Incidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individuals

Authors

  • Alina Burgi M.P.H.,

    1. Graduate School of Public Health, San Diego State University, San Diego, California
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  • Stephanie Brodine M.D.,

    1. Graduate School of Public Health, San Diego State University, San Diego, California
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  • Scott Wegner M.D.,

    1. United States Military HIV Research Program, Rockville, Maryland
    2. Tri-Service AIDS Clinical Consortium, Rockville, Maryland
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  • Mark Milazzo,

    1. United States Military HIV Research Program, Rockville, Maryland
    2. Tri-Service AIDS Clinical Consortium, Rockville, Maryland
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  • Mark R. Wallace M.D.,

    1. Tri-Service AIDS Clinical Consortium, Rockville, Maryland
    2. Infectious Diseases Division, Naval Medical Center, San Diego, California
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  • Katherine Spooner M.D.,

    1. Tri-Service AIDS Clinical Consortium, Rockville, Maryland
    2. Infectious Diseases Division, Walter Reed Army Medical Center, Washington, DC
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  • David L. Blazes M.D., M.P.H.,

    1. Tri-Service AIDS Clinical Consortium, Rockville, Maryland
    2. Infectious Diseases Division, National Naval Medical Center, Bethesda, Maryland
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  • Brian K. Agan M.D.,

    1. Tri-Service AIDS Clinical Consortium, Rockville, Maryland
    2. Infectious Diseases Division, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas
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  • Adam Armstrong D.O.,

    1. Tri-Service AIDS Clinical Consortium, Rockville, Maryland
    2. Infectious Diseases Division, Naval Medical Center Portsmouth, Portsmouth, Virginia
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  • Susan Fraser M.D.,

    1. Tri-Service AIDS Clinical Consortium, Rockville, Maryland
    2. Infectious Diseases Division, Tripler Army Medical Center, Honolulu, Hawaii
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  • Nancy F. Crum M.D., M.P.H.

    Corresponding author
    1. Tri-Service AIDS Clinical Consortium, Rockville, Maryland
    2. Infectious Diseases Division, Naval Medical Center, San Diego, California
    • c/o Clinical Investigation Department (KCA), Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 5, San Diego, CA 92134-1005
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    • Fax: (619) 532-8137


  • This is a U.S. government work and, as such, is in the public domain in the United States of America.

  • Presented in condensed form as abstract 886 at the 42nd Annual Meeting of the Infectious Diseases Society of America, Boston, Massachusetts, September 30–October 3, 2004.

Abstract

BACKGROUND

The objective of this study was to determine the rates and predictors of non-AIDS-defining cancers (NADCs) among a cohort of human immunodeficiency virus (HIV)-infected individuals.

METHODS

The authors conducted a retrospective study of 4144 HIV-infected individuals who had 26,916 person-years of follow-up and who had open access to medical care at 1 of the United States military HIV clinics during the years 1988–2003. Cancer incidence rates were race specific and were adjusted for age; these were compared with national rates using logistic regression to assess predictors of NADC development.

RESULTS

One hundred thirty-three NADCs were diagnosed with a rate of 980 diagnoses per 100,000 person-years. The most frequent NADCs were skin carcinomas (basal cell and squamous cell), Hodgkin disease, and anal carcinoma. The results showed that there were higher rates of melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease among the HIV-infected cohort compared with age-adjusted rates for the general United States population. Predictors of NADCs included age older than 40 years (odds ratio [OR], 12.2; P < 0.001), Caucasian/non-Hispanic race (OR, 2.1; P < 0.001), longer duration of HIV infection (OR, 1.2; P < 0.001), and a history of opportunistic infection (OR, 2.5; P < 0.001). The use of highly active antiretroviral therapy (HAART) was associated with lower rates of NADCs (OR, 0.21; P < 0.001). A low CD4 nadir or CD4 count at diagnosis (< 200 cells/mL) was not predictive of NADCs.

CONCLUSIONS

The most frequent NADCs were primary skin malignancies. Melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease occurred at higher rates among HIV-infected individuals. The implementation of screening programs for these malignancies should be considered. Most risk factors for the development of NADCs are nonmodifiable; however, the use of HAART appeared to be beneficial in protecting against the development of malignant disease. Cancer 2005. Published 2005 by the American Cancer Society.

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