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Researchers investigated the
incidence and timing of cancer diagnoses among patients who began triple-drug
antiretroviral therapy (ART) between 1996 and 2011. The researchers reviewed
the records of approximately 11,500 persons, examined trends in cancer
incidence for up to 10 years after treatment initiation, and investigated
factors associated with a cancer diagnosis.
The researchers divided cancers into
different categories: AIDS-defining cancers (Kaposi’s sarcoma, non-Hodgkin’s
lymphoma, and cervical cancer); non-AIDS-defining cancers; lymphomas; cancers
related to human papillomavirus (HPV); other virus- related cancers; and
virus-unrelated cancers. Patients were mostly male (80 percent) and racially
diverse. Median age at which they started ART was 38 years and most patients
were immunosuppressed when they began treatment. The researchers followed
patients for a median of three years and followed 10 percent of patients for 10
years.
Data showed 457 cancer diagnoses in
46,318 person-years of follow-up, which provided an incidence rate of 987 cases
per 100,000 person-years.
Incidence of AIDS-defining cancers
was similar to that for non-AIDS defining cancers (515 versus 466 per 100,000
person years). Kaposi’s sarcoma was the most common AIDS-defining cancer. The
most common non-AIDS cancer among women was breast cancer and among men was
anal cancer. Timing of cancer diagnosis differed based on whether or not the
cancer was AIDS-defining. Incidence of Kaposi’s was very high in the first six
months after therapy, fell during the second six months, and remained low
during the follow-up. Lymphomas followed the same trend. Incidence of non-AIDS
defining cancers increased with longer duration of follow-up, increasing 7
percent for each additional year of treatment. Each 10-year age increase
doubled the risk of non-lymphoma cancers and HPV-related cancers. CD4 cell
count at the time of therapy initiation was associated with cancer risk–low CD4
cell count was associated with lymphomas and HPV-related cancers.
Results show that ART improvements
did not affect the incidence of cancer in patients with HIV infection. The
researchers contended that results emphasized the need for early HIV diagnosis,
prevention measures such as vaccines, and cancer screening for persons with
HIV.
The full report,” Incidence and
Timing of Cancer in HIV-Infected Individuals Following Initiation of Combination
Antiretroviral Therapy,” was published online in the journal Clinical
Infectious Disease (2013; doi: 10.1093/cid/cit369).
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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