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. 2018 Jun 19;168(12):866-873.
doi: 10.7326/M17-2499. Epub 2018 May 8.

Projected Cancer Incidence Rates and Burden of Incident Cancer Cases in HIV-Infected Adults in the United States Through 2030

Meredith S Shiels  1 , Jessica Y Islam  2 , Philip S Rosenberg  1 , H Irene Hall  3 , Evin Jacobson  3 , Eric A Engels  1
Affiliations

Projected Cancer Incidence Rates and Burden of Incident Cancer Cases in HIV-Infected Adults in the United States Through 2030

Meredith S Shiels et al. Ann Intern Med. .

Abstract

Background: Persons living with HIV (PLWH) have an elevated risk for certain types of cancer. With modern antiretroviral therapy, PLWH are aging and cancer rates are changing.

Objective: To project cancer incidence rates and burden (number of new cancer diagnoses) among adult PLWH in the United States through 2030.

Design: Descriptive.

Setting: HIV/AIDS Cancer Match Study to project cancer rates and HIV Optimization and Prevention Economics model to project HIV prevalence.

Participants: HIV-infected adults.

Measurements: Projected cancer rates and burden among HIV-infected adults in the United States by age during 2006 to 2030 for AIDS-defining cancer (ADC)-that is, Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer-and certain types of non-AIDS-defining cancer (NADC). All other cancer types were combined.

Results: The proportion of adult PLWH in the United States aged 65 years or older is projected to increase from 8.5% in 2010 to 21.4% in 2030. Age-specific rates are projected to decrease through 2030 across age groups for Kaposi sarcoma, non-Hodgkin lymphoma, cervical cancer, lung cancer, Hodgkin lymphoma, and other cancer types combined, and among those aged 65 years or older for colon cancer. Prostate cancer rates are projected to increase. The estimated total cancer burden in PLWH will decrease from 8150 cases in 2010 (2730 of ADC and 5420 of NADC) to 6690 cases in 2030 (720 of ADC and 5980 of NADC). In 2030, prostate cancer (n = 1590) and lung cancer (n = 1030) are projected to be the most common cancer types.

Limitation: Projections assume that current trends in cancer incidence rates, HIV transmission, and survival will continue.

Conclusion: The cancer burden among PLWH is projected to shift, with prostate and lung cancer expected to emerge as the most common types by 2030. Cancer will remain an important comorbid condition, and expanded access to HIV therapies and cancer prevention, screening, and treatment is needed.

Primary funding source: National Cancer Institute.

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Conflict of interest statement

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2499.

Figures

Figure 1.
Figure 1.. Age-standardized cancer rates for U.S. adults with HIV.
Rates were standardized to the 2010 U.S. HIV population by age group. Rates for cervical and breast cancer were restricted to women, and rates for prostate cancer were restricted to men. ADC = AIDS-defining cancer; NADC = non–AIDS-defining cancer; PLWH = persons living with HIV.
Figure 1.
Figure 1.. Age-standardized cancer rates for U.S. adults with HIV.
Rates were standardized to the 2010 U.S. HIV population by age group. Rates for cervical and breast cancer were restricted to women, and rates for prostate cancer were restricted to men. ADC = AIDS-defining cancer; NADC = non–AIDS-defining cancer; PLWH = persons living with HIV.
Figure 1.
Figure 1.. Age-standardized cancer rates for U.S. adults with HIV.
Rates were standardized to the 2010 U.S. HIV population by age group. Rates for cervical and breast cancer were restricted to women, and rates for prostate cancer were restricted to men. ADC = AIDS-defining cancer; NADC = non–AIDS-defining cancer; PLWH = persons living with HIV.
Figure 2.
Figure 2.. Estimated number of adults living with HIV in the United States during 2006–2030, by age group.
Age groups were 18–24 y, 25–34 y, 35–44 y, 45–64 y, and ≥65 y.
Figure 3.
Figure 3.. Estimated number of incident diagnoses of ADC and NADC in adults living with HIV in the United States during 2006–2030, stratified by age.
Black segments represent ADC, green segments represent NADC, dark bars represent cancer cases among persons aged ≥45 y, and light bars represent cancer cases among those aged <45 y. ADC = AIDS-defining cancer; NADC = non–AIDS-defining cancer.
Figure 4.
Figure 4.. Estimated cancer burden (incident cancer diagnoses) among adults living with HIV in the United States, by cancer type, in 2010, 2020, and 2030.
KS = Kaposi sarcoma; NHL = non-Hodgkin lymphoma.
Figure 5.
Figure 5.. Estimated cancer burden (incident cancer diagnoses) among adults living with HIV in the United States, by cancer type, in 2012 and 2030.
Cancer burden estimates for 2030 were calculated 3 different ways: using the 2030 projected cancer incidence rates and 2030 projected age structure, using the 2012 modeled cancer incidence rates and 2030 projected age structure, and using the 2030 projected cancer incidence rates and 2012 modeled age structure. KS = Kaposi sarcoma; NHL = non-Hodgkin lymphoma.
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