Nick Mulcahy

April 05, 2017

WASHINGTON, DC – The burden of cancer among people living with HIV in the United States is undergoing notable change, according to new research presented here at the American Association for Cancer Research (AACR) 2017 Annual Meeting.

In this patient population, the number of cancers linked to AIDS and suppressed immunity, such as Kaposi sarcoma and non-Hodgkin's lymphoma, is declining, and cancers related to aging are projected to rise in coming years, say the investigators, led by researcher Jessica Islam, MPH, a doctoral student in epidemiology at the University of North Carolina at Chapel Hill.

In 2030, the most common cancers among people with HIV will be prostate, lung, and liver cancer, they report.

The study findings are based on the assumption that recent trends will continue in the next 2 decades.

The findings may or may not be accurate, said Ethel Cesarman, MD, PhD, professor of pathology at the Weill Cornell Medicine in New York City.

"We are only starting to learn the health consequences of HIV and aging," said Dr Cesarman, who is an expert in AIDS pathology and was asked for comment.

Dr Cesarman said that "HIV is not a death sentence anymore," but it was at one time. Only recently have there been large numbers of older HIV-positive people. "It's uncharted territory," she said. "We don’t know what is going to happen as people with HIV age."

There is no dispute that the widespread use of highly active antiretroviral therapy (HAART) has led to an increase in survival in people with HIV and has resulted in the aging of that population.

The study authors say that only 4.1% of the HIV population was older than 65 years in 2006, but that age group is projected to increase to 21.4% by 2030, according to their new estimates.

"That's a huge shift in proportion," Islam told Medscape Medical News.

She and her coauthors observe that HAART has kept immune system suppression at bay, and as a result, the number of cases of AIDS-linked cancers, which include cervical cancer, has dropped.

The investigators estimated the number of people living with HIV in the United States by age and calendar year (2006-2030) using statistical modeling. To estimate cancer burden, they calculated future incidence rates and HIV population counts from previously observed data.

The study's data sources included the National Cancer Institute HIV/AIDS Cancer Match Study and the Centers for Disease Control and Prevention.

The investigators report that the estimated total number of HIV patients living with cancer will decrease from 7900 in 2010 to 6495 in 2030.

The team also estimated the cancer burden by the types of cancer: AIDS-defining cancers, including Kaposi sarcoma, non-Hodgkin's lymphoma, and cervical cancer; and non-AIDS-defining cancers.

The numbers indicate a strong decrease in AIDS-defining cancers and a slight increase in other types of cancers, say the investigators.

The list of the most common cancers projected for people living with HIV in 2030 includes prostate (n = 1624), lung (n = 786), liver (n = 498), and anal cancers (n = 447) and non-Hodgkin's lymphoma (n = 429).

Dr Cesarman is uncertain about the future of cancer among people living with HIV, but she is pleased that Kaposi sarcoma has been on the decline in the United States. It is still the most common cancer in some African countries. "If we can control HIV, then the incidence of Kaposi sarcoma will drop," she observed.

The study was conducted in part by the Intramural Research Program of the National Cancer Institute and the Centers for Disease Control and Prevention. Jessica Islam and Dr Cesarman have disclosed no relevant financial relationships.

American Association for Cancer Research (AACR) 2017 Annual Meeting.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

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