Abstract
BackgroundThe burden of cancer is likely to increase among the human immunodeficiency virus (HIV)-positive population as it ages due to successful antiretroviral therapy (ART). The purpose of this study was to determine the risk of cancer in HIV-infected patients.MethodsThis study was a matched nested case–control study. It was performed using the National Health Insurance Research Database of Taiwan. The control group included non–HIV-infected patients matched by sex, age, and year of enrollment. Logistic regression analyses were performed and simultaneously adjusted for potential confounders (income, urbanization, and Charslon index of comorbidity to evaluate HIV infection as an independent risk of cancer. We calculated the overall and sex-specific standardized incidence ratios (SIR) to investigate the pattern of cancer risk and overall cancer risk in the patients with HIV infection.ResultsOf the 1,115 HIV-infected patients, 104 (9.33%) developed cancer during the 11-year follow-up period. The risk of cancer for patients with HIV infection was significant (adjusted odds ratio = 3.89, 95% confidence interval [CI] = 2.92–5.19) after adjustment for potential confounders. There was a significantly increased risk of developing non-Hodgkin lymphoma (SIR = 25.73, 95% CI = 6.83-90.85), cervical cancer (SIR = 4.01, 95% CI = 1.0-16.06), lymphoma (SIR = 20.26, 95% CI = 5.86-70.10), and respiratory and intrathoracic cancer (SIR = 20.09, 95% CI = 2.34-172.09) compared with the control group. In addition, HIV-infected patients were at significant risk for renal, oral, breast, liver, skin, and colorectal cancer.ConclusionsPatients with HIV infection are at increased risk for several specific cancers. Our results support the implementation of an active and accelerated cancer screening schedule for patients with HIV infection to increase their life span.
Highlights
The burden of cancer is likely to increase among the human immunodeficiency virus (HIV)-positive population as it ages due to successful antiretroviral therapy (ART)
Because the Longitudinal Health Insurance Database (LHID) data set consists of de-identified and secondary data released to the public for research, the study was exempt from full review by the Institutional Review Board of Taipei Medical University
This study found that patients with HIV infection had a significantly higher risk of developing cancer compared with patients without HIV infection, especially breast cancer, oral cancer, colorectal cancer, liver cancer, respiratory and intrathoracic cancer, bone and connective tissue cancer, genitourinary cancer, lymphoma, and central nervous system cancer
Summary
The burden of cancer is likely to increase among the human immunodeficiency virus (HIV)-positive population as it ages due to successful antiretroviral therapy (ART). The purpose of this study was to determine the risk of cancer in HIV-infected patients. The substantial improvement in survival after HIV infection has led to an increasing clinical impact of long-term morbidities, including cancers, in this population. The incidence of acquired immunodeficiency syndrome (AIDS)-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) in HIV-infected patients has increased, but the association between HIV infection and the risk of cancer is both clinically and epidemiologically controversial [1,5]. The purpose of this study was to elucidate the risk of cancer in patients with HIV infection during the follow-up period after diagnosis compared with patients without HIV infection during the same period. We hope to apply the findings of this study to a cancer prevention protocol for the HIV-infected population
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