Incidence of Types of Cancer among HIV-Infected Persons Compared with the General Population in the United States, 1992–2003

20 May 2008 | Volume 148 Issue 10 | Pages 728-736

Background: Persons who are HIV-infected may be at higher risk for certain types of cancer than the general population.

Objective: To compare cancer incidence among HIV-infected persons with incidence in the general population from 1992 to 2003.

Design: Prospective observational cohort studies.

Setting: United States.

Patients: 54 780 HIV-infected persons in the Adult and Adolescent Spectrum of HIV Disease Project (47 832 patients) and the HIV Outpatient Study (6948 patients), who contributed 157 819 person-years of follow-up from 1992 to 2003, and 334 802 121 records from the Surveillance, Epidemiology, and End Results program of 13 geographically defined, population-based, central cancer registries.

Measurements: Standardized rate ratios (SRRs) to compare cancer incidence in the HIV-infected population with standardized cancer incidence in the general population.

Results: The incidence of the following types of non–AIDS-defining cancer was significantly higher in the HIV-infected population than in the general population: anal (SRR, 42.9 [95% CI, 34.1 to 53.3]), vaginal (21.0 [CI, 11.2 to 35.9]), Hodgkin lymphoma (14.7 [CI, 11.6 to 18.2]), liver (7.7 [CI, 5.7 to 10.1]), lung (3.3 [CI, 2.8 to 3.9]), melanoma (2.6 [CI, 1.9 to 3.6]), oropharyngeal (2.6 [CI, 1.9 to 3.4]), leukemia (2.5 [CI, 1.6 to 3.8]), colorectal (2.3 [CI, 1.8 to 2.9]), and renal (1.8 [CI, 1.1 to 2.7]). The incidence of prostate cancer was significantly lower among HIV-infected persons than the general population (SRR, 0.6 [CI, 0.4 to 0.8]). Only the relative incidence of anal cancer increased over time.

Limitations: Lower ascertainment of cancer in the HIV cohorts may result in a potential bias to underestimate rate disparities. Tobacco use as a risk factor and the effect of changes in cancer screening practices could not be evaluated.

Conclusion: The incidence of many types of non–AIDS-defining cancer was higher among HIV-infected persons than among the general population from 1992 to 2003.

Editors' Notes Context Antiretroviral therapy has improved survival of HIV-infected individuals and dramatically decreased cases of AIDS-defining cancer. However, some evidence from small or selected populations with AIDS suggests that non–AIDS-defining cancer cases have increased. Contribution This study found that the incidence of several types of non–AIDS-defining cancer (Hodgkin lymphoma; melanoma; leukemia; and cancer of the liver, lung, anus, vagina, oropharynx, colon or rectum, and kidney) were significantly higher among a large, diverse, HIV-infected population than in the general population reported in the SEER database. Implication Patients infected with HIV—and their clinicians—should be alert for signs of non–AIDS-related cancer. —The Editors

 

Author and Article Information

From the Centers for Disease Control and Prevention, Emory University, and Northrop Grumman Information Technology, Atlanta, Georgia, and the University of Illinois at Chicago, Chicago, Illinois.

Acknowledgment: The authors thank Harold Jaffe and Robert Newton, Department of Public Health, University of Oxford, and Valerie Beral and Andrew Roddam, Nuffield Department of Clinical Medicine, Cancer Research UK Epidemiology Unit, University of Oxford, for their helpful comments and suggestions on this analysis. They also thank Milton Eisner of the SEER program for support with data management and analysis.

Grant Support: The ASD Project was funded through a program announcement and cooperative agreement with Program Announcement 00005 and HIV/AIDS Surveillance Seroprevalence. The HOPS was funded through a contract with the Cerner Corporation and the CDC (200-2006-18797).

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement: Study protocol: Not available. Statistical code: Available from the authors. Data set: The ASD Project, HOPS, and SEER program are all public-use data sets and are available to readers. However, confidentiality protections that govern the ASD Project and HOPS data require authors to strip record identifiers; it will therefore take some time to make these data available. In addition, CDC's heightened security procedures require persons who want to analyze ASD Project and HOPS data to 1) prepare a written proposal for CDC review and approval, 2) sign confidentiality and data use agreements, 3) conduct analyses in Atlanta, and 4) go through CDC security clearance for access to facilities. The authors would be happy to facilitate these procedures for persons interested in conducting analyses using ASD Project and HOPS data and welcome these requests.

Requests for Single Reprints: Pragna Patel, MD, MPH, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-46, Atlanta, GA 30333; e-mail, plp3{at}cdc.gov.

Current Author Addresses: Dr. Patel: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-46, Atlanta, GA 30333.

Ms. Hanson: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-48, Atlanta, GA 30333.

Dr. Sullivan: Rollins School of Public Health, Emory University, 1518 Clifton Road NE, 4th Floor, Atlanta GA 30322.

Dr. Novak: University of Illinois at Chicago, 808 South Wood Street, Room 888 M/C735, Chicago, IL 60612.

Ms. Moorman and Dr. Holmberg: Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA 30333.

Mr. Tong and Dr. Brooks: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-45, Atlanta, GA 30333.

Author Contributions: Conception and design: P. Patel, D.L. Hanson, P.S. Sullivan, R.M. Novak, S.D. Holmberg, J.T. Brooks.

Analysis and interpretation of the data: P. Patel, D.L. Hanson, P.S. Sullivan, R.M. Novak, T.C. Tong, J.T. Brooks.

Drafting of the article: P. Patel, D.L. Hanson, R.M. Novak, J.T. Brooks.

Critical revision of the article for important intellectual content: P. Patel, D.L. Hanson, P.S. Sullivan, R.M. Novak, S.D. Holmberg, J.T. Brooks.

Final approval of the article: P. Patel, P.S. Sullivan, R.M. Novak, A.C. Moorman, S.D. Holmberg, J.T. Brooks.

Statistical expertise: D.L. Hanson, T.C. Tong.

Obtaining of funding: A.C. Moorman, S.D. Holmberg.

Administrative, technical, or logistic support: P.S. Sullivan, S.D. Holmberg.

Collection and assembly of data: P.S. Sullivan, T.C. Tong.

^* For a list of the Adult and Adolescent Spectrum of Disease Project and HIV Outpatient Study Investigators, see the Appendix.