Cancer Risk in Older Persons Living With Human Immunodeficiency Virus Infection in the United States

Abstract

Background: Cancer risk is increased in persons living with human immunodeficiency virus (HIV) (PLWH). Improved survival has led to an aging of PLWH. We evaluated the cancer risk in older PLWH (age ≥50 years).

Methods: We included data from the HIV/AIDS Cancer Match Study (1996-2012) and evaluated risks of Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, and cervical, anal, lung, liver, oral cavity/pharyngeal, breast, prostate, and colon cancers in older PLWH with risk in the general population by calculating standardized incidence ratios (SIRs) and excess absolute risks (EARs). Cancer risk by time since HIV diagnosis was estimated using Poisson regression.

Results: We identified 10371 cancers among 183542 older PLWH. Risk was significantly increased for KS (SIR, 103.34), NHL (3.05), Hodgkin lymphoma (7.61), and cervical (2.02), anal (14.00), lung (1.71), liver (2.91), and oral cavity/pharyngeal (1.66) cancers, and reduced for breast (0.61), prostate (0.47), and colon (0.63) cancers. SIRs declined with age for all cancers; however, EARs increased with age for anal, lung, liver, and oral cavity/pharyngeal cancers. Cancer risk was highest for most cancers within 5 years after HIV diagnosis; risk decreased with increasing time since HIV diagnosis for KS, NHL, lung cancer, and Hodgkin lymphoma.

Conclusions: Cancer risk is elevated among older PLWH. Although SIRs decrease with age, EARs are higher for some cancers, reflecting a greater absolute excess in cancer incidence among older PLWH. High risk in the first 5 years after HIV diagnosis for some cancers highlights the need for early HIV diagnosis and rapid treatment initiation.

Figure 1.

Risk of cancers in persons living with human immunodeficiency virus (HIV) compared with the general population. The figure plots the standardized incidence ratios (SIRs) on the left y-axis, the excess absolute risks (EARs) per 100000 population on the right y-axis, and 3 age groups on the x-axis (<50, 50–59, and ≥60 years). A–C, Risks of 3 AIDS-defining cancers: Kaposi sarcoma (A), non-Hodgkin lymphoma (B), and cervical cancer (C). D–H, Risks of 5 non-AIDS-defining cancers: anal cancer (D), lung cancer (E), liver cancer (F), Hodgkin lymphoma (G), and oral cavity/pharynx cancer (H).