Evolving epidemiology of HIV-associated malignancies

Abstract

Purpose of review: The purpose of this review is to describe the epidemiology of cancers that occur at an elevated rate among people with HIV infection in the current treatment era, including discussion of the cause of these cancers, as well as changes in cancer incidence and burden over time.

Recent findings: Rates of Kaposi sarcoma, non-Hodgkin lymphoma and cervical cancer have declined sharply in developed countries during the highly active antiretroviral therapy era, but remain elevated 800-fold, 10-fold and four-fold, respectively, compared with the general population. Most studies have reported significant increases in liver cancer rates and decreases in lung cancer over time. Although some studies have reported significant increases in anal cancer rates and declines in Hodgkin lymphoma rates, others have shown stable incidence. Declining mortality among HIV-infected individuals has resulted in the growth and aging of the HIV-infected population, causing an increase in the number of non-AIDS-defining cancers diagnosed each year in HIV-infected people.

Summary: The epidemiology of cancer among HIV-infected people has evolved since the beginning of the HIV epidemic with particularly marked changes since the introduction of modern treatment. Public health interventions aimed at prevention and early detection of cancer among HIV-infected people are needed.

Figure 1. Cancer incidence rates among HIV-infected people in the United States (HIV/AIDS Cancer Match Study, 1996-2010)

Time trends in incidence rates of A) AIDS-defining cancers (Kaposi sarcoma, non-Hodgkin lymphoma and cervical cancer); and B) non-AIDS-defining cancers (anal cancer, liver cancer, Hodgkin lymphoma and lung cancer). Rates were estimated with data from the HIV/AIDS Cancer Match Study and standardized to the 2002 HIV population by age, sex, HIV risk group, race/ethnicity, and time since HIV/AIDS registration. Figures were generated with data from Robbins et al. [29].

Figure 2. Number of people living with AIDS in the US, 1980-2013

People living with AIDS in the United States, 1996-2013. Colored segments of each bar represent the number of people in each age group. Data were provided by the US Centers for Disease Control and Prevention. Figure is an updated version of a figure published in Shiels et al. [40].

Figure 3. Cancer burden in the US AIDS population, 1990-2005

Total number of cancer cases (i.e., cancer burden) among people with AIDS in the United States, 1990-2005. Bars represent the total number of cases occurring in each year, stratified by type of cancer (left axis). Dark gray bars represent AIDS-defining cancers, light gray bars represent non-AIDS-defining cancers and black bars represent poorly specified cancers. Points connected by lines represent overall cancer incidence rates, standardized by age group, race and sex to the 2000 AIDS population in the United States (right axis). The figure was previously published in Shiels et al. [40].