Journal of the National Cancer Institute Advance Access originally published online on June 12, 2007
JNCI Journal of the National Cancer Institute 2007 99(12):962-972; doi:10.1093/jnci/djm010
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© The Author 2007. Published by Oxford University Press.
ARTICLES |
AIDS-Related Cancer and Severity of Immunosuppression in Persons With AIDS
For the HIV/AIDS Cancer Match Study
Affiliations of authors: Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (RJB, AKC, JJG, EAE); Department of Epidemiology Research, State Serum Institute, Copenhagen, Denmark (RJB)
Correspondence to: Robert J. Biggar, MD, Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Room EPS 8014, Bethesda, MD 20852 (e-mail: biggarb{at}mail.nih.gov).
Background: The incidence of Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer has been declining among persons with AIDS. We investigated the association between cancer risk and CD4 cell count among such persons.
Methods: Data from US AIDS registries were linked to local cancer registry data. Cancer incidence per 100000 person-years was determined for the 4–27 months from the onset of AIDS from January 1, 1990, through December 31, 1995—before highly active antiretroviral therapy (HAART) became available—and from January 1, 1996, through December 31, 2002. The relationships between CD4 count at AIDS onset and cancer incidence were assessed by proportional hazards models.
Results: Among 325516 adults with AIDS, the incidence of Kaposi sarcoma was lower in 1996–2002 (334.6 cases per 100000 person-years) than in 1990–1995 (1838.9 cases per 100000 person-years), and the incidence of non-Hodgkin lymphoma followed a similar pattern (i.e., 390.1 cases per 100000 person-years in 1996–2002 and 1066.2 cases per 100000 person-years in 1990–1995). In 1996–2002, for each decline in CD4 cell count of 50 cells per microliter of blood, increased risks were found for Kaposi sarcoma (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.33 to 1.50), for central nervous system non-Hodgkin lymphoma subtypes (HR = 1.85, 95% CI = 1.58 to 2.16), and for non–central nervous system diffuse large B-cell lymphoma (HR = 1.12, 95% CI = 1.04 to 1.20) but not for non–central nervous system Burkitt lymphoma (HR = 0.93, 95% CI = 0.81 to 1.06). Cervical cancer incidence was higher in 1996–2002 (86.5 per 100000 person-years) than in 1990–1995 (64.2 per 100000 person-years), although not statistically significantly so (relative risk [RR] = 1.41, 95% CI = 0.81 to 2.46). After adjustment for age, race, and sex or mode of HIV exposure, the risks for Kaposi sarcoma (RR = 0.22, 95% CI = 0.20 to 0.24) and for non-Hodgkin lymphoma (RR = 0.40, 95% CI = 0.36 to 0.44) were lower in the period of 1996–2002 than in 1990–1995. Similar relationships of these cancers to CD4 count were observed for 1990–1995.
Conclusions: Both before and after HAART was available, CD4 count was strongly associated with risks for Kaposi sarcoma and non-Hodgkin lymphoma but not for cervical cancer and Burkitt lymphoma. The decreasing incidences of most AIDS-associated cancers in persons with AIDS during the 1990s are consistent with improving CD4 counts after HAART introduction in 1996.
| CONTEXT AND CAVEATS Prior knowledge The incidence of Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer has been declining among persons with AIDS since the introduction of highly active antiretroviral therapy (HAART) in 1996. Study design Data from local cancer registries were linked to those from US AIDS registries to investigate the association between CD4 cell count at AIDS diagnosis and cancer incidence in periods before and after the introduction of HAART. Contribution After HAART became available, the incidence of both Kaposi sarcoma and non-Hodgkin lymphoma decreased, but that of cervical cancer increased. CD4 count at AIDS onset was strongly associated with risks for Kaposi sarcoma and for non-Hodgkin lymphoma but not for cervical cancer. Implications The decreased incidences of Kaposi sarcomas and non-Hodgkin lymphomas are consistent with improving CD4 counts in persons with AIDS since the introduction of HAART. Limitations CD4 counts and cancer incidence and risk were assessed at different times. CD4 counts were measured at AIDS onset, but cancer risk was determined 4–27 months after AIDS onset, when CD4 counts would have been higher because of antiretroviral therapy.
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Manuscript received December 1, 2006; revised April 16, 2007; accepted May 8, 2007.
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