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Trends in AIDS-defining and non-AIDS-defining cancers among HIV-infected patients: a 20-year study
Presented by Nancy Crum-Cianflone, United States.
Crum-Cianflone N.1, Marconi V.1, Weintrob A.1, Ganesan A.1, Barthel R.V.1, Fraser S.1, Agan B.1, Wegner S.1, TriService AIDS Clinical Consortium, Infectious Disease Clinical Research Program
1TriService AIDS Clinical Consortium, Infectious Disease Clinical Research Program (IDCRP), USUHS, Bethesda, United States
Objectives: Cancers rates and types have changed over the course of the HIV epidemic. We present data on a large cohort of HIV-infected persons spanning a 20-year period to determine trends and predictors for malignancies.
Methods: We evaluated 4,507 participants (24,389 person-years of follow-up) in a prospective observational Natural History Study (1987-2006) among military beneficiaries. Time periods were defined as period 1 (1987-1996), 2 (1997-2001), and 3 (2002-2006). Cancers were defined as ADCs (KS, NHL, ICC) or NADCs. Statistical methods included chi-square, rank sum tests, and regression modeling.
Results: The participants mean age at HIV diagnosis was 29 years (17-75), 92% were male, 44% Caucasian, 45% African American, 8% Hispanic and 3% other. A total of 436/4507 (10%) developed cancer, of which 316 (72%) were ADCs: 231 (73%) were KS, 83 (26%) NHL, and 2 (1%) ICC. One-hundred and twenty (28%) were NADCs; those occurring with elevated SIRs included anal (SIR 37.8), Hodgkins (18.5), testicular (2.4), renal (1.3), and thyroid (1.9); prostate, breast, and gastrointestinal cancers occurred at lower than expected rates. The rate of ADCs significantly decreased from period 1 to 2 (p=0.001), and continues to decline into period 3 (23.6, 3.7, 2.4 cases/1000 person-years, respectively). Simultaneously, NADC incidence rates have increased since the availability of HAART: 3.8 cases (period 2) to 5.7 cases/1000 person-years (period 3). In the pre-HAART era, 18% of cancers were NADCs compared to 70% in period 3 (p<0.001). In the multivariate model, patients with NADCs compared to ADCs were older (32 vs. 28 years), had higher CD4 counts (443 vs. 68 cells/mm3) and suppressed HIV viral loads (42% vs. 5%) (p<0.01).
Conclusions: NADCs are accounting for an increasing proportion of cancers diagnosed in the late HAART era. Since NADCs are occurring in patients with robust CD4 counts, strategies beyond antiretroviral therapy are needed for their prevention.
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