HIV infection, immunosuppression, and age at diagnosis of non-AIDS-defining cancers

Meredith S. Shiels*, Keri N. Althoff, Ruth M. Pfeiffer, Chad J. Achenbach, Alison G. Abraham, Jessica Castilho, Angela Cescon, Gypsyamber D'Souza, Robert Dubrow, Joseph J. Eron, Kelly Gebo, M. John Gill, James J. Goedert, Surbhi Grover, Nancy A. Hessol, Amy Justice, Mari Kitahata, Angel Mayor, Richard D. Moore, Sonia NapravnikRichard M. Novak, Jennifer E. Thorne, Michael J. Silverberg, Eric A. Engels

*Corresponding author for this work

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Background. It is unclear whether immunosuppression leads to younger ages at cancer diagnosis among people living with human immunodeficiency virus (PLWH). A previous study found that most cancers are not diagnosed at a younger age in people with AIDS, with the exception of anal and lung cancers. This study extends prior work to include all PLWH and examines associations between AIDS, CD4 count, and age at cancer diagnosis. Methods. We compared the median age at cancer diagnosis between PLWH in the North American AIDS Cohort Collaboration on Research and Design and the general population using data from the Surveillance, Epidemiology and End Results Program. We used statistical weights to adjust for population differences. We also compared median age at cancer diagnosis by AIDS status and CD4 count. Results. After adjusting for population differences, younger ages at diagnosis (P < .05) were observed for PLWH compared with the general population for lung (difference in medians = 4 years), anal (difference = 4), oral cavity/pharynx (difference = 2), and kidney cancers (difference = 2) and myeloma (difference = 4). Among PLWH, having an AIDS-defining event was associated with a younger age at myeloma diagnosis (difference = 4; P = .01), and CD4 count <200 cells/μL (vs >500) was associated with a younger age at lung cancer diagnosis (difference = 4; P = .006). Conclusions. Among PLWH, most cancers are not diagnosed at younger ages. However, this study strengthens evidence that lung cancer, anal cancer, and myeloma are diagnosed at modestly younger ages, and also shows younger ages at diagnosis of oral cavity/pharynx and kidney cancers, possibly reflecting accelerated cancer progression, etiologic heterogeneity, or risk factor exposure in PLWH.

Original languageEnglish (US)
Pages (from-to)468-475
Number of pages8
JournalClinical Infectious Diseases
Volume64
Issue number4
DOIs
StatePublished - Feb 15 2017

Keywords

  • AIDS
  • Aging
  • Cancer
  • HIV
  • Immunosuppression

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Shiels, M. S., Althoff, K. N., Pfeiffer, R. M., Achenbach, C. J., Abraham, A. G., Castilho, J., Cescon, A., D'Souza, G., Dubrow, R., Eron, J. J., Gebo, K., Gill, M. J., Goedert, J. J., Grover, S., Hessol, N. A., Justice, A., Kitahata, M., Mayor, A., Moore, R. D., ... Engels, E. A. (2017). HIV infection, immunosuppression, and age at diagnosis of non-AIDS-defining cancers. Clinical Infectious Diseases, 64(4), 468-475. https://doi.org/10.1093/cid/ciw764