HIV infection and the risk of cancers with and without a known infectious cause.
OBJECTIVE
To evaluate the risk of cancers with and without a known infectious cause in HIV-infected persons.


METHODS
Retrospective cohort study.


METHODS
Adult HIV-infected and matched HIV-uninfected members of Kaiser Permanente followed between 1996 and 2007 for incident AIDS-defining cancers (ADCs), infection-related non-AIDS-defining cancers (NADCs; anal squamous cell, vagina/vulva, Hodgkin's lymphoma, penis, liver, human papillomavirus-related oral cavity/pharynx, stomach) and infection-unrelated NADC (all other NADCs).


RESULTS
We identified 20 277 HIV-infected and 202 313 HIV-uninfected persons. HIV-infected persons experienced 552 ADC, 221 infection-related NADC, and 388 infection-unrelated NADC. HIV-uninfected persons experienced 179 ADC, 284 infection-related NADC, and 3418 infection-unrelated NADC. The rate ratio comparing HIV-infected and HIV-uninfected persons for ADC was 37.7 [95% confidence interval (CI): 31.7-44.8], with decreases in the rate ratio over time (P < 0.001). The rate ratio for infection-related NADC was 9.2 (95% CI: 7.7-11.1), also with decreases in the rate ratio over time (P < 0.001). These results were largely influenced by anal squamous cell cancer and Hodgkin's lymphoma. The rate ratio for infection-unrelated NADC was 1.3 (95% CI: 1.2-1.4), with no change in the rate ratio over time (P = 0.44). Among infection-unrelated NADCs, other anal, skin, other head and neck, and lung cancer rates were higher and prostate cancer rates lower in HIV-infected persons. Among all infection-unrelated NADCs, the rate ratio decreased over time only for lung cancer (P = 0.007).


CONCLUSIONS
In comparison with those without HIV infection, HIV-infected persons are at particular risk for cancers with a known infectious cause, although the higher risk has decreased in the antiretroviral therapy era. Cancers without a known infectious cause are modestly increased in HIV-infected persons compared with HIV-uninfected persons.
Silverberg
Michael J
MJ
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA. Michael.J.Silverberg@kp.org
Chao
Chun
C
Leyden
Wendy A
WA
Xu
Lanfang
L
Tang
Beth
B
Horberg
Michael A
MA
Klein
Daniel
D
Quesenberry
Charles P
CP
Towner
William J
WJ
Abrams
Donald I
DI
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000453:epidemiology / Q000209:etiology; D018791:CD4 Lymphocyte Count; D002140:California / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D012042:Registries / Q000706:statistics & numerical data