HIV Infection, Immunodeficiency, Viral Replication, and the Risk of Cancer

• Published in: Cancer epidemiology, biomarkers & prevention Vol. 20; no. 12; pp. 2551 - 2559
• Main Authors: Silverberg, Michael J., Chao, Chun, Leyden, Wendy A., Xu, Lanfang, Horberg, Michael A., Klein, Daniel, Towner, William J., Dubrow, Robert, Quesenberry, Charles P., Neugebauer, Romain S., Abrams, Donald I.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Association for Cancer Research 01.12.2011
• Subjects: Adult; Anti-HIV Agents - administration & dosage; Biological and medical sciences; Cohort Studies; Female; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Neoplasms - immunology; Neoplasms - virology; Risk Factors; Tumors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Virus Replication; USA, California; Infection; Immunopathology; Cancerology; Viral disease; Risk factor; Risk; Replication; AIDS; Malignant tumor; Immune deficiency; Cancer
• ISSN: 1055-9965; 1538-7755; 1538-7755
• DOI: 10.1158/1055-9965.EPI-11-0777

Background: Few studies have compared cancer risk between HIV-infected individuals and a demographically similar HIV-uninfected internal comparison group, adjusting for cancer risk factors. Methods: We followed 20,775 HIV-infected and 215,158 HIV-uninfected individuals enrolled in Kaiser Permanente (KP) California for incident cancer from 1996 to 2008. Rate ratios (RR) were obtained from Poisson models comparing HIV-infected (overall and stratified by recent CD4 count and HIV RNA) with HIV-uninfected individuals, adjusted for age, sex, race/ethnicity, calendar period, KP region, smoking, alcohol/drug abuse, and overweight/obesity. Results: We observed elevated RRs for Kaposi sarcoma (KS; RR = 199; P < 0.001), non-Hodgkin lymphoma (NHL; RR = 15; P < 0.001), anal cancer (RR = 55; P < 0.001), Hodgkin lymphoma (HL; RR = 19; P < 0.001), melanoma (RR = 1.8; P = 0.001), and liver cancer (RR = 1.8; P = 0.013), a reduced RR for prostate cancer (RR = 0.8; P = 0.012), and no increased risk for oral cavity/pharynx (RR = 1.4; P = 0.14), lung (RR = 1.2; P = 0.15), or colorectal (RR = 0.9; P = 0.34) cancers. Lung and oral cavity/pharynx cancers were elevated for HIV-infected subjects in models adjusted only for demographics. KS, NHL, anal cancer, HL, and colorectal cancer had significant (P < 0.05) trends for increasing RRs with decreasing recent CD4. The RRs for lung and oral cavity/pharynx cancer were significantly elevated with CD4 < 200 cells/μL and for melanoma and liver cancer with CD4 < 500 cells/μL. Only KS and NHL were associated with HIV RNA. Conclusion: Immunodeficiency was positively associated with all cancers examined except prostate cancer among HIV-infected compared with HIV-uninfected individuals, after adjustment for several cancer risk factors. Impact: Earlier antiretroviral therapy initiation to maintain high CD4 levels might reduce the burden of cancer in this population. Cancer Epidemiol Biomarkers Prev; 20(12); 2551–9. ©2011 AACR.