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Screening HIV-infected patients for non-AIDS-defining malignancies

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Abstract

The use of antiretroviral therapy has reduced mortality and shifted the spectrum of malignancies affecting people living with HIV/AIDS (PLWH). We review guidelines and evidence for screening PLWH for non-AIDS-defining malignancies as compared with the general population. Cervical cancer screening clearly differs for HIV-seropositive women, with two Pap tests 6 months apart in the first year and then annually if normal. The role of cervical human papillomavirus screening has not yet been defined in HIV-seropositive women. Anal cancer screening consists of an annual digital rectal examination, and some (but not all) guidelines also recommend annual anal Pap tests. Screening for breast and colorectal cancer should follow standard, age-appropriate screening recommendations that apply to the general population. Screening HIV-infected men for prostate cancer, as with the general population, lacks a clear benefit. Despite increasing rates of hepatocellular carcinoma and lung cancers among PLWH, there is insufficient evidence to support routine screening.

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References and Recommended Reading

  1. Jones JL, Hanson DL, Dworkin MS, et al.: Surveillance for AIDS-defining opportunistic illnesses 1992–1997. MMWR 1999, 48:1–22.

    PubMed  Google Scholar 

  2. Palella FJ, Delaney KM, Moorman AC, et al.: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998, 338:853–860.

    Article  PubMed  Google Scholar 

  3. Cooley TP: Non-AIDS defining cancer in HIV-infected people. Hematol Oncol Clin North Am 2003, 17:889–899.

    Article  PubMed  Google Scholar 

  4. US Preventive Services Task Force: 2008 Recommendations of the US Preventive Services Task Force. Available at http://www.ahrq.gov/clinic/pocketgd08/pocketgd08.pdf. Accessed November 2008.

  5. Smith RA, Cokkinides V, Brawley OW: Cancer screening in the united states, 2008: a review of current American Cancer Society guidelines and cancer screening issues. CA Cancer J Clin 2008, 58:161–179.

    Article  PubMed  Google Scholar 

  6. Frisch M, Biggar RJ, Goerdert JJ: Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst 2000, 92:1500–1510.

    Article  CAS  PubMed  Google Scholar 

  7. Stein M, O’sullivan P, Wachtel T, et al.: Causes of death in persons with human immunodeficiency virus infection. Am J Med 1992, 93:387–390.

    Article  CAS  PubMed  Google Scholar 

  8. Bonnet F, Lewden C, May T, et al.: Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. Cancer 2004, 101:317–324.

    Article  PubMed  Google Scholar 

  9. Bedimo R: Non-AIDS-defining malignancies among HIV-infected patients in the highly active antiretroviral era. Curr HIV/AIDS Rep 2008, 5:140–149.

    Article  PubMed  Google Scholar 

  10. Grulich AE, van Leeuwen MT, Falster MO, et al.: Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007, 370:59–67.

    Article  PubMed  Google Scholar 

  11. Patel P, Hanson DL, Sullivan PS, et al.: Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med 2008, 148:728–736.

    PubMed  Google Scholar 

  12. American College of Obstetricians and Gynecologists (ACOG):Cancer Screening Guidelines. Available at http://www.acog.org. Accessed November 2008.

  13. Wright TC, Massad LS, Dunton CJ, et al.: 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 2007, 197:346–355.

    Article  PubMed  Google Scholar 

  14. Fletcher SW, Black W, Harris R, et al.: Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst 1993, 85:1644–1656.

    Article  CAS  PubMed  Google Scholar 

  15. Levin B, Lieberman DA, McFarland B, et al.: Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008, 58:130–160.

    Article  PubMed  Google Scholar 

  16. Selby JV, Friedman GD, Quesenberry CP, et al.: A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992, 326:653–657.

    CAS  PubMed  Google Scholar 

  17. Periodic Health Examinations: Summary of American Academy of Family Physicians (AAFP) Policy Recommendations & Age Charts. Available at http://www.aafp.org/exam. Accessed November 2008.

  18. Clark MA, Hartley A, Geh JI: Cancer of the anal canal. Lancet Oncol 2004, 5:149–157.

    Article  PubMed  Google Scholar 

  19. Scholefield JH, Sonnex C, Talbot IC, et al.: Anal and cervical intraepithelial neoplasia: possible parallel. Lancet 1989, 2:756–769.

    Google Scholar 

  20. Palefsky JM, Holly EA, Ralston ML, et al.: Anal squamous intraepithelial lesions in HIV-positive and HIV-negative homosexual and bisexual men: prevalence and risk factors. J Acquir Immune Defic Syndr Hum Retrovirol 1998, 17:320–326.

    CAS  PubMed  Google Scholar 

  21. Hessol NA, Holly EA, Efird JT, et al.: Anal intraepithelial neoplasia in a multisite study of HIV-infected and high-risk HIV-uninfected women. AIDS 2009, 23:59–70.

    Article  PubMed  Google Scholar 

  22. Chin-Hong PV, Palefsky JM: Human papillomavirus anogenital disease in HIV-infected individuals. Dermatol Ther 2005, 18:67–76.

    Article  PubMed  Google Scholar 

  23. Goldie SJ, Kuntz KM, Weinstein MC, et al.: The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. JAMA 1999, 281:1822–1829.

    Article  CAS  PubMed  Google Scholar 

  24. Mathews C, Caperna J, Cachay ER, et al.: Early impact and performance characteristics of an established anal dysplasia screening program: program evaluation considerations. Open AIDS J 2007, 1:11–20.

    PubMed  Google Scholar 

  25. US Department of Health and Human Services: AIDSinfo. Treatment and Prevention Guidelines. Available at http:// AIDSinfo.nih.gov. Accessed December 2008.

  26. New York State Department of Health AIDS Institute: Neoplastic Complications of HIV Infection. Available at www.hivguidelines.org. Accessed November 2008.

  27. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2008. CA Cancer J Clin 2008, 58:71–96.

    Article  PubMed  Google Scholar 

  28. Pantanowitz L, Dezube BJ: Reasons for a deficit of breast cancer among HIV-infected patients. J Clin Oncol 2004, 22:1349–1350.

    Article  Google Scholar 

  29. Stuart T, Tsai SCJ, Grayson H, et al.: Incidence of de novo breast cancer in women chronically immunosuppressed after organ transplantation. Lancet 1995, 346:796–798.

    Article  Google Scholar 

  30. Preston-Martin S, Kirsten LM, Pogoda JM, et al.: Use of mammographic screening by HIV-infected women in the Women’s Interagency HIV Study (WIHS). Prev Med 2002, 34:386–392.

    Article  PubMed  Google Scholar 

  31. Koethe JR, Moore RD, Wagner KR: Physician specialization and women’s primary care services in an urban HIV clinic. AIDS Patient Care STDs 2008, 22:373–380.

    Article  PubMed  Google Scholar 

  32. Hurley J, Franco S, Gomez-Fernandez C, et al.: Breast cancer and human immunodeficiency virus: a report of 20 cases. Clin Breast Cancer 2001, 3:215–220.

    Article  Google Scholar 

  33. Olowole SF, Ali AO, Shafaee Z, et al.: Breast cancer in women with HIV/AIDS: report of five cases with a review of the literature. J Surg Oncol 2005, 89:23–27.

    Article  Google Scholar 

  34. Voutsadakis IA, Silverman LR: Breast cancer in HIV-positive women: a report of four cases and review of the literature. Cancer Invest 2002, 20:452–457.

    Article  PubMed  Google Scholar 

  35. Schuman P, Ohmit SE, Klein RS, et al.: Longitudinal study of cervical squamous intraepithelial lesions in human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women. J Infect Dis 2003, 188:128–136.

    Article  PubMed  Google Scholar 

  36. Heard I, Schmitz V, Costagliola D, et al.: Early regression of cervical lesions in HIV-seropositive women receiving highly active antiretroviral therapy. AIDS 1998, 12:1459–1464.

    Article  CAS  PubMed  Google Scholar 

  37. 1997 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons with human immunodeficiency virus. USPHS/IDSA Prevention of Opportunistic Infections Working Group. MMWR Morb Mortal Wkly Rep 1997, 46:1–46.

  38. Hankins CA, Lamont JA, Handley MA: Cervicovaginal screening in women with HIV infection: a need for increased vigilance? Can Med Assoc J 1994, 150:681–686.

    CAS  Google Scholar 

  39. Stein MD, Cunningham WE, Nakazono T, et al.: Screening for cervical cancer in HIV-infected women receiving care in the United States. J Acquir Immune Defic Syndr 2001, 27:463–466.

    CAS  PubMed  Google Scholar 

  40. Denny L, Kuhn L, De Souza M, et al.: Screen-and-treat approaches for cervical cancer prevention in low-resource settings. JAMA 2005, 294:2173–2181.

    Article  CAS  PubMed  Google Scholar 

  41. Bedimo R, Chen RY, Accortt NA, et al.: Trends in AIDS-defining and non-AIDS defining malignancies among HIV-infected patients: 1989–2002. Clin Infect Dis 2004, 39:1380–1384.

    Article  PubMed  Google Scholar 

  42. Yeguez JF, Martinez SA, Sands DR, et al.: Colorectal malignancies in HIV-positive patients. Am Surg 2003, 69:981–987.

    PubMed  Google Scholar 

  43. Reinhold JP, Moon M, Tenner CT, et al.: Colorectal cancer screening in HIV-infected patients 50 years of age and older: missed opportunities for prevention. Am J Gastroenterol 2005, 100:1805–1812.

    Article  PubMed  Google Scholar 

  44. Bruix J, Sherman M: Management of hepatocellular carcinoma. Hepatology 2005, 42:1208–1236.

    Article  PubMed  Google Scholar 

  45. Staples CT, Rimland D, Dudas D: Hepatitis C in the HIV (human immunodeficiency virus) Atlanta V.A. (Veterans Affairs Medical Center) Cohort Study (HAVACS): the effect of coinfection on survival. Clin Infect Dis 1999, 29:150–154.

    Article  PubMed  Google Scholar 

  46. Davila JA, Morgan RO, Shaib Y, et al.: Hepatitis C infection and the increasing incidence of hepatocellular carcinoma: a population-based study. Gastroenterology 2004, 127:1372–1380.

    Article  PubMed  Google Scholar 

  47. Rosenthal E, Poiree M, Pradier C, et al.: Mortality due to hepatitis C-related liver disease in HIV-infected patients in France (Mortavic 2001 study). AIDS 2003, 17:1803–1809.

    Article  PubMed  Google Scholar 

  48. Zhang BH, Yang BH, Tang ZY: Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004, 130:417–422.

    PubMed  Google Scholar 

  49. Cadranel J, Garfield D, Lavole A, et al.: Lung cancer in HIV infected patients: facts, questions and challenges. Thorax 2006, 61:1000–1008.

    Article  CAS  PubMed  Google Scholar 

  50. Marcus PA: Lung cancer screening: an update. J Clin Oncol 2001, 19:83s–86s.

    CAS  PubMed  Google Scholar 

  51. Henschke CI, Yankelevitz DF, Libby DM, et al.: Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006, 355:1763–1771.

    Article  PubMed  Google Scholar 

  52. Ilic D, O’Connor D, Green S, et al.: Screening for prostate cancer. Cochrane Database Syst Rev 2006, 19:CD004720.

    Google Scholar 

  53. US Preventive Services Task Force: Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008, 149:185–191.

    Google Scholar 

  54. Hessol NA, Pipkin S, Schwarcz S, et al.: The impact of highly active antiretroviral therapy on non-AIDS-defining cancers among adults with AIDS. Am J Epidemiol 2007, 165:1143–1153.

    Article  PubMed  Google Scholar 

  55. Crum NF, Spencer CR, Amling CL: Prostate carcinoma among men with human immunodeficiency virus infection. Cancer 2004, 101:294–299.

    Article  PubMed  Google Scholar 

  56. Vianna LE, Lo Y, Klein RS: Serum prostate-specific antigen levels in older men with or at risk for HIV. HIV Med 2006, 7:471–476.

    Article  CAS  PubMed  Google Scholar 

  57. Justice AC, Chang CH, Fusco J, et al.: Extrapolating long-term HIV/AIDS survival in the post-HAART era [abstract 1158:489]. In Abstracts of the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy; San Francisco, CA; September 26–29, 1999. Washington, DC: American Society for Microbiology; 1999.

    Google Scholar 

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Correspondence to Adrienne A. Phillips.

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Phillips, A.A., Justman, J.E. Screening HIV-infected patients for non-AIDS-defining malignancies. Curr HIV/AIDS Rep 6, 83–92 (2009). https://doi.org/10.1007/s11904-009-0013-0

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