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AIDS patients have increased risk of death due to non-AIDS-related cancers
Michael Carter, 2016-05-26 10:40:00
People diagnosed with AIDS
have a very high risk of dying of a non-AIDS-defining cancer, Italian
investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Overall, people with an AIDS diagnosis had a seven-fold increase in their risk of dying from a
non-AIDS-defining malignancy compared to HIV-negative patients. The risk of
death due to certain cancers was remarkably high, including anal cancer. AIDS
patients with a history of injecting drug use had especially high excess
mortality due to non-AIDS-related cancers.
documented a statistically higher mortality…for cancers not directly associated
with HIV/AIDS, with an overall 7.3-fold excess risk for all non-ADCs
[AIDS-defining cancers] combined,” write the authors. “This latter figure can
be interpreted as a combination of the increased incidence of such malignancies
and the reduced cancer survival of people with HIV/AIDS.”
Patients with HIV
should be closely monitored for both virus and life-style related cancers,
suggest the investigators.
Three cancers are
classified as AIDS-related: non-Hodgkin lymphoma, Kaposi sarcoma and cervical
cancer. However, thanks to effect antiretroviral therapy, the incidence of
these cancers in patients with HIV is falling.
In contrast, non-AIDS-defining
cancers are now recognised as an important cause of serious illness and death
in people with HIV. However, the increased risk of death that patients with
HIV have due to non-AIDS-defining cancers compared to age- and sex-matched
individuals in the general population is unclear.
investigators therefore designed a population-based, retrospective study to
quantify the excess risk of cancer-related death among patients with AIDS
compared to patients in the general population.
collected from death certificates and central registries for patients aged
between 15 and 74 years who were diagnosed with or died of AIDS between 2006
and 2011. Death records of approximately 952,000 non-AIDS patients who died in
the same time period were used for comparison purposes. Causes of death for
non-AIDS patients were scrutinised to ensure that patients with
AIDS/HIV-related causes of death were excluded.
among AIDS patients compared to non-AIDS patients was estimated using sex- and
age-adjusted standardised mortality ratios (SMRs).
People with AIDS
were followed for a median of 2.5 years and contributed 14,180 person-years of
analysis. During this time, 1229 patients died. Mortality was highest among patients
with a history of injecting drug use (IDU) and lowest among gay men (17%).
cancers were reported on 23% of death certificates, with non-Hodgkin lymphoma
reported on 18% of certificates, Kaposi sarcoma on 5% of certificates and
cervical cancer on 2.5% of certificates.
cancers were reported on the death certificates of 10% of AIDS patients. The
most common were lung cancer (38 deaths, 3%), liver cancer (17 deaths, 1.4%)
and Hodgkin lymphoma (twelve deaths, 1%). Non-AIDS-defining malignancies were
more common among patients aged 50 years and over () compared to younger
patients (14 vs. 8%, respectively). Cancer was recorded on the death
certificates of 47% of non-AIDS patients.
non-AIDS-defining cancers were considered together, patients with AIDS had a
seven-fold increase of death due to these cancers compared to non-AIDS
patients. The excess mortality risk was higher for younger (under 50 years)
AIDS patients compared to older AIDS patients (SMR = 14.2 vs. 5.2, respectively).
elevated risks of death were detected for anal cancer (SMR = 228) and Hodgkin lymphoma (SMR = 122). A significant risk
of excess mortality was identified for several cancers, including non-specified
uterine cancers (SMR = 52.5), liver cancer (SMR = 13.2), melanoma (SMR = 11), lung
cancer (SMR = 8), head and neck cancers (SMR = 7.8), leukaemia (SMR = 7.6) and
cancer of the colon-rectum (SMR = 5.4).
had an especially high risk of death due to liver cancer (SMR = 38.8 vs. 7.6
for over 50s) and lung cancer (SMR = 38.8 vs. 57 for over 50s).
Patients with a
history of injecting drug use had a higher risk of death due to non-AIDS
cancers (SMR = 20.0) compared to other HIV risk groups. As expected, risk of
liver cancer (often due to the blood-borne viruses, HBV and HCV) was especially
high (SMR = 74.7) for injecting drug users. However, patients who injected
drugs also had a remarkably high risk of death due to anal cancer (SMR = 440)
and non-specified uterine cancer (SMR = 157).
infected with HIV sexually, the overall risk of a non-AIDS-defining cancer was
increased five-fold compared to non-AIDS patients. Mortality risk due to anal
cancer (SMR = 189.5) and Hodgkin lymphoma (SMR = 116) was especially elevated
in this risk group, and they also had excess mortality risk due to leukemia
(SMR = 8.2), lung cancer (SMR =5.1) and colorectal cancer (SMR = 3.5).
“It is worth
remembering that our data included only HIV-infected individuals having already
had an AIDS diagnosis,” comment the authors. “Thus, study results cannot be
referred to HIV-infected people at an earlier stage of immunodeficiency.”
They believe their
findings show the need for AIDS patients to be monitored for cancers related to
viruses (e.g., anal or liver cancer) and life-style related cancers (e.g., lung
cancer), concluding “our results call for taking primary and secondary
preventive actions to reduce both cancer incidence and mortality among people
with HIV or AIDS.”