Earlier age at cancer diagnosis and increased incidence of non-AIDS defining cancers in patients with advanced HIV infection
M.L. Nguyen1, A. Sumbry2, D. Reddy1, K. Harvey1, C. Gunthel1, C. Tsui1, D. Ziemer3, C. del Rio4, J.L. Young5
1Emory University School of Medicine, Medicine, Atlanta, United States, 2Emory University School of Medicine, Medicine, Altanta, United States, 3Grady Health Systems, Atlanta, United States, 4Rollins School of Public Health, Emory University, Global Health, Atlanta, United States, 5Rollins School of Public Health, Emory University, Epidemiology, Atlanta, United States
Background: As persons with HIV survive longer with combined antiretroviral therapy , diseases with long latency periods such as the non -AIDS defining cancers (NADM) and cardiovascular diseases are emerging. Observational studies had reported that most cancers seem to occur at an earlier age in HIV + patiients. We evaluated the age at cancer diagnosis and the standardized incidence ratio(SIR) based on age, sex and race compared to the 17 registries of the Surveillance, Epidemiology and End Results (SEER) data.
Methods: Patients seen at the Infectious Diseases Ponce de Leon Center (IDP) Ryan-White funded clinic were linked to the Grady Health System Cancer registry during the period 2000-2007. Person-years of follow up and SIR were calculated.Continuous variables were compared using Student´s t test, and count variables were compared using Poisson regression.
Results: From 2000 to 2007, we identified 516 patietns with cancers: 320 with AIDS -defining cancers (ADC ) and 196 with NADC. The overall mean age at cancer diagnosis in the HIV + patients was 42.0.±3.8 years. The age at cancer diagnosis and the SIR for individual cancers are presented in Table 1. Except for Hodgkin´s lymphoma, all listed cancers were diagnosed on average 10 -24 years earlier than in the general population. The incidence rates are overall much higher than the general population , except for prostate cancer and breast cancer.
[Age at cancer diagnosis and SIR]
| ||Cervical cancer||Non-Hodgkin lymphoma||Hodgkin lymphoma||Hepatocellular cancer||Anal/Rectal SCC||Bronchus/Lung cancer||Head and Neck cancer||Breast cancer||Prostate cancer|
|Mean age ±SD
|Student´s t-test p value||0.053||0.0001||0.685||0.0001||0.0001||0.0001||0.0001||0.0001||0.0001|
|SIR(by age, sex, race)
Mid-p exact test)||11.95
Conclusion: Many NADC occur at an increased rate compared to the general population and at an earlier age. This finding may impact screening practices in HIV-infected patients.
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