Immunosuppression and cancer: A comparison of risks in recipients of organ transplants and in HIV-positive individuals.
The comparison of cancers occurring excessively among HIV-infected and transplanted individuals may help to elucidate the relationship between immune surveillance, viral infections, and cancer. A longitudinal study was conducted on 2002 HIV-infected Italian subjects, 6072 HIV-infected French individuals, and 2878 Italian recipients of solid organ transplants. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were computed to quantify the risk for cancer, compared with the French and Italian general populations. The SIRs for all cancers were 9.8 (95% CI: 9.0-10.6) for HIV-infected individuals versus 2.2 (95% CI: 1.9-2.5) for transplant recipients. In both groups, most of the excess risk was attributable to virus-related cancers, such as Kaposi's sarcoma (KS; SIR = 451 in HIV-positive individuals, 125 in transplant recipients), non-Hodgkin's lymphoma (NHL; SIR = 62.1 and 11.1, respectively), and liver cancer (SIR = 9.4 and 4.1, respectively). Significantly increased SIRs for anal cancer and Hodgkin's lymphoma were found only among HIV-positive individuals. Among women younger than 40 years of age, a more than 10-fold increase in cervical cancer risk was found in both groups. Among HIV-infected individuals treatment with highly active antiretroviral therapies drastically reduced SIRs for KS and NHL only. These results show that HIV-infected individuals and transplant recipients share a similar pattern of cancer risk, largely due to virus-related cancers.
Busnach
G
G
Unità Nefrologia, Dialisi & Terapia Trapianto Renale, Ospedale Niguarda Ca' Granda, Milan, Italy.
Piselli
P
P
Arbustini
E
E
Baccarani
U
U
Burra
P
P
Carrieri
M P
MP
Citterio
F
F
De Juli
E
E
Bellelli
S
S
Pradier
C
C
Rezza
G
G
Serraino
D
D
D015331:Cohort Studies; D005260:Female; D005602:France; D015658:HIV Infections / Q000150:complications / Q000601:surgery*; D006679:HIV Seropositivity; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D007558:Italy; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D016377:Organ Transplantation / Q000009:adverse effects*
D007166:Immunosuppressive Agents