Abstract

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A wide range of cancers is associated with HIV infection: meta-analysis of studies of cancer in people with HIV/AIDS and in transplant recipients

Presented by Andrew Grulich, Australia.

Grulich A.¹, van Leeuwen M.¹, Falster M.¹, Vajdic C.¹

¹University of New South Wales, National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia

Objectives: Recent studies in transplant recipients have demonstrated that the range of immune-deficiency associated cancers may be wider than previously appreciated. There is also increasing concern regarding cancer morbidity in people with HIV. We examined the pattern of cancer incidence in prospective population-based studies of people with HIV/AIDS, and compared this to the pattern after organ transplantation.
Methods: Six studies of HIV were included that were conducted in the US, Australia, Italy, Switzerland and the UK. Four studies of organ transplant recipients were included that were conducted in Australia, Sweden, Finland and Denmark. Random-effects meta-analyses of log standardised incidence ratios (SIRs) were calculated by cancer site.
Results: A wide range of cancers occurred at increased rates, and the pattern of increased incidence was strikingly similar in both populations. The majority of cancers occurring at increased rates were those known to be related to infectious causes, including EBV (NHL, HD), HHV-8 (KS), HPV (anogenital and some upper aerodigestive cancers), HBV/HCV (liver cancer) and h pylori (stomach). Most common epithelial cancers, including cancer of the colorectum, breast, prostate and ovary, did not occur at increased rates in either population.

Organism	Cancer	People with HIV/AIDS: SIR and 95% CI		Transplant recipients: SIR and 95% CI
EBV	Hodgkin lymphoma	11.0	8.43-14.4	4.14	2.18-7.88
HPV	Anus	28.8	21.6-38.3	4.85	1.36-17.3
	Penis	4.42	2.77-7.07	15.9	5.85-34.7
	Vulva/vagina	6.45	4.07-10.21	22.8	15.8-32.7
	Oral cavity/pharynx	2.32	1.65-3.25	3.61	1.92-6.77
HBV/HCV	Liver	5.22	3.32-8.20	2.07	0.74-5.78
H pylori	Stomach	1.90	1.53-2.36	2.01	1.37-2.97

Conclusions: A wide range of mainly infection-associated cancers occurs at increased rates in people who are immune deficient due to HIV. Infection-related cancer should be recognised as an increasingly important outcome of long term HIV infection.

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