Medical News

Rates of Non-AIDS-Defining Cancers in People With HIV Infection Before and After AIDS Diagnosis

July 22, 2002

This article is part of The Body PRO's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.

Studies linking AIDS and cancer registries have provided valuable information on malignant disorders associated with advanced HIV infection. Since its mid-1990s introduction, potent antiretroviral therapy has lead to reductions in AIDS incidence of over 70 percent in treated cohorts. To gain understanding of morbidity, including cancer, that occurs prior to advanced immune deficiency, it is important that studies of people with HIV include people with and without AIDS.

In Australia, there has been a nationwide registration of cancer since 1980 and notification of HIV diagnosis since 1985. The researchers performed a population-based linkage study between databases related to HIV infection and AIDS and cancer registries to assess the relative risk of non-AIDS-defining cancer in HIV-infected people in Australia.

HIV and AIDS are reported with a name code (first two letters of first and last name), date of birth and sex. The researchers attempted linkage for all individuals who had complete data for these three fields on either the national HIV or AIDS database. Linkage was performed using a modified version of the national cancer register, with full names converted to name codes. A match was accepted if there was an exact match on all three fields, or there was a near match supported by consistency between the registers in dates of death and area of residence. Standardized incident ratios (SIRs) were calculated based on age-, sex-, year-, and state-specific incidence rates of cancer in the general population. Forty-six percent of people with HIV and 100 percent of people with AIDS were eligible for linkage with the cancer registry.

In total, 1,355 cancers, including 196 non-AIDS-defining cancers, were registered in 13,067 people with HIV or AIDS. There were significantly increased rates of several cancers, including lip, anus, connective tissue, Hodgkin's disease, myeloma and leukemia. SIRs were not significantly raised for lung cancer and cancer of the testis. Colon cancer rates were significantly decreased.

To assess the association between cancer incidence and immune deficiency, four time periods were defined based on increasing HIV disease progression. Overall, 37 percent of person-years were in period 1 (least immune deficient), 46 percent in period 2, 9 percent in period 3, and 7.4 percent in period 4 (most immune deficient). In period 1, rates were significantly increased only for cancer of the anus, liver and testis. Incidence rates of most cancers were increased in period 3. Of the cancers that occurred at increased rates overall, there were significant increasing trends in cancer rates across the four periods for connective tissue, Hodgkin's disease and multiple myeloma. If the period including the six months around the AIDS diagnosis was excluded, a significantly increasing trend was seen only for connective tissue cancer.

The researchers concluded that people with HIV with mild immune deficiency prior to AIDS were at increased risk of anal cancer, but this may reflect other risk factors. Other cancers occurred only later in the course of HIV infection. "This is reassuring evidence that people with HIV who are only mildly immune deficient may not be at increased risk of non-AIDS-defining cancers, but larger studies with longer periods of follow-up are needed to confirm this," they wrote.

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Adapted from:
05.24.02; Vol. 16; No. 8: P. 1155-1161; Andrew E. Grulich; Yueming Li; Ann McDonald; Patricia K.L. Corell; Matthew G. Law; John M. Kaldor

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.


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