Cumulative incidence of cancer among individuals with acquired immunodeficiency syndrome in the United States

Abstract

Background: The overall burden of cancer may increase as individuals with acquired immunodeficiency syndrome (AIDS) live longer because of highly active antiretroviral therapy (HAART), which has been widely available since 1996.

Methods: A population-based, record-linkage study identified cancers in 472,378 individuals with AIDS from 1980 to 2006. By using nonparametric competing-risk methods, the cumulative incidence of cancer was estimated across 3 calendar periods (AIDS onset in 1980-1989, 1990-1995, and 1996-2006).

Results: Measured at 5 years after AIDS onset, the cumulative incidence of AIDS-defining cancer (ADC) declined sharply across the 3 AIDS calendar periods (from 18% in 1980-1989, to 11% in 1990-1995, to 4.2% in 1996-2006 [ie, the HAART era]). The cumulative incidence of Kaposi sarcoma declined from 14.3% during 1980 to 1989, to 6.7% during 1990 to 1995, and to 1.8% during 1996 to 2006. The cumulative incidence of non-Hodgkin lymphoma (NHL) declined from 3.8% during 1990 through 1995 to 2.2% during 1996 through 2006; during the HAART era, NHL was the most common ADC (53%). The cumulative incidence of non-AIDS-defining cancer (NADC) increased from 1.1% to 1.5% with no change thereafter (1%; 1996-2006), in part because of declines in competing mortality. However, cumulative incidence increased steadily over time for specific NADCs (anal cancer, Hodgkin lymphoma, and liver cancer). The cumulative incidence of lung cancer increased from 0.14% during 1980 to 1989 to 0.32% during 1990 to 1995, and no change was observed thereafter.

Conclusions: Dramatically declining cumulative incidence was noted in 2 major ADCs (Kaposi sarcoma and NHL), and increases were observed in some NADCs (specifically, cancers of the anus, liver, and lung and Hodgkin lymphoma). As HIV/AIDS is increasingly managed as a chronic disease, greater attention should be focused on cancer screening and prevention.

Figure 1. Cumulative Incidence of AIDS-defining and non-AIDS-defining Cancer Among People with AIDS in the United States, 1980–2006

Cumulative incidence of AIDS-defining and non-AIDS-defining cancer among people with AIDS in the United States. Results are shown for AIDS-defining cancers overall (panel A), and the 2 major AIDS-defining cancers, Kaposi sarcoma (panel B) and non-Hodgkin lymphoma (panel C). Cumulative incidence of non-AIDS-defining cancers overall is shown in panel D. Estimates are stratified by calendar year of AIDS onset: 1980–1989 (dotted line), 1990–1995 (dashed line), 1996–2006 (solid line). Cumulative incidence was estimated using competing risk time-to-event methods and is expressed as a percentage. Follow-up time is measured beginning at AIDS onset. The gray vertical line indicates cumulative incidence estimates compared at month 60 of follow-up (5-year cumulative incidence). Note vertical scales vary among the panels.

Figure 2. Cumulative Incidence of Selected Non-AIDS-defining Cancers Among People with AIDS in the United States, 1980–2006

Cumulative incidence of selected non-AIDS-defining cancers among people with AIDS in the United States. Results are shown for anal cancer (panel A), Hodgkin lymphoma (panel B), liver cancer (panel C) and lung cancer (panel D). Estimates are stratified by calendar year of AIDS onset: 1980–1989 (dotted line), 1990–1995 (dashed line), 1996–2006 (solid line). Cumulative incidence was estimated using competing risk time-to-event methods and is expressed as a percentage. Follow-up time is measured beginning at AIDS onset. The gray vertical line indicates cumulative incidence estimates compared at month 60 of follow-up (5-year cumulative incidence). Note vertical scales vary among the panels.