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Risk of Non-AIDS-Related Malignancies Higher Among HIV-Infected Veterans: Presented at ICAAC
By Ed Susman
CHICAGO, IL -- September 21, 2007 -- Despite treatment with highly-active antiretroviral therapy (HAART), the incidence of non-AIDS-defining malignancies appears to be higher in patients infected with HIV that in those who do not have HIV, according to a review of cases at the Veterans Administration North Texas Health Care System, Dallas, Texas.
Compared with HIV-negative patients, the incidence ratio of non-AIDS-defining malignancies in HIV-positive patients was 1.6 (95% confidence interval: 1.5-1.7), a significant 60% greater risk.
Non-AIDS-defining malignancies include all cancers except Kaposi's Sarcoma, lymphoma, cervical, skin, and ill-defined cancers.
Roger Bedimo, MD, Assistant Professor of Internal Medicine/Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, reported the results of a case review here at the 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).
Dr. Bedimo and colleagues examined records of 33,420 HIV-positive veterans and 66,840 HIV-negative veterans who were followed for a median of 5.1 years and 6.4 years, respectively. The rate of cancer per 100,000 person-years was 1,260 among HIV-positive patients and 841 among HIV-negative patients.
The incidence rate of anal cancer was 14.9 times greater for HIV-positive patients (111.2 per 100,000 person-years) than for HIV-negative patients (7.4 per 100,000 person-years), Dr. Bedimo said at his poster presentation on September 19th.
Hodgkin's disease occurred 4.6 times more often among HIV-positive patients (76.9 per 100,000 person-years) than for HIV-negative patients (15.9 per 100,000 person-years).
Liver cancer occurred 2.8 times more frequently among HIV-infected patients and lung cancer occurred twice as often; the risk of melanoma was 70% higher among patients with HIV. The risk of prostate cancer was about the same in the two groups.
All the differences between the groups reached statistical significance, as 95% confidence interval did not cross unity, except for prostate cancer.
"Potential explanations for the increases in non-AIDS-defining malignancies include the longer survival of HIV patients on highly-active antiretroviral therapy, but only partial immune recovery is achieved in a majority of patients," Dr. Bedimo said. He also noted that among HIV patients, other oncologic viruses such as human papilloma virus replicate more rapidly.
"There is also the potential oncogenicity of long-term HIV infection or of long-term HAART therapy," he suggested.
[Presentation title: Incidence of Non-AIDS-Defining Malignancies in HIV-Infected Vs. Non-Infected Veterans in the HAART Era: Impact of Immunosuppression. Abstract H-1721]
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