Increasing Incidence of Non-AIDS-defining Cancers in HIV Positive
Individuals
The
most frequently observed AIDS-defining
cancers are non
Hodgkin's lymphoma and Kaposi’s
sarcoma. With improved survival rates due to the widespread
use of potent HAART regimens, however, there is an increasing incidence
in the appearance of non-AIDS-defining
cancers (NADCs) among individuals with HIV infection.
The
objective of this study, published in the October 2005 issue of
the journal Cancer, was to determine the rates and predictors
of NADCs in a cohort of HIV patients. The preliminary findings of
the present study were first presented at the 42nd Annual Meeting
of the Infectious Diseases Society of America. Abstract 886.
(Boston, Massachusetts, September 30-October 3, 2004).
The
authors conducted a retrospective study of 4,144 HIV-infected individuals
who had 26,916 person-years of follow-up and who had open access
to medical care at 1 of the United States military HIV clinics during
the years 1988-2003.
Cancer
incidence rates were race specific and were adjusted for age; these
were compared with national rates using logistic regression to assess
predictors of NADC development.
Results
· One
hundred thirty-three NADCs were diagnosed with a rate of 980 diagnoses
per 100,000 person-years.
· The
most frequent NADCs were skin
carcinomas (basal cell and squamous cell), Hodgkin's
disease, and anal
carcinoma.
· The
results showed that there were higher rates of melanoma, basal and squamous
cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin
disease among the HIV-infected cohort compared with age-adjusted
rates for the general United States population.
· Predictors
of NADCs included age older than 40 years, Caucasian/non-Hispanic
race, longer duration of HIV infection, and a history of opportunistic infection.
· The
use of HAART was associated with lower rates of NADCs.
· A
low CD4 nadir or CD4 count at diagnosis (< 200 cells/mL) was
not predictive of NADCs.
The
most frequent NADCs were primary skin malignancies.
Melanoma,
basal and squamous cell skin carcinomas, anal carcinoma, prostate
carcinoma, and Hodgkin disease occurred at higher rates among HIV-infected
individuals.
In
conclusion, the authors write, “The implementation of screening
programs for these malignancies should be considered.”
“Most
risk factors for the development of NADCs are non modifiable; however,
the use of HAART appeared to be beneficial in protecting against
the development of malignant disease.”
Graduate
School of Public Health, San Diego State University, San Diego,
California, United States Military HIV Research Program, Rockville,
Maryland, Tri-Service AIDS Clinical Consortium, Rockville, Maryland,
Infectious Diseases Division, Naval Medical Center, San Diego, California,
Infectious Diseases Division, Walter Reed Army Medical Center, Washington,
DC, Infectious Diseases Division, National Naval Medical Center,
Bethesda, Maryland, Infectious Diseases Division, Wilford Hall
United States Air Force Medical Center, Lackland Air Force Base,
Texas, Infectious Diseases Division, Naval Medical Center Portsmouth,
Portsmouth, Virginia, Infectious Diseases Division, Tripler Army
Medical Center, Honolulu, Hawaii.
09/21/05
Reference
A
Burgi and others. Incidence and risk factors for the occurrence
of non-AIDS-defining cancers among human immunodeficiency virus-infected
individuals. Cancer 104(7): 1505-1511. October 2005.
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