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Trends in cancer incidence among HIV-infected persons in the United States in the HAART era
Presented by Pragna Patel, United States.
Patel P.1, Hanson D.1, Novak R.M.2, Moorman A.1, Tong T.1, Holmberg S.3, Sullivan P.1, Brooks J.T.1, Adult/Adolescent Spectrum of Disease (ASD) and HIV Outpatient Study (HOPS) Investigators
1Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, United States, 2University of Illinois at Chicago, Chicago, IL, United States, 3Research Triangle Institute (RTI) International, Atlanta, GA, United States
Objectives: Although incidence of AIDS-defining cancers has declined in the highly active antiretroviral therapy (HAART) era, less is known about incidence of non-AIDS defining cancers among HIV-infected persons. Incidence trends for select cancers among HIV-infected persons were determined and compared to incidence in the general population for three time periods.
Methods: Data were combined from the Adult/Adolescent Spectrum of HIV Disease project and the HIV Outpatient Study, representing nearly 160,000 person-years of follow-up, for the pre-HAART (1992-1995), early HAART (1996-1999) and contemporary HAART (2000-2003) eras. Data from the Surveillance, Epidemiology, and End Results (SEER) project were used to calculate cancer incidence in the general population. Multivariable Poisson regression was implemented to assess linear trends among HIV-infected persons in the incidence of three AIDS-defining and nine non-AIDS-defining cancers, in models controlling for age, race, gender, HIV risk, nadir CD4 cell count and antiretroviral use.In separate stratified models controlling for age, race, and sex, incidence rate ratios(IRRs) were calculated to compare cancer incidence between the HIV and SEER populations for each time period.
Results: Incidence of seven non-AIDS defining cancers were significantly higher in the ASD/HOPS population than in the SEER population. Among the ASD/HOPS population, incidence rates declined for Kaposi’s sarcoma([KS] RR=0.36,p<0.001) and non-Hodgkin’s lymphoma([NHL] RR=0.51,p<0.001) and increased significantly across the three time periods for anal cancer(relative risk(RR)=1.96,p<0.001),prostate cancer(RR=1.83,p=0.009), melanoma(RR=1.55,p=0.047),colon cancer (RR=1.40,p=0.028) and Hodgkin’s lymphoma (RR=1.36,p=0.032). IRRs of the rates within the HIV-infected population compared to SEER population declined significantly over the three time periods for KS (IRRs=197.0, 174.1, 112.1, p<0.001) and NHL (IRRs=79.4,40.3,17.0,p<0.001) but increased for anal cancer (IRRs=31.4,48.2,59.4,p=0.021).
Conclusions: Although incidence of KS and NHL has decreased, seven non-AIDS cancers were elevated among HIV-infected persons;anal cancer is increasing at a greater rate compared with the general population. Research is needed to improve screening methods to detect treatable precursor lesions for anal cancer.
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