People living with HIV remain at risk for AIDS-defining cancers in the age of effectiveness of antiretroviral treatments, and also have higher rates of various non-AIDS-defining cancers than the general population, including lung, anal, and cancer of the liver, according to the findings of a study of more than 86.000 HIV-positive patients published in October 6 in the annals of Internal Medicine .
Since the advent of combination antiretroviral therapy (ART) in the mid-1990 decade, rates of all three AIDS-defining cancers - Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical cancer have fallen among people with HIV. These cancers are caused by opportunistic viruses that can take over "sectors" of the body when the immune system is damaged and T-CD4 cell counts. are low, but human papillomavirus (HPV) also causes cervical and anal cancer in non-HIV positive people.
However, most studies have found that HIV-positive people have a greater overall risk for other non-AIDS-related cancers compared to HIV-negative patients in the populations studied, although data have been inconsistent on certain types of cancers . In fact, cancer rates among people with HIV have increased over time as long as they live long enough to develop malignant neoplasms.
Michael Silverberg of Kaiser Permanente Northern California, and fellow researchers evaluated trends in cumulative incidence of common types of cancer in people with HIV positive status among participants in the large American AIDS Cohort Collaboration for Research and Design (NA-ACCORD).
Included in this study were 86.620 people with HIV from 16 cohorts in the US and Canada, as well as 196.987 HIV-negative adult patients from 5 cohorts selected to be similar in terms of age, gender and race / ethnicity. Participants were followed up between 1996 - when HAART began to become widely available - and in 2009.
About 85% of HIV-positive NA-ACCORD patients were men, about 40% were white and 40% were black, and the mean age was approximately 45 years. About 40% were men who had sex with men and about 20% had a history of injecting drug use. About 20% were co-infected with hepatitis C virus (HCV) and 4% also had hepatitis B virus (HBV). The TARV portion increased from 39% in the 1996-1999 period to 74% during 2005-2009, and the average count of CD4 increased from 309 to 382 cells / mm3.
The researchers analyzed the cumulative incidence (new cases) for 9 cancers by 75-years of age, as well as the timing trends in cumulative incidence and risk rates, according to the HIV status and taking into account the risk of death competition due to other causes.
- All causes of mortality have declined over time for the HIV-positive group, and are expected to fall in 5140 by 100.000 person-years during the period 1996-1999 to 2844 during 2005-2009, but remained more than 3 times greater than HIV-negative (863 during 2005-2009).
- Cumulative incidence of 75-years of the 2-related AIDS cancer remained highest for people with HIV compared to HIV-negative cohorts:
Kaposi's sarcoma: 4,4% vs 0,01%.
Non-Hodgkin's lymphoma: 4,5% vs 0,7%.
- For non-AIDS-defining cancers, some had higher rates among seropositive than HIV-negative patients, while others were about the same:
Lung cancer: 3,4 2,8% vs%.
Anal Cancer: 1,5% vs 0,05%.
Colorectal cancer: 1,0 1,5% vs%.
Cancer of the liver: only 1,1 0,4% vs%.
Hodgkin's lymphoma: 0,9% vs 0,09%.
The oral cavity or mouth and throat cancer: 0,8% vs 0,8%.
The Melanoma: 0,5% vs. 0,6%.
- Anal, rectal, and liver cancer showed increased cumulative incidence over time, but risk-rate trends were stable, so that researchers attributed the increase in cancer cases that decreased the mortality rate, allowing more opportunity to be diagnosed with cancer.
- Lung cancer, Hodgkin's lymphoma, and melanoma showed decreasing risk rates in trends but the cumulative incidence of trends were not observed in order to counterbalance the effects of declining mortality.
- Lung cancer (its incidence) decreased over time between HIV-positive and negative people, probably due to a decline in smoking.
"In the era prior to antiretroviral therapy, people who were infected with HIV were dying of AIDS. Now that the use of this therapy is greatly increasing the shelf life of HIV-infected patients, the risk of developing other diseases, such as cancer, has increased, "Silverberg said in a Kaiser Permanente press release. "These patients have a higher incidence of cancer compared to the general population, immune function and chronic inflammation, as well as a higher prevalence of risk factors such as smoking and viral co-infections."
"Our approach allowed us to separate the effects of longevity from other cancer risk factors," Silverberg explained. "For example, we found that longevity was the main contributor to increased risk over time for anal, rectal and liver cancer. The risk of other cancers, such as lung cancer, melanoma, and Hodgkin's lymphoma, do not seem to increase over time. This was possible because the increased risk with longevity was offset by other factors such as, for example, smoking reduction or adverse exposure to sun exposure. "
Non-AIDS-defining cancers in this study were a mix of those caused by viruses - including anal cancer (HPV) and liver cancer (HBV and HCV) - as well as those in which the viral cause such as melanoma and lung cancer were not confirmed. Many people co-infected with HIV / HCV are reaching the age at which HCV-related hepatocellular carcinoma, a type of liver cancer, usually develops in advanced ages.
The reasons for an increased risk of non-infectious cancers in seropositive patients in people on ART are not fully understood, however, residual immune system damage that can not be reversed even with treatment and chronic inflammation due to the low but persistent level of HIV infection may play a role. I have suffered from pulmonary embolism in my life, and the first doctor who treated me about this, Dr. Vanessa, who wore sandals typical of Greek slaves, translated with extreme ease my propensity for blood clots. , in addition to the two TEPs, I had about six thrombophlebitis in the legs and arms because of the HIV inves- sion that caused a perennial vasculitis that was prone to clots. I take two injections of clexane and a child AAS all the nights before bed, nevertheless I did a little surgery to put a filter in the vena cava and try to approach it, well, approach zero risk index.
"The cumulative high incidences by age group 75 years for Kaposi's sarcoma, non-Hodgkin's lymphoma and lung cancer support a rapid and sustained ART and cessation of smoking," the study authors concluded.
In their discussions the researchers suggest that seropositive smokers may benefit from new guidelines for lung cancer and annual screening with a low dose of contrast, computed tomography as well as broader efforts aimed at cessation of smoking. Translator's note. I would buy champix if I could. But one thousand and three hundred reais !!! People with HIV may also need a more frequent screening for colon cancer.
On infectious cancers, stressed the importance of universal HBV vaccination expanded vaccination against HPV to antiviral treatment for hepatitis B and hepatitis C - the latter of which can now be cured with effective treatment and well tolerated with interferon in therapies distribution. The increased risk of anal cancer highlights the need to further investigate the damages and benefits of anal dysplasia screening (eg Pap smears). An early and perhaps suspected antiretroviral therapy is the only known approach capable of preventing Kaposi's sarcoma and non-Hodgkin's lymphoma, and it may also play a role in reducing other cancers linked to immunosuppression or inflammation.
Written by Liz Highleyman Posted on Tuesday, 06 October from 2015 to 00: 00h
Translated from original People with HIV Are at Higher Risk for Several Types of Cancer, Large Study Finds by Claudio Souza. Reviewed by Mara Macedo