Clinical

Many non-AIDS-defining cancers more common in HIV patients

Last Updated: 2008-05-19 17:00:21 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Several types of non-AIDS-defining cancers occur more frequently among HIV-infected individuals - particularly anal cancer - than in the general population, investigators report in the Annals of Internal Medicine for May 20th.

While highly active antiretroviral therapy (HAART) has significantly reduced the incidence of AIDS-defining cancers in the US, the rates of non-AIDS-defining cancer have increased.

To investigate this issue further, Dr. Pragna Patel, at the Centers for Disease Control and Prevention in Atlanta, and colleagues analyzed data from the Adult and Adolescent Spectrum of HIV Disease (ASD) Project, the HIV Outpatient Study (HOPS), and the Surveillance, Epidemiology, and End Results (SEER) program.

Between 1992 and 2003, there were 3550 cases of cancer recorded in the ASD and HOPS studies, of which 20% were non-AIDS-defining cancers. Ten types of cancer occurred significantly more often than in the general population.

The greatest differences were observed for anal cancer (standardized rate ratio, 42.9), vaginal cancer (SRR, 21.0), and Hodgkin lymphoma (SRR, 14.7). SRRs for liver and lung cancer were 7.7 and 3.3, respectively. For melanoma, oropharyngeal, leukemia, colorectal, and renal cancers, the SRRs ranged from 1.8 to 2.6.

Dr. Patel's group attributes the high rate of anal cancer to human papillomavirus infection leading to anal intraepithelial neoplasia among men who have sex with men.

Because HAART has no effect on anal intraepithelial neoplasia, they predict that individuals co-infected with HIV and HPV will remain at greater risk for anal cancer over time, and that the incidence will rise as HIV-infected persons live longer.

"Primary prevention strategies to reduce HPV infection and HPV-associated diseases, such as vaccination and circumcision, warrant further evaluation," the authors maintain.

Dr. Patel and colleagues advise patients and their physicians to remain alert for signs of non-AIDS-related cancer.

Ann Intern Med 2008;148:728-736.