Cancer Among HIV-Infected People in North America

Summary and Comment |
October 6, 2015

Cancer Among HIV-Infected People in North America

  1. Carlos del Rio, MD

Cumulative incidence remains highest for Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer, but rates of anal, colorectal, and liver cancers are increasing.

  1. Carlos del Rio, MD

Now that antiretroviral therapy (ART) has prolonged the lives of HIV-infected patients, various cancers have become increasingly common. However, whether this effect stems from longer lifespan or represents a true increase in incidence remains uncertain. In HIV-infected people, cancer risk may be increased because of impaired immune function and chronic inflammation or the presence of risk factors such as viral coinfections or smoking.

In a study involving 16 NA-ACCORD cohorts from the U.S. and Canada, investigators compared trends in cumulative incidence of nine cancers (lung, anal, colorectal, liver, and oropharyngeal cancers, Kaposi sarcoma [KS], non-Hodgkin lymphoma [NHL], Hodgkin disease [HL], and melanoma) between 86,620 HIV-infected and 196,987 HIV-uninfected adults between 1996 and 2009. The cumulative incidence by age 75 years was higher among HIV-infected individuals than among uninfected ones for KS (4.4% vs. 0.01%), NHL (4.5% vs. 0.7%), lung cancer (3.4% vs. 2.8%), anal cancer (1.5% vs. 0.05%), liver cancer (1.1% vs. 0.4%), and HL (0.9% vs. 0.09%). Among HIV-infected people, annual trends in cumulative incidence significantly declined for KS and NHL, but significantly increased for anal, colorectal, and liver cancers.

Comment

ART has transformed the lives of patients with HIV infection, enabling them to live long enough to develop cancers. The high cumulative rates of KS, NHL, and lung cancer by age 75 support early identification of people with HIV infection, as well as early and sustained ART, smoking cessation, and lung cancer screening for such individuals.

Editor Disclosures at Time of Publication

  • Disclosures for Carlos del Rio, MD at time of publication Consultant / Advisory board InnaVirVax Grant / Research support National Institutes of Health (NIH); NIH/National Institute of Allergy and Infectious Diseases; Centers for Disease Control and Prevention; NIH/National Institute on Drug Abuse; Addis Ababa University Editorial boards AIDS Research and Human Retroviruses; Journal of AIDS Leadership positions in professional societies HIV Medicine Association (Board of Directors); International Antiviral Society–USA (Board of Directors)

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