Cancer Burden Growing Among AIDS Patients

Major Finding: Among people with AIDS and non–AIDS-defining cancers, cancer-attributable mortality rose from 72% to 87% between 1980 and 2006.

Data Source: Records of 372,364 people with AIDS along with links to corresponding cancer registry records.

Disclosures: The researchers had no conflicts to report.

Although AIDS-related mortality has declined since highly active antiretroviral therapy became widely available in the mid-1990s, there has been a corresponding increase in the incidence of cancer among people with AIDS, according to a study of more than 300,000 individuals.

The rates of the AIDS-defining cancers—Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical cancer—remain high in people with AIDS compared with the general population, but people with AIDS are also at high risk of several types of non–AIDS-defining cancers.

“Among those who die with AIDS and cancer, cancer now accounts for the vast majority of all deaths,” said Edgar P. Simard, Ph.D., of the National Cancer Institute. “And in the entire population, non–AIDS-defining cancers represent an increasing fraction of all deaths.”

Dr. Simard and his colleagues used data from 372,364 people diagnosed with AIDS in the United States between 1980 and 2006 and linked those with corresponding cancer registry records. The investigators divided their analyses into three eras: 1980–1989, when there was little in the way of effective AIDS treatment; 1990–1995, when one- and two-drug regimens were typical; and 1996–2006, when highly active antiretroviral therapy (HAART) became widely used.

Since numerous studies have already been done on cancer in the 2 years following AIDS diagnosis, the investigators focused on cancer risk 3–5 years after AIDS onset, Dr. Simard said at the Conference on Retroviruses and Opportunistic Infections.

As expected, the incidence of AIDS-defining cancers was very high during years 3–5 after diagnosis. Compared with the general population, people with AIDS had 5,321 times the risk of developing Kaposi's sarcoma, 32 times the risk of developing non-Hodgkin's lymphoma, and 5.6 times the risk of developing cervical cancer, he reported.

People with AIDS also had significant increases in the risk of developing four different non–AIDS-defining cancers. They had a 27-fold increase in the risk of anal cancer, a 9.1-fold increase in the risk of Hodgkin's lymphoma, a 3.7-fold increase in the risk of liver cancer, and a 3.0-fold increase in the risk of lung cancer. Overall, people with AIDS had a statistically significant 70% increase in the risk of developing any non–AIDS-defining cancer.

The cumulative incidence of AIDS-defining cancers declined significantly. At 60 months following diagnosis, the cumulative incidence was 8.7% for the 1980–1989 era, 6.4% for 1990–1995, and 2.1% for 1996–2006, Dr. Simard said.

Yet the cumulative incidence of the four non–AIDS-defining cancers increased significantly. The 60-month cumulative incidence of lung cancer rose from 0.14% in 1980–1989 to 0.28% in 1990–1995 and to 0.37% in 1996–2006. The cumulative incidence of Hodgkin's lymphoma rose from 0.04% in 1980–1989 to 0.10% in 1990–1995 to 0.17% in the 1996–2006 era, he said.

The cancer-attributable mortality of both AIDS-defining and non–AIDS-defining cancers increased significantly from the earliest to the latest treatment eras. Among AIDS-defining cancers, the cancer-attributable mortality rose from 69% to 88%, and among non–AIDS-defining cancers, the cancer-attributable mortality rose from 72% to 87%.

Cancer prevention and treatment “will become increasingly important as survival from AIDS increases and the population continues to age,” he said.

Major Finding: Among people with AIDS and non–AIDS-defining cancers, cancer-attributable mortality rose from 72% to 87% between 1980 and 2006.

Data Source: Records of 372,364 people with AIDS along with links to corresponding cancer registry records.

Disclosures: The researchers had no conflicts to report.

Although AIDS-related mortality has declined since highly active antiretroviral therapy became widely available in the mid-1990s, there has been a corresponding increase in the incidence of cancer among people with AIDS, according to a study of more than 300,000 individuals.

The rates of the AIDS-defining cancers—Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical cancer—remain high in people with AIDS compared with the general population, but people with AIDS are also at high risk of several types of non–AIDS-defining cancers.

“Among those who die with AIDS and cancer, cancer now accounts for the vast majority of all deaths,” said Edgar P. Simard, Ph.D., of the National Cancer Institute. “And in the entire population, non–AIDS-defining cancers represent an increasing fraction of all deaths.”

Dr. Simard and his colleagues used data from 372,364 people diagnosed with AIDS in the United States between 1980 and 2006 and linked those with corresponding cancer registry records. The investigators divided their analyses into three eras: 1980–1989, when there was little in the way of effective AIDS treatment; 1990–1995, when one- and two-drug regimens were typical; and 1996–2006, when highly active antiretroviral therapy (HAART) became widely used.

Since numerous studies have already been done on cancer in the 2 years following AIDS diagnosis, the investigators focused on cancer risk 3–5 years after AIDS onset, Dr. Simard said at the Conference on Retroviruses and Opportunistic Infections.

As expected, the incidence of AIDS-defining cancers was very high during years 3–5 after diagnosis. Compared with the general population, people with AIDS had 5,321 times the risk of developing Kaposi's sarcoma, 32 times the risk of developing non-Hodgkin's lymphoma, and 5.6 times the risk of developing cervical cancer, he reported.

People with AIDS also had significant increases in the risk of developing four different non–AIDS-defining cancers. They had a 27-fold increase in the risk of anal cancer, a 9.1-fold increase in the risk of Hodgkin's lymphoma, a 3.7-fold increase in the risk of liver cancer, and a 3.0-fold increase in the risk of lung cancer. Overall, people with AIDS had a statistically significant 70% increase in the risk of developing any non–AIDS-defining cancer.

The cumulative incidence of AIDS-defining cancers declined significantly. At 60 months following diagnosis, the cumulative incidence was 8.7% for the 1980–1989 era, 6.4% for 1990–1995, and 2.1% for 1996–2006, Dr. Simard said.

Yet the cumulative incidence of the four non–AIDS-defining cancers increased significantly. The 60-month cumulative incidence of lung cancer rose from 0.14% in 1980–1989 to 0.28% in 1990–1995 and to 0.37% in 1996–2006. The cumulative incidence of Hodgkin's lymphoma rose from 0.04% in 1980–1989 to 0.10% in 1990–1995 to 0.17% in the 1996–2006 era, he said.

The cancer-attributable mortality of both AIDS-defining and non–AIDS-defining cancers increased significantly from the earliest to the latest treatment eras. Among AIDS-defining cancers, the cancer-attributable mortality rose from 69% to 88%, and among non–AIDS-defining cancers, the cancer-attributable mortality rose from 72% to 87%.

Cancer prevention and treatment “will become increasingly important as survival from AIDS increases and the population continues to age,” he said.

Major Finding: Among people with AIDS and non–AIDS-defining cancers, cancer-attributable mortality rose from 72% to 87% between 1980 and 2006.

Data Source: Records of 372,364 people with AIDS along with links to corresponding cancer registry records.

Disclosures: The researchers had no conflicts to report.

Although AIDS-related mortality has declined since highly active antiretroviral therapy became widely available in the mid-1990s, there has been a corresponding increase in the incidence of cancer among people with AIDS, according to a study of more than 300,000 individuals.

The rates of the AIDS-defining cancers—Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical cancer—remain high in people with AIDS compared with the general population, but people with AIDS are also at high risk of several types of non–AIDS-defining cancers.

“Among those who die with AIDS and cancer, cancer now accounts for the vast majority of all deaths,” said Edgar P. Simard, Ph.D., of the National Cancer Institute. “And in the entire population, non–AIDS-defining cancers represent an increasing fraction of all deaths.”

Dr. Simard and his colleagues used data from 372,364 people diagnosed with AIDS in the United States between 1980 and 2006 and linked those with corresponding cancer registry records. The investigators divided their analyses into three eras: 1980–1989, when there was little in the way of effective AIDS treatment; 1990–1995, when one- and two-drug regimens were typical; and 1996–2006, when highly active antiretroviral therapy (HAART) became widely used.

Since numerous studies have already been done on cancer in the 2 years following AIDS diagnosis, the investigators focused on cancer risk 3–5 years after AIDS onset, Dr. Simard said at the Conference on Retroviruses and Opportunistic Infections.

As expected, the incidence of AIDS-defining cancers was very high during years 3–5 after diagnosis. Compared with the general population, people with AIDS had 5,321 times the risk of developing Kaposi's sarcoma, 32 times the risk of developing non-Hodgkin's lymphoma, and 5.6 times the risk of developing cervical cancer, he reported.

People with AIDS also had significant increases in the risk of developing four different non–AIDS-defining cancers. They had a 27-fold increase in the risk of anal cancer, a 9.1-fold increase in the risk of Hodgkin's lymphoma, a 3.7-fold increase in the risk of liver cancer, and a 3.0-fold increase in the risk of lung cancer. Overall, people with AIDS had a statistically significant 70% increase in the risk of developing any non–AIDS-defining cancer.

The cumulative incidence of AIDS-defining cancers declined significantly. At 60 months following diagnosis, the cumulative incidence was 8.7% for the 1980–1989 era, 6.4% for 1990–1995, and 2.1% for 1996–2006, Dr. Simard said.

Yet the cumulative incidence of the four non–AIDS-defining cancers increased significantly. The 60-month cumulative incidence of lung cancer rose from 0.14% in 1980–1989 to 0.28% in 1990–1995 and to 0.37% in 1996–2006. The cumulative incidence of Hodgkin's lymphoma rose from 0.04% in 1980–1989 to 0.10% in 1990–1995 to 0.17% in the 1996–2006 era, he said.

The cancer-attributable mortality of both AIDS-defining and non–AIDS-defining cancers increased significantly from the earliest to the latest treatment eras. Among AIDS-defining cancers, the cancer-attributable mortality rose from 69% to 88%, and among non–AIDS-defining cancers, the cancer-attributable mortality rose from 72% to 87%.

Cancer prevention and treatment “will become increasingly important as survival from AIDS increases and the population continues to age,” he said.