Risk of Second Primary Cancer on the Rise in People With HIV

By Anne Harding

September 28, 2018

NEW YORK (Reuters Health) - People living with HIV are at sharply increased risk of several types of first and second primary cancers compared with the general population, new findings show.

"This is something that we're likely going to see more of as people with HIV are living longer, they're getting older, and this is something we really need to pay attention to into the future," Dr. Nancy A. Hessol, a professor of clinical pharmacy and medicine at the University of California, San Francisco, told Reuters Health by phone.

Up to 18% of all cancers diagnosed in the U.S. are second cancers, Dr. Hessol and her colleagues note in The Lancet HIV, online September 20. People with HIV face a higher risk of primary AIDS-defining and non-AIDS-defining cancers, they add, but to date researchers have not distinguished between their risk of first and second primary cancers.

To investigate, the team looked at more than 22,600 people who were diagnosed with HIV at age 16 or older in San Francisco in 1990-2010, matching them to California Cancer Registry data on primary cancers diagnosed in 1985-2013. Their analysis included 4,144 first primary cancers, 372 second primary cancers, 26 third primary cancers and three cancers that were a patient's fourth or later.

Standardized incidence ratios for 14 first primary cancers were higher in people with HIV, including Kaposi sarcoma (SIR, 127), non-Hodgkin lymphoma (17.2), invasive cervical cancer (8.0), anal cancer (46.7), vulvar cancer (13.3), Hodgkin's lymphoma (10.4) and eye and orbit cancer (4.2), the researchers found.

The risk of second primary cancers was significantly increased for Kaposi sarcoma (SIR, 28.0), anal cancer (17.0), non-Hodgkin lymphoma (11.1), Hodgkin's lymphoma (5.4) and liver cancer (3.6).

Over time the incidence of first and second primary AIDS-defining cancers declined, but the incidence of second primary non-AIDS defining cancers increased.

"Even in the era of effective antiretroviral therapy, people need to understand that this is something that is not only not going away, it's on the rise," Dr. Hessol said.

Surviving longer means a longer latency period for cancer-linked viruses such as Epstein-Barr, herpesvirus-8 and human papilloma virus, she added, as well as more extended exposure to behavioral risk factors such as drinking alcohol and smoking.

"Most health care providers are aware that women with HIV may be at increased risk for invasive cervical cancer, so they may be vigilant with Paps and other screening for that disease, but in terms of these other cancers I don't believe there are recommendations to have any sort of extra efforts to screen people for perhaps early detection of those types of cancer," she added.

Dr. Hessol and her colleagues conclude: "Additional research into interventions to improve prevention, early detection, and treatment of cancer in people living with HIV infection is of increasing importance and holds the promise of reducing cancer incidence and mortality in this vulnerable population."

"The largest HIV burden is in sub-Saharan countries, in which ART use is relatively recent and high-risk populations (mainly non-smoking heterosexual people) and the spectrum of cancer (high burden of cervical cancer and hepatitis B-associated liver cancer) are different from the USA," Dr. Silvia Franceschi of the Centro di Riferimento Oncologico di Aviano in Aviano, Italy, writes in an accompanying editorial.

"Ageing and improvements in HIV and, possibly, cancer survival among people with HIV is likely to further increase the cumulative risk of development of second primary cancers," Dr. Franceschi adds. "Therefore, there is a need for urgent preventive measures and more research on the relationship between impaired immunity and cancer outcomes and treatments."

SOURCE: https://bit.ly/2R1JXBz and https://bit.ly/2N6cMtn

Lancet HIV 2018.