HIV-related anal cancer incidence increased in long-term survivors

Long-term HIV infection increases the incidence of anal cancer among homosexual men in Australia by 34-fold, according to new data presented Tuesday at the Fourth International AIDS Malignancy Conference at the National Institutes of Health. The Australian study also found that lip cancer was increased by 2.5-fold, seminoma by 2.7-fold, melanoma by 1.27-fold, and Hodgkin disease by 4-fold in HIV-infected subjects.

According to Dr Andrew Grulich of the National Centre in HIV Epidemiology in Sydney, as long-term survival with HIV without progression to AIDS increases, cancers associated with only moderate degrees of immune deficiency are likely to become more important causes of morbidity in HIV.

‘The rates of anal cancer and HIV were higher in our study than US rates because 85% of the HIV-infected people in our study are gay men; and that percentage is much lower in the US,’ Dr Grulich said. His group identified a total of 1223 cancers (1,032 of which were AIDS-defining) among 7775 people with AIDS, while more than 200 cancers were identified through the HIV register.

The study used Australian national data on HIV/AIDS reported between 1983 and 1999, which were linked to data on cancer reported between 1982 and 1998. Cancers were included if they occurred 5 years prior and 2 years after an AIDS diagnosis (for AIDS matches) or after the date of HIV diagnosis (for HIV matches).

The researchers also found that rates of most common cancers, including lung and testicular cancer, did not increase. In addition, liver cancer rates were not higher either, despite high rates of hepatitis B and C infections among HIV-infected people in Australia.

‘This is the first linkage study on people with HIV who have not developed AIDS,’ Dr Grulich said. ‘As AIDS diagnoses decrease due to highly active antiretroviral therapy,’ he believes that ‘matching HIV and cancer databases will continue to become more important throughout the world.’

Comment

Routine screening by pap smear and HPV typing would appear to be essential in the management of both HIV-infected men and women. Treatment of HSIL by other modalities in addition to surgical ablation should also be studied (ie. 5-FU creams).