Cancer risk in older people living with human immunodeficiency virus infection in the United States

Abstract

Background

Cancer risk is increased in people living with HIV (PLWH). Improved survival has led to an aging of PLWH. We evaluated the cancer risk in older PLWH (age ≥50 years).

Methods

We included data from the HIV/AIDS Cancer Match Study (1996-2012) and evaluated risk of Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, and cervical, anal, lung, liver, oral cavity/pharyngeal, breast, prostate, and colon cancers in older PLWH compared to the general population by calculating the standardized incidence ratios (SIRs) and excess absolute risks (EARs). Cancer risk by time since HIV diagnosis was estimated using Poisson regression.

Results

We identified 10,371 cancers among 183,542 older PLWH. Risk was significantly increased for KS (SIR=103.34), NHL (SIR=3.05), Hodgkin lymphoma (SIR=7.61), and cervical (SIR=2.02), anal (SIR=14.00), lung (SIR=1.71), liver (SIR=2.91), and oral cavity/pharyngeal (SIR=1.66) cancers, and reduced for breast (SIR=0.61), prostate (SIR=0.47), and colon (SIR=0.63) cancers. SIRs declined with age for all cancers; however, EARs increased with age for anal, lung, liver, and oral cavity/pharyngeal cancers. Cancer risk was highest for most cancers within 5 years after HIV diagnosis; risk decreased with increasing time since HIV diagnosis for KS, NHL, lung cancer, and Hodgkin lymphoma.

Conclusions

Cancer risk is elevated among older PLWH. Although SIRs decrease with age, EARs are higher for some cancers, reflecting a greater absolute excess in cancer incidence among older PLWH. High risk in the first 5 years after HIV diagnosis for some cancers highlights the need for early HIV diagnosis and rapid treatment initiation.