“The incidence of five non-AIDS defining malignancies — lung cancer, head and neck cancer, Hodgkin’s disease, anorectal cancer and melanoma — are significantly higher in HIV-infected persons than in the general population,” Dr. Pragna Patel, of the of the HIV Outpatient Study (HOPS), told participants at the 11th Annual Retroviral Conference (San Francisco, 2/04).
Conversely, rates of the AIDS-defining malignancies Kaposi’s sarcoma and cervical cancer have decreased, while the rate of non-Hodgkin’s lymphoma has stayed the same. These findings point to a changing pattern in cancer among HIV-infected patients since the emergence of highly active antiretroviral therapies in 1996.
Dr. Patel, based in Atlanta, and other HOPS members evaluated cancer incidence rates over an 11-year period, between 1992 and 2002.
HOPS included nine clinics in eight cities where more than 3000 HIV patients were seen annually. Also included in the analysis were close to 8000 patients seen at two Chicago HIV clinics. These data were compared with data complied for the general population and cancer registries. The numbers were adjusted for age, race, smoking, and gender.
Compared with the general population, Dr. Patel’s group found that HIV-infected patients in HOPS were twice as likely to have lung cancer, 5 times more likely to have Hodgkin’s disease, 10 times as likely to have anorectal cancer, and 3 times more likely to have melanoma.
For the Chicago-based patients, the risks of all five non-AIDS-defining cancers were increased in HIV patients compared with the general population. The risks of lung cancer, Hodgkin’s disease, anorectal cancer, melanoma, and head and neck cancer were increased by 4-, 77-, 5-, 4-, and 10-fold, respectively.
“Lower mean nadir CD4 cell counts in all the cancer patients compared with patients without cancer suggest that immunosuppression may lead to poor tumor surveillance, allowing for the development of these cancers,” Dr. Patel told the audience.
“Furthermore, co-infections with oncogenic viruses in the face of HIV may render patients more susceptible to developing certain cancers,” she suggested. “For example, [human papillomavirus] is associated with anorectal cancer, and head and neck cancer, while [Epstein-Barr virus] is associated with Hodgkin’s disease.” [Deborah Mitchell, Reuters Health February 11, 2004; Abstinence Clearinghouse 18Feb04]