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. 2015 Oct 23;29(16):2173-81.
doi: 10.1097/QAD.0000000000000808.

Cancers attributable to infections among adults with HIV in the United States

Catherine de Martel  1 , Meredith S Shiels, Silvia Franceschi, Edgar P Simard, Jérôme Vignat, H Irene Hall, Eric A Engels, Martyn Plummer
Affiliations

Cancers attributable to infections among adults with HIV in the United States

Catherine de Martel et al. AIDS. .

Abstract

Objective: HIV-infected people are at increased risk of cancers of infectious origin. We estimated the burden of cancer attributable to infections among HIV-infected people in the United States in 2008.

Design: Incidence rates for cancer sites associated with infections were estimated from record linkage between HIV/AIDS registries and cancer registries.

Methods: Rates were applied to estimates of the population living with diagnosed HIV in the United States in 2008 to obtain the number of incident cancer cases. Site-specific attributable fractions and corresponding 95% confidence intervals (CIs) were estimated from infection prevalence among cancer cases. Infection prevalence data were derived from literature review of case series.

Results: Of an estimated 6200 incident cancer cases (95% CI 6000-6500), 2500 (95% CI 2400-2700) were attributable to infection (attributable fraction = 40%, 95% CI 39-42). The most important infections were Kaposi sarcoma herpes virus, Epstein-Barr virus, and human papillomavirus, which together were responsible for 2200 new cancer cases (95% CI 2100-2400), mainly Kaposi sarcoma, lymphomas, and ano-genital cancers. The attributable fraction in HIV-infected people was highest in the age group 20-29 years (69%, 95% CI 65-72). MSM were the HIV transmission group with the highest attributable fraction (48%, 95% CI 46-50), due to the high incidence of both Kaposi sarcoma and anal cancer.

Conclusion: The very high fraction of cancer attributable to infection in HIV-infected people points to special opportunities to prevent these cancers, that is, avoidance, detection, and early treatment of cancer-associated infections, and universal early detection and uninterrupted treatment of HIV infection to avoid immunosuppression.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1. Cancer attributable to infection in the general population and HIV-infected people in the USA in 2008
Abbreviations: AF attributable fraction; KSHV Kaposi sarcoma herpes virus; EBV Epstein-Barr virus; HPV human papillomavirus; HBV hepatitis B virus; HCV hepatitis C virus; H. pylori Helicobacter pylori
Figure 2
Figure 2. Estimated cancer incidence among HIV-infected people in the USA in 2008 by age
Abbreviations: KSHV Kaposi sarcoma herpes virus; EBV Epstein-Barr virus; HPV human papillomavirus; HBV hepatitis B virus; HCV hepatitis C virus; H. pylori Helicobacter pylori
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