Cancer Burden Expected to Change for HIV-Positive Population

For people with HIV, certain cancers mark the shift from HIV to acquired immunodeficiency syndrome (AIDS); these cancers are known as AIDS-defining cancers (ADCs). As the HIV-positive population ages, it appears that developing non-AIDS-defining cancers (NADCs) will become a greater burden than ADCs.

Jessica Y. Islam, (photo) a doctoral student at the University of North Carolina Chapel Hill (UNC), led research showing that by 2030, there will be a significant decrease in ADCs but that HIV-positive people will face increased risk of the same cancers that more frequently affect the general population.

The researchers looked at cancer incidence data collected between 2000 and 2012 for the HIV/AIDS Cancer Match Study. They examined information for three specific ADCs, Kaposi sarcoma, non-Hodgkin lymphoma (NHL), and cervical cancer, along with NADCs such as anal, breast, colon, lung, liver, prostate, and oral cancers, in order to project incidence rates among people living with HIV through 2030. In addition, the team used Poisson regression and stratified by age and risk group. “To estimate cancer burden, observed and projected incidence rates and HIV population counts were multiplied,” the researchers reported.

The results showed that although cancer rates are generally decreasing, NADCs—especially prostate, lung, liver, and anal cancers—will increase among the HIV-positive population. Cancer will remain an important co-morbidity for people living with HIV, said the study’s senior author Meredith S. Shiels, PhD.

A key factor in the projected increase in risk of NADCs is the fact that HIV-positive people now live longer. The researchers report that the HIV population aged 65 and older is expected to increase from 4.1% in 2006 to 21.4% in 2030. The risk for certain cancers is simply higher among older people, whether or not they are HIV-positive.

Widespread use of highly-active antiretroviral therapies (HAART) is helping people live longer. “Declines in cancer incidence rates, particularly for AIDS-defining cancers, are likely driven by widespread treatment with modern antiretroviral therapies, which reduce immune suppression and decrease risk of some cancers,” Islam explained in a news release.

Studying future cancer risk and burden for the HIV-positive population may help researchers target prevention of particular types of cancer, as well as implement early detection programs. The current study suggests there will be a shift in the burden of cancer types.

“Lung cancer rates are expected to decrease [overall] in the future, but the burden [among the HIV-positive population] is expected to increase due to the growing number of older people living with HIV,” Shiels used as an example.

Targeted cancer prevention efforts—including smoking cessation programs, treatment of hepatitis C and B viruses, continued treatment using HAART, and increased cancer screenings—are necessary for the HIV-positive population, the team advised.

The study, “Projections of cancer incidence and burden among the HIV-positive population in the United States through 2030,” was presented at the American Association for Cancer Research (AACR) Annual Meeting in Washington, District of Columbia. The news release and photo were provided by UNC School of Medicine. The study was funded by the Intramural Research Program of the National Cancer Institute and the Centers for Disease Control and Prevention.

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