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Association
of Cancer with AIDS-Related Immunosuppression in Adults [Frisch
M, et al. JAMA 2001;285:1736]: This
report from the "AIDS-Cancer Match Registry Study Group"
examines the frequency of cancer as reported to the Cancer Registry
in the U.S. from 1978 to 1996. There is a separate analysis of AIDS-defining
cancers (KS, non-Hodgkin lymphoma, and cervical cancer), which accounted
for 30,853 of the 35,278 (87%) cancers reported. The results were
reported for the relative rate of the designated cancer reported
from 60 months before to 27 months after the diagnosis of AIDS.
The RR for KS in men after AIDS was 175.8 and for women was 405.2;
for NHL it was 72.8, and for cervical cancer it was 5.2. There were
4,422 non-AIDS-defining cancers reported during the five years before
AIDS through 27 months after AIDS. High RRs were found for Hodgkin's
disease - 11.5, anal cancer - 32.8, and angiosarcoma - 13.4. The
overall RR for non-AIDS-defining cancers was 2.7, which is significantly
greater than the rate for the general population (p = <0.001).
The details are shown in the following table:
Risk
of Cancer in 302,834 Adults with AIDS
1978-96 from 60 Months Before to 27 Months After AIDS |
| Cancer |
No. |
RR |
| AIDS-defining |
|
|
|
Kaposi's sarcoma |
21,155 |
177.7* |
|
Non-Hodgkin lymphoma |
9,350 |
72.8 |
|
Cervical cancer |
348 |
5.2 |
| Non-AIDS-defining |
4,422 |
2.7** |
|
Leukemia |
175 |
3.6 |
|
Hodgkin's disease |
612 |
11.5** |
|
Oral cavity |
260 |
3.1 |
|
Lip |
20 |
3.1** |
|
GI tract |
637 |
2.3 |
|
Anal |
221 |
33.8 |
|
Larynx |
118 |
2.8 |
|
Lung |
808 |
4.5** |
|
Breast |
143 |
1.1 |
|
Angiosarcoma |
23 |
13.4 |
|
Male genital tract |
328 |
1.1 |
|
CNS |
156 |
3.5** |
*
The RR for KS within 27 months after another AIDS-defining diagnosis
was 175.8 for men, 267.2 for gay men, and 405.2 for women.
** P <0.05 for correlation with immunosuppression as indicated
by pre-AIDS to post AIDS trends in incidence. Thus, CNS tumors
were more frequent after AIDS Compared to pre-AIDS, which the
authors attributed to Immunosuppression as a predisposing factor.
|
Comment:
These results largely reflect the experience with cancer in HIV-infected
persons in the pre-HAART era. One of the major goals of this project
was to determine the potential importance of immunosuppression on
cancer rates. The strongest association for a non-AIDS-defining
cancer is with Hodgkin's disease, which showed a RR of 11.5 and
with HPV-associated cancers including anal cancer and lip cancer.
Breast cancer was the only cancer to show a significant decrease
in RR. The conclusion is that most non-AIDS-defining cancers are
not associated with advancing immunosuppression, although Hodgkin's
disease is the notable exception.
posted
4/13/2001
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