title: HIV Infection, Immunosuppression, and Age at Diagnosis of Non-AIDS-Defining Cancers.
abstract: It is unclear whether immunosuppression leads to younger ages at cancer diagnosis among people living with human immunodeficiency virus (PLWH). A previous study found that most cancers are not diagnosed at a younger age in people with AIDS, with the exception of anal and lung cancers. This study extends prior work to include all PLWH and examines associations between AIDS, CD4 count, and age at cancer diagnosis.
  
  
  
  We compared the median age at cancer diagnosis between PLWH in the North American AIDS Cohort Collaboration on Research and Design and the general population using data from the Surveillance, Epidemiology and End Results Program. We used statistical weights to adjust for population differences. We also compared median age at cancer diagnosis by AIDS status and CD4 count.
  
  
  
  After adjusting for population differences, younger ages at diagnosis (P < .05) were observed for PLWH compared with the general population for lung (difference in medians = 4 years), anal (difference = 4), oral cavity/pharynx (difference = 2), and kidney cancers (difference = 2) and myeloma (difference = 4). Among PLWH, having an AIDS-defining event was associated with a younger age at myeloma diagnosis (difference = 4; P = .01), and CD4 count <200 cells/µL (vs ≥500) was associated with a younger age at lung cancer diagnosis (difference = 4; P = .006).
  
  
  
  Among PLWH, most cancers are not diagnosed at younger ages. However, this study strengthens evidence that lung cancer, anal cancer, and myeloma are diagnosed at modestly younger ages, and also shows younger ages at diagnosis of oral cavity/pharynx and kidney cancers, possibly reflecting accelerated cancer progression, etiologic heterogeneity, or risk factor exposure in PLWH.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
authors.forename: Meredith S
authors.initials: MS
authors.lastname: Shiels
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Keri N
authors.initials: KN
authors.lastname: Althoff
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Achenbach
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Abraham
authors.affiliation: Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Castilho
authors.affiliation: Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Cescon
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.affiliation: Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Dubrow
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Gebo
authors.affiliation: Department of Medicine, University of Calgary, Alberta, Canada.
authors.forename: M
authors.initials: M
authors.lastname: John Gill
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Goedert
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA.
authors.forename: Surbhi
authors.initials: S
authors.lastname: Grover
authors.affiliation: School of Pharmacy, University of California, San Francisco, USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Hessol
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Justice
authors.affiliation: Center for AIDS Research, University of Washington, Seattle, USA.
authors.forename: Mari
authors.initials: M
authors.lastname: Kitahata
authors.affiliation: School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico, USA.
authors.forename: Angel
authors.initials: A
authors.lastname: Mayor
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.affiliation: Division of Infectious Diseases, University of Illinois College of Medicine, Chicago, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Novak
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D055815:Young Adult
keywords: AIDS; HIV; aging; cancer; immunosuppression