HIV: Cancer Prevention Needed as Patients Live Longer

Marcia Frellick

October 05, 2015

The dramatic success of antiretroviral therapy has allowed people with HIV to live longer, but their chances of getting cancer are also rising, new research shows.

That means targeted cancer prevention efforts, especially smoking cessation programs and lung cancer screening, may benefit this group, according to a study by Michael J. Silverberg, PhD, MPH, research scientist with Kaiser Permanente in Oakland, California, and colleagues, published online October 5 in the Annals of Internal Medicine.

The authors compared time trends in cumulative cancer incidence by age 75 years in 86,620 people with HIV and 196,987 people without HIV. Patients with HIV had an approximately 1 in 25 lifetime risk of developing Kaposi sarcoma, non-Hodgkin lymphoma, or lung cancer. They also had an increasing cumulative incidence over time for anal, colorectal, and liver cancer.

Table. Cumulative Incidence of Cancer by Age 75 Years

Cancer With HIV Without HIV
Kaposi sarcoma 4.4% 0.01%
Non-Hodgkin lymphoma 4.5% 0.7%
Lung cancer 3.4% 2.8%
Anal cancer 1.5% 0.05%
Colorectal cancer 1.0% 1.5%
Liver cancer 1.1% 0.4%
Hodgkin lymphoma 0.9% 0.09%
Melanoma 0.5% 0.6%
Oral cavity/pharyngeal cancer 0.8% 0.8%

The information has clinical implications for cancer prevention efforts. Annual lung cancer screening with low-dose computed tomography is recommended for heavy smokers aged 55 to 80 years in the general population. Given the high smoking rates among people with HIV, smokers with HIV should be good candidates for screening, the authors write.

However, research is urgently needed, they say, to understand risks and benefits resulting from high false-positive rates.

"[T]he increase in anal cancer risk highlights the need for further evidence about the harms and benefits of anal dysplasia screening," the authors write. "Although there are no formal guidelines, it would be prudent for physicians to be alert for early signs and symptoms of [Kaposi sarcoma and non-Hodgkin lymphoma]."

The increasing risk for liver cancer indicates the need to ensure universal hepatitis B (HBV) vaccination for people with HIV who are HBV-seronegative, as recommended. In addition, clinicians need to treat HBV infection using antiretroviral therapy regimens with anti-HBV activity and to treat hepatitis C infection with new interferon-free therapies.

Further pinpointing risk for different types of cancers will help inform which prevention efforts are most beneficial.

"As the population with HIV ages, future estimates of cumulative incidence could be stratified by levels of cancer risk factors, such as CD4+ count, smoking, alcohol consumption, and HBV or [hepatitis C virus] infection, to more accurately inform patients and providers about risk and to help further target prevention efforts," the authors write.

Dr Silverberg reports receiving support from Pfizer and Merck. Several coauthors report support from the National Institutes of Health; Gilead Sciences; and the National Institute of Allergy and Infectious Diseases.

Ann Intern Med. Published online October 5, 2015.

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