Cutaneous malignancies among HIV-infected persons.
BACKGROUND
As the life expectancy of persons infected with human immunodeficiency virus (HIV) increases, cancers have become an important cause of morbidity and mortality. Although cutaneous cancers are the most common malignant neoplasms in the general population, little data exist among HIV-positive persons, especially regarding the impact of HIV-specific factors.


METHODS
We evaluated the incidence rates and factors associated with the development of cutaneous malignancies among HIV-infected persons by examining data that were prospectively collected from a large HIV study that included 4490 participants (1986-2006). Poisson regression and Cox proportional hazards models were performed.


RESULTS
Six percent of HIV-infected persons (n = 254) developed a cutaneous malignancy during 33 760 person-years of follow-up (mean, 7.5 years). Since the advent of highly active antiretroviral therapy (HAART), the incidence rates of cutaneous non-AIDS-defining cancers (NADCs), in particular basal cell carcinoma, have exceeded the rates of cutaneous AIDS-defining cancers such as Kaposi sarcoma. Factors associated with the development of cutaneous NADCs in the multivariate models included increasing age (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.7-2.6) and race. Compared with the white/non-Hispanic race, African Americans (HR, 0.03; 95% CI, 0.01-0.14) and other races (HR, 0.14; 95% CI, 0.03-0.57) had a lower risk of cutaneous NADCs. There were no significant associations between cutaneous NADCs and time-updated CD4 lymphocyte counts, HIV RNA levels, or receipt of HAART.


CONCLUSIONS
At present, the most common cutaneous malignancies among HIV-infected persons are NADCs. Cutaneous NADCs do not appear to be significantly associated with immune function or HAART but rather are related to traditional factors such as aging and skin color.
Crum-Cianflone
Nancy
N
Tri-Service AIDS Clinical Consortium, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. crum@med.navy.mil
Hullsiek
Katherine Huppler
KH
Satter
Elizabeth
E
Marconi
Vincent
V
Weintrob
Amy
A
Ganesan
Anuradha
A
Barthel
R Vincent
RV
Fraser
Susan
S
Agan
Brian K
BK
D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D016001:Confidence Intervals; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D004279:DNA, Viral