The burden of cancer among HIV-infected persons in the U.S. population
Presented by Eric Engels (United States).
M. Shiels1, R. Pfeiffer1, M. Gail1, I. Hall2, J. Li2, A. Chaturvedi1, K. Bhatia1, T. Uldrick1, R. Yarchoan1, J. Goedert1, E. Engels1
1National Cancer Institute, Rockville, United States, 2Centers for Disease Control and Prevention, Atlanta, United States
Background: Antiretroviral therapy has improved survival among HIV-infected persons, decreased incidence of AIDS-defining cancers, and increased the at-risk population for non-AIDS-defining cancers. We estimated the number of cancers occurring over time in the U.S. HIV population.
Methods: CDC collects data on all U.S. HIV cases. Cancer incidence rates were obtained through linkage of HIV and cancer registries in 15 U.S. areas. For persons with AIDS, cancer counts were estimated for 1991-2005 by applying cancer incidence rates to the U.S. AIDS population by year, age, sex, race/ethnicity, transmission category, and time since AIDS. For persons with HIV-only (not AIDS), counts were estimated for 2004-2007 by applying overall cancer rates for 1998-2005 to HIV data from 34 states with confidential name-based HIV reporting since 2004.
Results: The U.S. AIDS population increased from 93,802 people (8% 50+ years old) in 1991 to 399,762 (29% 50+ years old) in 2005. During 1991-2005, 76,558 cancers occurred in this population. AIDS-defining cancers (mainly Kaposi sarcoma and non-Hodgkin lymphoma) declined from 7,284 cases in 1993 to 1,736 cases in 2005. In contrast, non-AIDS-defining cancers increased across years (n= 416 in 1991 vs. n=2,437 in 2005). Anal cancer (n=18 in 1991, n=358 in 2005) and prostate cancer (n=10 in 1991, n=123 in 2005) increased steeply, partially due to rising rates. Although lung cancer and Hodgkin lymphoma rates remained relatively stable, cases increased (lung cancer: n=112 in 1991, n=478 in 2005; Hodgkin lymphoma: n=72 in 1991, n=169 in 2005). During 2004-2007 in 34 states, 4,388 cancers occurred among persons with HIV-only, including 892 lung cancers, 381 anal cancers, and 327 Hodgkin lymphomas.
Conclusions: Dramatic increases in non-AIDS-defining cancers among persons with AIDS are driven by growth and aging of the AIDS population, and rising incidence rates for some cancers. Cancer prevention and treatment in HIV-infected persons are increasingly important.
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