Increased Incidence of Cancer Observed in HIV/hepatitis C Virus-Coinfected Patients Versus HIV-Monoinfected

Héctor Meijide; Sonia Pértega; Iria Rodríguez-Osorio; Ángeles Castro-Iglesias; Josefa Baliñas; Guillermo Rodríguez-Martínez; Álvaro Mena; Eva Poveda

Disclosures

AIDS. 2017;31(8):1099-1107. 

In This Article

Abstract and Introduction

Abstract

Background: Cancer is a growing problem in persons living with HIV infection (PLWH) and hepatitis C virus (HCV) coinfection could play an additional role in carcinogenesis. Herein, all cancers in an HIV-mono and HIV/HCV-coinfected cohort were evaluated and compared to identify any differences between these two populations.

Methods: A retrospective cohort study was conducted including all cancers in PLWH between 1993 and 2014. Cancers were classified in two groups: AIDS-defining cancer (ADC) and non-AIDS-defining cancer (NADC). Cancer incidence rates were calculated and compared with that observed in the Spanish general population (GLOBOCAN, 2012), computing the standardized incidence ratios (SIRs). A competing risk approach was used to estimate the probability of cancer after HIV diagnosis. Cumulative incidence in HIV-monoinfected and HIV/HCV-coinfected patients was also compared using multivariable analysis.

Results: A total of 185 patients (117 HIV-monoinfected and 68 HIV/HCV) developed cancer in the 26 580 patient-years cohort, with an incidence rate of 696 cancers per 100 000 person-years, higher than in the general population (SIR = 3.8). The incidence rate of NADC in HIV/HCV-coinfected patients was 415.0 (SIR = 3.4), significantly higher than in monoinfected (377.3; SIR = 1.8). After adjustments, HIV/HCV-coinfected patients had a higher cumulative incidence of NADC than HIV-monoinfected (adjusted hazard ratio = 1.80), even when excluding hepatocellular carcinomas (adjusted hazard ratio = 1.26).

Conclusion: PLWH have a higher incidence of NADC than the general population and HCV-coinfection is associated with a higher incidence of NADC. These data justify the need for prevention strategies in these two populations and the importance of eradicating HCV.

Introduction

Antiretroviral therapy (ART) has improved the survival of people living with HIV (PLWH), leading to a growing interest in the epidemiology of chronic illnesses, such as cardiovascular diseases or malignancies.[1–7] Cancer incidence in PLWH is expected to increase because of advances in treatment, demographic changes, immune dysfunction/reconstitution, aging, and continuous exposure to carcinogens.[8–11] Despite a decline of AIDS-defining cancers (ADCs), the risk of the most frequent non-AIDS-defining cancers (NADCs) remains higher than in the general population.[12–14]

Globally, hepatitis C virus (HCV) coinfection is common among PLWH; in high-income countries, about 30% of PLWH are coinfected with HCV.[15] Liver disease progression is faster in HIV/HCV-coinfected patients than in HCV-monoinfected,[16] and HCV is an increasingly frequent cause of death among PLWH. At the diagnosis of hepatocellular carcinoma (HCC), PLWH are younger and more frequently symptomatic with advanced tumors than HIV-negative patients.[17] With the improvement and the globalization of ART, the incidence of HCC has increased steadily in PLWH, driven primarily by HCV infection.

Regardless of the HIV infection, around 15% of cancer cases worldwide are attributable to infectious agents.[18] In addition to HCC, HCV infection has also been associated with an increased risk of developing many other nonliver cancers, with a higher incidence, mortality and a younger age at diagnosis and death than the general population.[19,20] Non-HIV-infected patients with chronic HCV infection have two- to three-fold increased risk of non-Hodgkin lymphoma (NHL) compared with the HCV-negative population.[21,22]

There are few studies analyzing the impact of chronic HCV infection in PLWH, in terms of malignancy development and mortality.[23,24] The aim of this study is to analyze the incidence of cancer in PLWH infected and noninfected with HCV and determine the additional cancer risk in comparison to the general population.

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