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. 2011 Dec;20(12):2551-9.
doi: 10.1158/1055-9965.EPI-11-0777. Epub 2011 Nov 22.

HIV infection, immunodeficiency, viral replication, and the risk of cancer

Michael J Silverberg  1 , Chun Chao, Wendy A Leyden, Lanfang Xu, Michael A Horberg, Daniel Klein, William J Towner, Robert Dubrow, Charles P Quesenberry Jr, Romain S Neugebauer, Donald I Abrams
Affiliations

HIV infection, immunodeficiency, viral replication, and the risk of cancer

Michael J Silverberg et al. Cancer Epidemiol Biomarkers Prev. 2011 Dec.

Abstract

Background: Few studies have compared cancer risk between HIV-infected individuals and a demographically similar HIV-uninfected internal comparison group, adjusting for cancer risk factors.

Methods: We followed 20,775 HIV-infected and 215,158 HIV-uninfected individuals enrolled in Kaiser Permanente (KP) California for incident cancer from 1996 to 2008. Rate ratios (RR) were obtained from Poisson models comparing HIV-infected (overall and stratified by recent CD4 count and HIV RNA) with HIV-uninfected individuals, adjusted for age, sex, race/ethnicity, calendar period, KP region, smoking, alcohol/drug abuse, and overweight/obesity.

Results: We observed elevated RRs for Kaposi sarcoma (KS; RR = 199; P < 0.001), non-Hodgkin lymphoma (NHL; RR = 15; P < 0.001), anal cancer (RR = 55; P < 0.001), Hodgkin lymphoma (HL; RR = 19; P < 0.001), melanoma (RR = 1.8; P = 0.001), and liver cancer (RR = 1.8; P = 0.013), a reduced RR for prostate cancer (RR = 0.8; P = 0.012), and no increased risk for oral cavity/pharynx (RR = 1.4; P = 0.14), lung (RR = 1.2; P = 0.15), or colorectal (RR = 0.9; P = 0.34) cancers. Lung and oral cavity/pharynx cancers were elevated for HIV-infected subjects in models adjusted only for demographics. KS, NHL, anal cancer, HL, and colorectal cancer had significant (P < 0.05) trends for increasing RRs with decreasing recent CD4. The RRs for lung and oral cavity/pharynx cancer were significantly elevated with CD4 < 200 cells/μL and for melanoma and liver cancer with CD4 < 500 cells/μL. Only KS and NHL were associated with HIV RNA.

Conclusion: Immunodeficiency was positively associated with all cancers examined except prostate cancer among HIV-infected compared with HIV-uninfected individuals, after adjustment for several cancer risk factors.

Impact: Earlier antiretroviral therapy initiation to maintain high CD4 levels might reduce the burden of cancer in this population.

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Conflict of interest statement

Conflicts of interest: The authors report research grant support from Pfizer (MJS, CC, WAL, LX, MAH, DK, WJT, CPQ), Merck (MJS, CC, MAH, WJT, CPQ), Gilead (WJT) and Tibotec (WJT). No other conflicts are reported.

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