relative risk for most cancers decline with age, the excess absolute risk (EAR) — a measure of absolute risk and a reflection of the number of excess cancers that occur among people living with HIV (PLWH) — increase with age for some non-AIDS-defining cancers (NADC), researchers reported.
“The introduction of highly active ART (HAART) has led to a steady increase in the life expectancy of PLWH,” Parag Mahale, MBBS, PhD, postdoctoral fellow at the National Cancer Institute, and colleagues wrote. “Consequently, the number of older PLWH in the U.S. has also increased.”
Rates of AIDS-defining cancers have declined over the past 20 years because of improved immunity due to HAART, but rates of many types of NADC increase with age, according to Mahale and colleagues.
“It is unclear whether age-related immune senescence in the setting of HIV-related immunosuppression will result in particularly elevated cancer rates among older PLWH,” they said.
The researchers reviewed data from the HIV/AIDS Cancer Match Study, which was conducted from 1996 to 2012, to evaluate the risk for various AIDS-defining cancers, such as Kaposi sarcoma, cervical cancer and non-Hodgkin lymphoma; and the risk for NADC, including Hodgkin lymphoma, lung, liver, anal, oral/pharyngeal, prostate, colon and breast cancer among PLWH aged 50 years or older.
The researchers compared cancer incidence rates between PLWH and the general population by calculating both standardized incidence ratios (SIRs) to measure relative risk, and EARs.
Mahale and colleagues reported 10,371 instances of cancer in 183,542 patients. The risk for breast cancer was reduced among PLWH compared with the general population (SIR = 0.61), as were risks for colon cancer (SIR = 0.63) and prostate cancer (SIR = 0.47), the researchers reported. However, risk was significantly increased for Kaposi sarcoma (SIR = 103.34), non-Hodgkin lymphoma (SIR = 3.05) and Hodgkin lymphoma (SIR = 7.61), as well as anal cancer (SIR = 14), cervical cancer (SIR = 2.02), lung cancer (SIR = 1.71), oral/pharyngeal cancer (SIR = 1.66) and liver cancer (SIR = 2.91).
Although SIRs for all cancers decreased with age, Mahale and colleagues wrote, EARs rose with age for lung, liver, oral/pharyngeal and anal cancers.
The risk for cancer was highest within the 5 years following HIV diagnosis, the researchers reported. Risk for non-Hodgkin lymphoma, Kaposi sarcoma, Hodgkin lymphoma and lung cancer decreased over time following HIV diagnosis.
“Despite lower relative risks, the absolute risk difference is higher for some NADC among older PLWH, leading to a greater incidence of excess cancers in this group,” Mahale and colleagues wrote. “Thus, there is a continued need for cancer prevention and early detection among older PLWH.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to Top
Cancer has been closely associated with HIV since the first cases of AIDS were reported in 1981. In the early epidemic, nearly 50% of men who have sex with men (MSM) had Kaposi sarcoma as their presenting complaint. With the introduction of potent ART starting in 1996, the incidence of AIDS-defining cancers, especially Kaposi sarcoma and non-Hodgkin lymphoma, have declined sharply. But rates are still higher in PLWH and those with other cancers, termed NADC, are increasingly recognized. Particularly because PLWH are now surviving longer, it is not surprising that cancer risk increases as it does in the uninfected population. The epidemiology of NADC in the infected population is complex and estimates must take into account the age of the population at risk, which tends to be lower in PLWH, as well as other cancer risk factors, particularly cigarette smoking, which is more common in MSM than in the general population. Studies like the one in Clinical Infectious Diseases by Mahale and colleagues are important in examining this situation because they analyze large datasets to adjust for these complexities. The researchers report that cancer rates remain elevated, an important finding for clinicians who must be observant for these comorbidities in HIV care. Interestingly, they find some common cancers, such as breast and prostate cancers, may actually be less common in PLWH. Because epidemiology can often lead to suggestions of disease pathogenesis, these and related studies will be of considerable interest as the PLWH continue to mature.
Click Here to Manage Email Alerts