Spectrum of cancer risk late after AIDS onset in the United States

Abstract

Background: Persons living with AIDS today remain at elevated cancer risk. Highly active antiretroviral therapy (HAART), widely available since 1996, prolongs life, but immune function is not fully restored. We conducted this study to assess long-term cancer risk among persons with AIDS relative to the general population and the impact of HAART on cancer incidence.

Methods: Records of 263 254 adults and adolescents with AIDS (1980-2004) from 15 US regions were matched to cancer registries to capture incident cancers during years 3 through 5 and 6 through 10 after AIDS onset. Standardized incidence ratios (SIRs) were used to assess risks relative to the general population. Rate ratios (RRs) were used to compare cancer incidence before and after 1996 to assess the impact of availability of HAART.

Results: Risk was elevated for the 2 major AIDS-defining cancers: Kaposi sarcoma (SIRs, 5321 and 1347 in years 3-5 and 6-10, respectively) and non-Hodgkin lymphoma (SIRs, 32 and 15). Incidence of both malignancies declined in the HAART era (1996-2006). Risk was elevated for all non-AIDS-defining cancers combined (SIRs, 1.7 and 1.6 in years 3-5 and 6-10, respectively) and for the following specific non-AIDS-defining cancers: Hodgkin lymphoma and cancers of the oral cavity and/or pharynx, tongue, anus, liver, larynx, lung and/or bronchus, and penis. Anal cancer incidence increased between 1990-1995 and 1996-2006 (RR, 2.9; 95% confidence interval [CI], 2.1-4.0), as did that of Hodgkin lymphoma (RR, 2.0; 95% CI, 1.3-2.9).

Conclusion: Among people who survived for several years or more after an AIDS diagnosis, we observed high risks of AIDS-defining cancers and increasing incidence of anal cancer and Hodgkin lymphoma.

Figure 1

Incidence of selected AIDS-defining malignancies as a function of calendar year. The panels show cancer incidence during the period 3-10 years after AIDS onset, as a function of attained calendar year. The points correspond to the individual year estimates, while the lines correspond to results from the joinpoint regression. Annual percentage change is indicated for calendar years where the change was significantly different from zero (P<.05). Panels correspond to (a) Kaposi sarcoma; (b) non-Hodgkin lymphoma; (c) diffuse large B-cell non-Hodgkin lymphoma; (d) central nervous system non-Hodgkin lymphoma. Abbreviation: PY, person-years.

Figure 2

Incidence of selected non-AIDS-defining malignancies as a function of calendar year. The panels show cancer incidence during the period 3-10 years after AIDS onset, as a function of attained calendar year. The points correspond to the individual year estimates, while the lines correspond to results from the joinpoint regression. Annual percentage change is indicated for calendar years where the change was significantly different from zero (P<.05). Panels correspond to (a) anal cancer; (b) Hodgkin lymphoma; (c) lung cancer; (d) all non-AIDS-defining cancers. Abbreviation: PY, person-years.