Cancer in People with HIV Infection Compared with the General Population, 1992–2003

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The summary below is from the full report titled "Incidence of Types of Cancer among HIV-Infected Persons Compared with the General Population in the United States, 1992–2003." It is in the 20 May issue of Annals of Internal Medicine (volume 148, pages 728-736). The authors are P. Patel, D.L. Hanson, P.S. Sullivan, R.M. Novak, A.C. Moorman, T.C. Tong, S.D. Holmberg, and J.T. Brooks, for the Adult and Adolescent Spectrum of Disease Project and HIV Outpatient Study Investigators.

What is the problem and what is known about it so far?

Human immunodeficiency virus (HIV) is the cause of AIDS, an illness that interferes with the body's ability to fight infection and some types of cancer. Human immunodeficiency virus passes from person to person through contact with blood or other body fluids that contain the virus. Before treatments were available, most people infected with HIV developed, and often died of, infections or certain types of cancer that meant they had AIDS (known as "AIDS-defining cancer"). Kaposi sarcoma, non-Hodgkin lymphoma, and advanced cervical cancer are examples of AIDS-defining cancer.

Treatments containing multiple drugs have dramatically improved health outcomes for HIV-infected patients. These treatments are known as HAART (highly active antiretroviral therapy). With HAART, fewer people with HIV infection develop AIDS and the infections and types of cancer related to AIDS.

Because people with HIV infection who receive this treatment are living longer than they used to, they may eventually die of causes unrelated to HIV infection. Some studies suggest that people with HIV infection may be more likely than the general population to develop types of cancer that do not indicate AIDS in people with HIV infection.

Why did the researchers do this particular study?

To see whether people infected with HIV have a higher risk for non–HIV-related cancer than the general population.

Who was studied?

54,780 people who were participating in 1 of 2 studies of HIV infection from 1992 to 2003. To obtain information on the frequency of cancer in the general population, the researchers used the Surveillance, Epidemiology, and End Results (SEER) database. The SEER database includes information on cancer from 13 regions in the United States.

How was the study done?

The researchers compared the frequencies of AIDS-defining cancer and other types of cancer in HIV-infected patients with the frequency of those types of cancer in the SEER database.

What did the researchers find?

Cases of AIDS-defining cancer were more frequent among HIV-infected patients than among the general population in the SEER database. Several non–AIDS-defining types of cancer were more common among HIV-infected patients than among the general population. These included anal, vaginal, liver, lung, mouth or throat, colon, and kidney cancer; Hodgkin lymphoma; leukemia; and melanoma. Prostate cancer was less common in HIV-infected persons than in the general population.

What were the limitations of the study?

The researchers did not have information on tobacco use or cancer prevention practices. Some of the people in the SEER database may have also had HIV infection. Some types of cancer were too uncommon for the researchers to know for certain whether the frequency differed between the HIV-infected persons and the general population.

What are the implications of the study?

Many non–AIDS-defining types of cancer occur more frequently in people with HIV infection than in the general population. Patients with HIV infection and their doctors should be alert for signs of these types of cancer.