HIV Accelerates Cancer Progression

Although some HIV-infected individuals may be diagnosed with cancer at an early stage because they receive more continuous care than the average people, study shows a higher likelihood of late-stage cancer diagnosis in HIV-infected individuals. This may indicate HIV/AIDS may accelerate cancer progression. The study was presented at the 25th Conference on Retroviruses and Opportunistic Infections (CROI 2018) in Boston last month.

Previous studies have shown that people carrying HIV virus may have several types of cancer, particularly the viral-related cancers such as cervical and anal cancers(caused by human papillomaviruses, HPV), liver cancer(caused by hepatitis B and hepatitis C) and certain types of Lymphoma (associated with eb virus). But for other types of cancers, there appears to be no difference between HIV-positive and HIV-negative people.

Keri Calkins and his colleagues from Johns Hopkins University in Baltimore compare HIV-positive patients at the Johns Hopkins University Clinical Cohort of HIV and the surveillance, epidemiology, and end results at the National Cancer Institute (SEER) Results for most HIV-negative general populations represented in the database.

To date, there has been limited research on disease progression and prognosis in HIV-positive patients. Some studies have shown that people living with HIV are later diagnosed with cancer, are less likely to be treated, and have lower survival rates, but the data has been inconsistent, and they believe this is the background. Greater immunosuppression may result in more severe cancers and may reduce the tolerability of cancer treatment. People who are HIV positive are also more likely to have risk factors such as smoking and co-infection of the virus, thereby affecting the risk and outcome of cancer.

The researchers compared 254 people who first diagnosed the first cancer (excluding Kaposi’s sarcoma) between 1997 and 2014, and nearly 1.9 million who were diagnosed in the SEER database between 2000 and 2014.

In the Johns Hopkins cohort, 69% were male, 78% were black, and the median age was 50. The most common cancers are non-Hodgkin’s lymphoma (21%), lung cancer (17%), liver cancer (9%), Hodgkin’s lymphoma (7%), prostate cancer (7%), breast cancer (6% ) and anal cancer (6%).

Based on age, sex, race/ethnicity, year of diagnosis, and type of cancer, the Johns Hopkins population is more likely to be diagnosed with local cancer than people in the SEER database (30% vs 6%, with a 24% probability difference) %). Local cancer usually indicates that it is in an early stage, although some cancers progress slowly and can still be localized after they develop.

Similarly, the risk of cancer spreading to the distal body in the HIV-positive group was also higher (45% vs. 9%, and the probability difference was 36%). Distal metastases usually indicate advanced cancers, although some cancers develop rapidly and can spread throughout the body soon after they appear.

In general, in the Johns Hopkins University and SEER database, people are almost as likely to receive any cancer treatment (83% and 87%, respectively). This condition persists when a person with a CD4 count higher or lower than 200 cells/mm3 is observed, the latter indicating a large amount of immunosuppression.

The overall survival rate of HIV-positive cancer patients is 5.4 months shorter than that of the general population. In the first five years after adjusting for demographic factors, diagnosis years and cancer types, the survival period of these people is shorter than that of the general population.  However, after cancer staging and treatment, the difference was no longer statistically significant.

In HIV-positive patients with lower CD4 counts, the difference in survival was more pronounced at 11.7 months. This difference was small (by 6.8 months), but it remained significant after adjustment for cancer staging and treatment.

It is worth noting that the number of CD4 cells in hiv-positive patients does not differ between more than 200 cells/mm3, and almost all are now receiving modern antiretroviral therapy.

The researchers conclude that “AIDS patients are more likely to be diagnosed with cancer in the early and late stages, suggesting that HIV may lead to faster progress, and HIV care may improve early detection.”

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