Are Non-HIV Malignancies Increased in the HIV-Infected Population?
- 247 Downloads
Purpose of review
The introduction of antiretroviral therapy (ART) has revolutionized HIV infection management, resulting in improved outcomes and survival for people living with HIV (PLWH). However, as PLWH are living longer and aging, non-AIDS-defining cancers (NADCs) represent a significant source of morbidity and mortality in the HIV-infected population. Here, we review the epidemiology of NADCs in PLWH.
Cancer mortality among PLWH is much higher than that among the general population. Up to 10% of deaths among PLWH have been attributed to NADCs. Furthermore, PLWH have an increased risk for specific NADCs, including lung cancer, hepatocellular carcinoma, head and neck cancers, anal cancer, and Hodgkin lymphoma. In the past decade, the incidence rates of AIDS-defining cancers (ADCs) have been decreasing while the incidence rates of NADCs have been increasing. In particular, the incidence of specific NADCs are changing at different rates. For example through 2010, the incidence rates for anal, liver, and prostate cancers among PLWH had increased, while incidence rates for lung cancer had decreased and incidence rates for colorectal cancer remained relatively stable over time. However, as early ART becomes more prevalent and the percentage of PLWH over 50 increases, these trends may evolve further.
Incidence of NADCs should be expected to increase further as the PLWH population continues to age. Screening and prevention for these cancers among the HIV-infected population should be emphasized.
KeywordsHIV/AIDS Cancer Epidemiology Antiretroviral therapy ART
NIH R01 CA206479 (Chiao), NIH P30 AI027767 (Thrift)
Compliance with Ethical Standards
Conflict of Interest
The authors declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.CDC. HIV in the United States: At A Glance. 2017. https://www.cdc.gov/hiv/statistics/overview/ataglance.html.
- 10.Koethe JR, Jenkins CA, Lau B, Shepherd BE, Justice AC, Tate JP, et al. North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Rising obesity prevalence and weight gain among adults starting antiretroviral therapy in the United States and Canada. AIDS Res Hum Retrovir. 2016;32(1):50–8.Google Scholar
- 17.•• Engels EA, Yanik EL, Wheeler W, et al. Cancer-attributable mortality among people with treated human immunodeficiency virus infection in North America. Clin Infect Dis. 2017;65(4):636–43. This prospective cohort study among 46,956 individuals in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) showed that approximately 10% of deaths in people living with HIV receiving ART were due to cancer. The fraction of deaths due to cancer increased over time and is expected to further increase as AIDS-related mortality decreases and the HIV-infected population ages. CrossRefPubMedPubMedCentralGoogle Scholar
- 18.•• Hernandez-Ramirez RU, Shiels MS, Dubrow R, Engels EA. Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study. Lancet HIV. 2017;4(11):e495–504. This article decribes the risk of cancer among the HIV/AIDS Cancer Match Study, the largest population-based study of cancer among HIV-infected individuals. They showed that risk for some non-AIDS-defining cancers (i.e., anus, liver, and lung) remain high among people with HIV during the modern treatment era. CrossRefPubMedGoogle Scholar
- 23.•• Shiels MS, Althoff KN, Pfeiffer RM, et al. HIV infection, immunosuppression, and age at diagnosis of non-AIDS-defining cancers. Clin Infect Dis. 2017;64(4):468–75. This study showed that there is no acceleration of cancer development among people living with HIV; for most cancers, the mean age at diagnoses is not different between individuals with and without HIV infection. PubMedPubMedCentralGoogle Scholar
- 34.• Reddy KP, Kong CY, Hyle EP, et al. Lung cancer mortality associated with smoking and smoking cessation among people living with HIV in the United States. JAMA Intern Med. 2017;177(11):1613–21. This simulation study showed that there is a large burden of lung cancer among people living with HIV in the USA such that lung cancer is now a leading cause of death. For people living with HIV who adhere to ART, smoking rather than HIV itself contributes more to poor health and mortality risk. CrossRefPubMedGoogle Scholar
- 35.• Coghill AE, Pfeiffer RM, Shiels MS, Engels EA. Excess mortality among HIV-infected individuals with cancer in the United States. Cancer Epidemiol Biomark Prev. 2017;26(7):1027–33. This large cohort study using data from the HIV/AIDS Cancer Match Study and the National Center for Health Statistics showed that individuals with both HIV and cancer are at especially high risk for mortality compared to individuals with either HIV or cancer. CrossRefGoogle Scholar
- 48.EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43.Google Scholar