title: HIV infection status, immunodeficiency, and the incidence of non-melanoma skin cancer.
abstract: Background The incidence of non-melanoma skin cancers (NMSCs), including basal cell (BCC) or squamous cell carcinoma (SCC), is not well documented among HIV-positive (HIV(+)) individuals. Methods We identified 6560 HIV(+) and 36 821 HIV-negative (HIV(-)) non-Hispanic white adults who were enrolled and followed up in Kaiser Permanente Northern California from 1996 to 2008. The first biopsy-proven NMSCs diagnosed during follow-up were identified from pathology records. Poisson models estimated rate ratios that compared HIV(+) (overall and stratified by recent CD4 T-cell counts and serum HIV RNA levels) with HIV(-) subjects and were adjusted for age, sex, smoking history, obesity diagnosis history, and census-based household income. Sensitivity analyses were adjusted for outpatient visits (ie, a proxy for screening). All statistical tests were two-sided. Results The NMSC incidence rate was 1426 and 766 per 100 000 person-years for HIV(+) and HIV(-) individuals, respectively, which corresponds with an adjusted rate ratio of 2.1 (95% confidence interval [CI] = 1.9 to 2.3). Similarly, the adjusted rate ratio for HIV(+) vs HIV(-) subjects was 2.6 (95% CI = 2.1 to 3.2) for SCCs, and it was 2.1 (95% CI = 1.8 to 2.3) for BCCs. There was a statistically significant trend of higher rate ratios with lower recent CD4 counts among HIV(+) subjects compared with HIV(-) subjects for SCCs (P trend < .001). Adjustment for number of outpatient visits did not affect the results. Conclusion HIV(+) subjects had a twofold higher incidence rate of NMSCs compared with HIV(-) subjects. SCCs but not BCCs were associated with immunodeficiency.
authors.affiliation: Kaiser Permanente, Division of Research, 2000 Broadway, Oakland, CA 94612, USA. michael.j.silverberg@kp.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
authors.forename: Wendy
authors.initials: W
authors.lastname: Leyden
authors.forename: E Margaret
authors.initials: EM
authors.lastname: Warton
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
authors.forename: Maryam M
authors.initials: MM
authors.lastname: Asgari
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000276:immunology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016017:Odds Ratio; D018579:Patient Selection; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000276:immunology* / Q000473:pathology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology