Association of cancer with AIDS-related immunosuppression in adults

nContext Large-scale studies are needed to determine if cancers other than Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer occur in excess i n persons with human immunodeficiency virus (HIV) infection or acquired imm unodeficiency syndrome (AIDS), Objectives To examine the general cancer pattern among adults with HIV/AIDS and to distinguish immunosuppression-associated cancers from other cancers that may occur in excess among persons with HIV/AIDS, Design, Setting, and Subjects Analysis of linked population-based AIDS and cancer registry data from 11 geographically diverse areas in the United Sta tes, including 302834 adults aged 15 to 69 years with HIV/AIDS, The period of study varied by registry between 1978 and 1996, Main Outcome Measure Relative risks (RRs) of cancers, calculated by dividin g the number of observed cancer cases by the number expected based on conte mporaneous population-based incidence rates. We defined cancers potentially influenced by immunosuppression by 3 criteria: (1) elevated overall RR in the period from 60 months before to 27 months after AIDS; (2) elevated RR i n the 4- to 27-month post-AIDS period; and (3) increasing trend in RR from before to after AIDS onset, Results Expected excesses were observed for the AIDS-defining cancers, but non-AIDS-defining cancers also occurred in statistically significant excess (n =4422; overall RR, 2.7; 95% confidence interval [CI], 2,7-2,8), Of indi vidual cancers, only Hodgkin disease (n=612; RR, 11.5; 95% CI, 10.6-12,5), particularly of the mixed cellularity (n=217; RR, 18.3; 95% CI, 15.9-20.9) and lymphocytic depletion (n=36; RR, 35.3; 95% CI, 24.7-48.8) subtypes; lun g cancer (n=808; RR, 4.5; 95% CI, 4.2-4.8); penile cancer (n=14; RR, 3.9; 9 5% CI, 2.1-6.5); soft tissue malignancies (n=78; RR, 3.3; 95% CI, 2.6-4.1); lip cancer (n=20; RR, 3,1; 95% CI, 1.9-4.8); and testicular seminoma (n=11 5; RR, 2.0; 95% CI, 1.7-2.4) met all 3 criteria for potential association w ith immunosuppression, Conclusion Although occurring in overall excess, most non-AIDS-defining can cers do not appear to be influenced by the advancing immunosuppression asso ciated with HIV disease progression. Some cancers that met our criteria for potential association with immunosuppression may have occurred in excess i n persons with HIV/AIDS because of heavy smoking (lung cancer), frequent ex posure to human papillomavirus (penile cancer), or inaccurately recorded ca ses of Kaposi sarcoma (soft tissue malignancies) in these persons. However, Hodgkin disease, notably of the mixed cellularity and lymphocytic depletio n subtypes, and possibly lip cancer and testicular seminoma may be genuinel y influenced by immunosuppression.