title: HIV infection, immunodeficiency, viral replication, and the risk of cancer.
abstract: BACKGROUND
  Few studies have compared cancer risk between HIV-infected individuals and a demographically similar HIV-uninfected internal comparison group, adjusting for cancer risk factors.
  
  
  METHODS
  We followed 20,775 HIV-infected and 215,158 HIV-uninfected individuals enrolled in Kaiser Permanente (KP) California for incident cancer from 1996 to 2008. Rate ratios (RR) were obtained from Poisson models comparing HIV-infected (overall and stratified by recent CD4 count and HIV RNA) with HIV-uninfected individuals, adjusted for age, sex, race/ethnicity, calendar period, KP region, smoking, alcohol/drug abuse, and overweight/obesity.
  
  
  RESULTS
  We observed elevated RRs for Kaposi sarcoma (KS; RR = 199; P < 0.001), non-Hodgkin lymphoma (NHL; RR = 15; P < 0.001), anal cancer (RR = 55; P < 0.001), Hodgkin lymphoma (HL; RR = 19; P < 0.001), melanoma (RR = 1.8; P = 0.001), and liver cancer (RR = 1.8; P = 0.013), a reduced RR for prostate cancer (RR = 0.8; P = 0.012), and no increased risk for oral cavity/pharynx (RR = 1.4; P = 0.14), lung (RR = 1.2; P = 0.15), or colorectal (RR = 0.9; P = 0.34) cancers. Lung and oral cavity/pharynx cancers were elevated for HIV-infected subjects in models adjusted only for demographics. KS, NHL, anal cancer, HL, and colorectal cancer had significant (P < 0.05) trends for increasing RRs with decreasing recent CD4. The RRs for lung and oral cavity/pharynx cancer were significantly elevated with CD4 < 200 cells/μL and for melanoma and liver cancer with CD4 < 500 cells/μL. Only KS and NHL were associated with HIV RNA.
  
  
  CONCLUSIONS
  Immunodeficiency was positively associated with all cancers examined except prostate cancer among HIV-infected compared with HIV-uninfected individuals, after adjustment for several cancer risk factors.
  
  
  CONCLUSIONS
  Earlier antiretroviral therapy initiation to maintain high CD4 levels might reduce the burden of cancer in this population.
authors: Kaiser Permanente Northern California, Oakland, CA 94612, USA. Michael.J.Silverberg@kp.org
authors: Michael J
authors: MJ
authors: Silverberg
authors: Chun
authors: C
authors: Chao
authors: Wendy A
authors: WA
authors: Leyden
authors: Lanfang
authors: L
authors: Xu
authors: Michael A
authors: MA
authors: Horberg
authors: Daniel
authors: D
authors: Klein
authors: William J
authors: WJ
authors: Towner
authors: Robert
authors: R
authors: Dubrow
authors: Charles P
authors: CP
authors: Quesenberry
authors: Romain S
authors: RS
authors: Neugebauer
authors: Donald I
authors: DI
authors: Abrams
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000276:immunology* / Q000821:virology*; D012307:Risk Factors; D019562:Viral Load; D014779:Virus Replication
chemical_list: D019380:Anti-HIV Agents