Excess Cancer Burden Heavy among US HIV Population

By Larry Hand

NEW YORK (Reuters Health) - A new analysis of the excess cancer burden among HIV-infected people in the U.S. provides opportunities to develop cancer control initiatives for this population, researchers say.

"It was already known that HIV-infected people have increased cancer risks, so it was not surprising that excess cancers exist in this population," Hilary A. Robbins, of Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, told Reuters Health by email.

"However," she said, "we were impressed by the large number of excess cancers, and the degree to which the composition of cancer types varies across subgroups. Both of these results suggest that cancer control initiatives targeted to HIV-infected people could have a large impact."

Robbins and colleagues analyzed data from six states from the HIV/AIDS Cancer Match (HACM) Study, which links population-based state HIV and cancer registries, as well as data from the Surveillance, Epidemiology, and End Results program.

They estimate that 7,760 cancers occurred among HIV-infected individuals in 2010, and that 3,920 were excess cancers. The most common excess cancers were non-Hodgkin lymphoma (n=1,440, 88% excess), Kaposi's sarcoma (n=910, 100% excess), anal cancer (n=740, 97% excess), and lung cancer (440, 52% excess).

Among the more than 859,500 people thought to be living with diagnosed HIV in the U.S. by mid-2010, most were between 40 and 59 years old, male (74.9%), and men who have sex with men (MSM). Almost 40% had been living five or more years with a diagnosis of AIDS.

The researchers determined that the total cancer burden was highest among people in the 50-59 age bracket, MSM, those living five or more years with AIDS, and non-Hispanic blacks. But the largest excess burden was among people 15-29 years old (93%).

"MSM represented 55.7% of the total HIV population, and 65% of all excess cancers," the researchers write. "Only 18% of excess cancers occurred among women (n=700)."

"About half of the excess cancers were cancers that are normally preventable when HIV is controlled by medications, so this highlights a need for continued improvements in access and adherence to HIV therapy," Robbins told Reuters Health.

"Lung cancer is also common, and smoking cessation would help reduce the cancer burden, especially among older individuals. It will also be important to assess the effectiveness of screening for lung cancer and anal cancer (another common cancer) among HIV-infected people," she said.

The results provide a framework for tailoring cancer control to the HIV population, she added. "We know how to reduce some of these excess cancers, for example, by improving effectiveness of HIV therapy to prevent non-Hodgkin lymphoma. For other cancers, particularly anal cancer, our study quantified the magnitude of the problem, but further research is needed to evaluate and implement new strategies."

She concluded, "Our results remind clinicians that the spectrum of cancers among HIV patients is quite different from what is seen in the general population, and individual-level strategies for prevention and early detection should be targeted to those cancers that are especially common."

The National Cancer Institute supported the research. The authors report no disclosures.

SOURCE: https://bit.ly/1w5dRbL

J Natl Cancer Inst 2015.

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