title: Characteristics of colorectal cancer in the human immunodeficiency virus-infected African American population.
abstract: Colorectal Cancer (CRC) is the second leading cause of cancer mortality in the United States. African Americans (AAs) have the highest incidence of CRC of any American ethnic group. Survival from CRC in AAs is lower than in Caucasians, and the mean age of CRC development in AAs is younger. The AA community also has a high rate of HIV infection, accounting for 50.3% of all cases despite making up only 13.6% of the population. This retrospective cohort study identified 17 AA HIV patients with CRC. The patients were matched with 42 HIV-negative CRC patients (controls), based on age, sex, and TNM stage. Data were obtained from 3 hospitals in New Jersey: St. Michael's Medical Center, Trinitas Medical Center and St. Joseph's Medical Center. The age, sex, HIV status, tumor site, stage, drug usage, Hepatitis C status, and survival outcome of subjects and controls were compared. Data from the Surveillance Epidemiology & End Results (SEER) specific to AAs were also compared. The mean age of CRC diagnosis was younger, 50.7 years (median: 52 years, range: 35-71 years), versus 59.42 years (median: 66 years) (P < 0.0001) in the SEER AA population. Of the patients, 29.4% were diagnosed with CRC at less than 45 years of age, versus only 6.35% of the SEER AA population (P < 0.0002). The male-to-female ratio was 11:6. Seven individuals used IV drugs, and 7 had hepatitis C. The mean CD4+ T-cell count was 510.81 cells/mm(3) (median 419). At the time of CRC diagnosis, the average duration of HIV infection was 7.6 years (range 0-22.4 years).Of patients, 87.5% had left-sided CRC, versus 57.55% of the SEER population (P < 0.024). Of the patients, 52.94% had stage III-IV, at diagnosis, versus 43.84% in SEER. There was no statistically significant survival difference between the cases and controls. In our cohort of HIV-infected AA's with CRC, the staging and outcome of CRC did not appear to be affected by the degree of immunosuppression. HIV-infected AA with CRC presented with a higher percentage of left-sided CRC than AA's without HIV. Additionally, AAs with HIV tended to be younger at the time of CRC diagnosis. Our findings suggest that screening for CRC should be offered to HIV-infected AAs before the age of 45, and that sigmoidoscopy with fecal occult blood testing might be an acceptable screening modality. However, the exact age of initiation, optimal frequency, and preferred method of screening (colonoscopy vs. sigmoidoscopy) in this population requires further study.
authors.affiliation: Department of Internal Medicine, Saint Michael's Medical Center, Newark, NJ, USA. Ice9996@aol.com
authors.forename: Avishek
authors.initials: A
authors.lastname: Kumar
authors.forename: Nihar
authors.initials: N
authors.lastname: Shah
authors.forename: Yashpal
authors.initials: Y
authors.lastname: Modi
authors.forename: Hamid S
authors.initials: HS
authors.lastname: Shaaban
authors.forename: Joseph
authors.initials: J
authors.lastname: DePasquale
authors.forename: Vincent A
authors.initials: VA
authors.lastname: DeBari
authors.forename: Swaroopa
authors.initials: S
authors.lastname: Yerrabothala
authors.forename: Michael
authors.initials: M
authors.lastname: Maroules
authors.forename: Gunwant K
authors.initials: GK
authors.lastname: Guron
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States / Q000453:epidemiology