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New Cancer Rates Climbing With Age in HIV Patients, but Age Impact Differs by Cancer Type

May 5, 2017

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What the Results Mean for You

This large many-year study made several important findings about cancer risk in people with HIV, including these key results:

  • Age 50 or older was linked to a higher incidence (new cancer detection rate) of both infection-related cancers and infection-unrelated cancers.
  • The impact of being 50 or older was greater for infection-unrelated cancers (7.3-folder higher incidence) than for infection-related cancers (1.6-fold higher incidence).
  • Incidence of infection-related cancer was 1.17-fold higher for every additional 10 years of age, while incidence of infection-unrelated cancer was 2.07-fold higher for every 10 years of age.
  • Incidence of infection-related cancer is expected to fall from 3.1 cases per 1000 people to 2.1 per 1000 over 5 years.
  • Incidence of infection-unrelated cancer is expected to rise from 4.1 cases per 1000 people to 5.9 per 1000 over 5 years.
  • Incidence of infection-unrelated cancer is expected to fall from 1.7 cases per 1000 people to 0.8 per 1000 people over 5 years in people who never smoked.

Infection-unrelated cancers include lung cancer, prostate cancer, cancer of the colon and rectum, and breast cancer. The researchers believe the rate of infection-unrelated cancer will rise for several reasons: (1) The HIV population is aging and these cancers become more frequent with older age. (2) Smoking causes two major infection-unrelated cancers -- lung cancer and cancer of the colon and rectum -- and a high proportion of people with HIV continue to smoke. (3) Low CD4 count and high viral load add to the risk of infection-related cancers. Because fewer people with HIV have untreated and advanced HIV infection, the rate of infection-related cancers is going down, so infection-unrelated cancers become more prominent.

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Because of the projected surge in infection-unrelated cancers in people with HIV, the EuroSIDA researchers believe more attention should be paid to preventing these cancers and to studying the potential benefits of testing for these cancers. Regular testing for three infection-unrelated cancers -- prostate cancer, colorectal cancer, and breast cancer -- has become routine for many people, especially as they age. High rates of these cancers in people with HIV should encourage anyone with HIV to talk to their provider about current guidelines on testing for these cancers.

The leading infection-unrelated cancer in this EuroSIDA group, and in many HIV populations, is lung cancer. Avoiding smoking -- or quitting if you already smoke -- can help prevent not only lung cancer but mouth and throat cancer, colorectal cancer, liver cancer, other cancers, and other major diseases like heart disease and stroke. Quitting smoking isn't easy, but the United States has more people who quit smoking than who continue to smoke.2 Your HIV provider can help you quit by prescribing certain drugs or nicotine replacement therapy and by guiding you to effective smoke-ending strategies like the internet-based Positively Smoke Free, created especially for people with HIV (see link at reference 3).

Drinking too much alcohol can lead to cancer of the head and neck, esophagus, liver, breast, colon, and rectum.4 If you drink too much, talk to your HIV provider or case worker about finding ways to limit or stop drinking.

Some infection-related cancers can be prevented by using condoms to prevent transmission of cancer-causing viruses (HBV, HCV, HPV) and by getting vaccinated against HBV and HPV. Everyone with HIV who does not already carry hepatitis B virus (HBV) should get the HBV vaccine. The CDC recommends the HPV vaccine for women up to age 26, for gay or bisexual men with or without HIV up to age 26, and for other men up to age 21.5


References

  1. Shepherd L, Borges A Ledergerber B, et al. Infection-related and -unrelated malignancies, HIV and the aging population. HIV Med. 2016;17:590-600.
  2. The Health Consequences of Smoking -- 50 Years of Progress: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
  3. Positively Smoke Free. Created by experts, refined by real users like you.
  4. National Cancer Institute. Alcohol and cancer risk.
  5. Centers for Disease Control and Prevention. Human papillomavirus (HPV): Questions and answers. 2015.
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This article was provided by The Center for AIDS Information & Advocacy. It is a part of the publication HIV Treatment ALERTS!. Visit CFA's website to find out more about their activities and publications.
 

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