AIDS Patients at Increased Risk for HPV-Related Cancers

People with AIDS have a statistically significant higher risk of human papillomavirus (HPV)-associated cancers, with risks increasing along with immunosuppression, according to a new study.

Dr. Anil K. Chaturvedi of the National Cancer Institute and colleagues analyzed 499,230 AIDS diagnoses from the beginning of the epidemic through 2004, which were then linked to cancer registries in 15 US regions.

Among people with AIDS, researchers saw a statistically significant increased risk of all in situ HPV-related cancers, with standardized incidence ratios (SIRs) ranging from 8.9 for cervical cancer to 68.6 for anal cancer in men. For invasive cancers, SIRs ranged from 1.6 for oropharyngeal cancer to 34.6 for anal cancer in men.

During the era of highly active antiretroviral therapy beginning in 1996, low CD4 T-cell count was significantly associated with increased risk of invasive anal cancer among men, and with a non-statistically significant increased risk of in situ vagina or vulva cancer and of invasive cervical cancer. Incidence of in situ anal cancer among men rose from 18.3 cases per 100,000 person-years in 1990-1995 to 29.5 cases in the era of HAART, a 61 percent increase. Incidence of invasive anal cancer among men rose 104 percent between 1990-1995 and the HAART era, from 20.7 cases to 42.3 cases per 100,000 person-years.

"Risk of HPV-associated cancers was elevated among persons with AIDS and increased with increasing immunosuppression," concluded the study's authors. "The increasing incidence for anal cancer during 1996-2004 indicates that prolonged survival may be associated with increased risk of certain HPV-associated cancers."

The full report, "Risk of Human Papillomavirus-Associated Cancers Among Persons with AIDS," was published online in the Journal of the National Cancer Institute (2009;doi:10.1093/jnci/djp205).