The association of HIV infection and cancer is well documented. This association is more obvious with the acquired immunodeficiency syndrome (AIDS)-defining cancers, namely Kaposi sarcoma, certain high-grade B-cell lymphomas, primary CNS lymphomas, and invasive cervical cancer.1 On the other hand, the relationship between non–AIDS-defining cancers that do not have an infectious component and HIV infection is less well understood.
For example, a previous study of more than 10,000 subjects found no association between HIV infection and lung cancer in a sample of women. There was also no statistically significant increase in risk in a sample of men after adjustment for prior AIDS diagnosis.2
A recent study by Italian investigators sought to re-examine the association between HIV infection and non–AIDS-defining malignancies, including lung cancer. The study was presented at the 23rd European Congress of Clinical Microbiology and Infectious Diseases in Berlin.3 The investigators retrospectively analyzed the records of 5090 HIV-infected patients in Italy and examined the local cancer registry to examine the incidence of non–AIDS-defining cancers. In this population, the most common cancers were non-melanoma skin cancer (29.7%), lung cancer (16.7%), and breast cancer (7.3%).3
Interestingly, the study found that HIV-infected males were at a higher risk for cancer (standardized incidence ratio [SIR] = 1.86; 95% confidence interval [CI], 1.55 to 2.26) than people in the general population. Risk was increased for lung carcinoma (SIR = 3.59; 95% CI, 2.36 to 5.45) and testis cancer (SIR = 3.11; 95% CI, 1.48 to 6.52). On the other hand, no differences were found in the risk of prostate and breast cancers in HIV-positive men (SIR = 1.10; 95% CI, 0.53 to 2.32) and women (SIR = 0.91; 95% CI, 0.47 to 1.74). The only predictors of non–AIDS-defining non–virus-related cancers were older age (incidence rate ratio (IRR) = 1.10; 95% CI, 1.08 to 1.12 per each additional year) and a shorter exposure or no exposure to HAART (IRR = 2.31; 95% CI, 1.38 to 3.89; P = .002).3
Cancer as a cause of morbidity and mortality may increase in an aging HIV population and so all health care providers will need to approach signs and symptoms in these patients with a heightened index of suspicion.
1. Engels EA, Pfeiffer RM, Goedert JJ, et al. Trends in cancer risk among people with AIDS in the United States 1980–2002. AIDS. 2006;20:1645–1654. (Abstract)
2. Hessol NA, Martinez-Maza O, Levine A, et al. Incidence and risk factors for lung cancer among women in the women’s interagency HIV study (WIHS) and men in the multicenter AIDS cohort study (MACS). Infect Agent Cancer. 2012;7(suppl 1):O24. (Abstract)
3. Albini L, Calabresi A, Gotti D, et al. Burden of non-virus-related, non-AIDS-defining cancers among HIV-infected patients in the highly active antiretroviral therapy (HAART) era. AIDS Res Hum Retroviruses. 2013;29:1097-1104. (Full text)