HIV infection associated with increased cancer-specific mortality

1. In a retrospective review of a large cancer database of over 1.8 million patients, HIV infection was associated with increased risk of cancer-specific mortality compared to uninfected patients, regardless of cancer stage or treatment received.

Evidence Rating Level: 3 (Average)

Study Rundown: Infection with HIV is a known risk factor for malignancy, including both AIDS-defining cancers such as Kaposi sarcoma as well as non-AIDS-defining cancers such as Hodgkin lymphoma, anal, and lung cancer. The introduction of effective antiretroviral therapy has significantly improved the survival of patients with HIV. However, the effect of HIV infection on cancer-specific mortality has not been well-established. The purpose of this retrospective review was to evaluate the effect of HIV infection on cancer-related mortality. The authors performed a retrospective review of a linkage database of two large HIV/AIDS and cancer databases from the United States from 1996 to 2010 and compared the cancer-specific mortality rates of over 6,000 HIV-infected patients and 1.8 million uninfected patients.

At the conclusion of the study, the authors found that HIV-infected patients had a greater cancer-specific mortality for several different types of common cancers (i.e. colorectal, lung, melanoma, breast) compared to uninfected patients. HIV-infected patients were more likely to present at a later cancer stage and to not undergo any cancer treatment compared to non-infected patients. However, the increased risk of cancer-specific mortality in the HIV-infected cohort remained even after adjusting for these variables. The results of this study support the hypothesis that HIV-infection may increase the risk of cancer-specific mortality independent of cancer stage or type of care received. However, the study is limited by the retrospective nature of the study as well as the use of death certificate reports as the cause of death, which may reduce the accuracy of the data. Additional, large prospective trials are required to more accurately characterize this association.

Click to read the study in JCO

Relevant Reading: Trends in cancer risk among people with AIDS in the United States 1980-2002

In-Depth [retrospective cohort]: This study was a retrospective analysis of data from the HIV/AIDS Cancer Match (HACM) study, which linked 14 population-based HIV and cancer registries in the United States from 6 different states. The authors included patients diagnosed with one of 14 common cancers, including cancers of the oral cavity/pharynx, colorectal, anus, liver, pancreas, larynx, lung, breast, cervix, prostate, kidney/renal pelvis, Hodgkin’s Lymphoma, diffuse large B-cell lymphoma and melanoma from 1996 to 2010. The primary outcome was cancer-specific mortality. Other outcomes included all-cause mortality and HIV-specific mortality. A total of 1,816,461 patients were included in this study, of which 6,459 was infected with HIV. At the conclusion of the study, HIV-infected patients had overall increased cancer-specific mortality for 7 of the 14 cancers compared to non-infected cohort: colorectal (HR: 1.49; 95% CI: 1.21 to 1.84), pancreas (HR: 1.71; 95% CI: 1.35 to 2.18), larynx (HR: 1.62; 95% CI: 1.06 to 2.47), lung (HR: 1.28; 95% CI: 1.17 to 1.39), melanoma (HR: 1.72; 95% CI: 1.09 to 2.70), breast (HR: 2.61; 95% CI: 2.06 to 3.31), and prostate (HR: 1.57; 95% CI: 1.02 to 2.41). Patients with HIV-infections was diagnosed with more advanced cancers (32.2% versus 17.7%, p < .01), and were less likely to receive any first-line treatment (68.6% versus 74.6%, p < .01) compared to the non-infected cohort. Adjustment for cancer treatment had little effect on this association.

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