People living with HIV remain at risk for defining cancers of AIDS in the era of the effectiveness of antiretroviral treatments, and also have higher rates of many non-defining cancers of AIDS than the general population, including lung, anal, and cancer liver, according to the findings of a study of more than 86.000 HIV-positive patients published inFrom October 6in the Annals of Internal Medicine.
Since the advent of combination antiretroviral therapy (HAART) in the mid-1990, rates of the three definitores cancers of AIDS - Kaposi's sarcoma, non-Hodgkin's lymphoma and cervical cancer has fallen among people with HIV. These cancers are caused by opportunistic viruses that can take possession of "sectors" of the organism when the immune system is damaged and CD4 T-cell counts. They are low, but human papillomavirus (HPV) also causes cervical and anal cancer in HIV-positive people do not.
However, most studies have found that HIV positive people have a higher overall risk for other cancers unrelated to AIDS compared to HIV-negative patients of the populations studied, although the data have been inconsistent on certain types of cancers . In fact, cancer rates among people with HIV has increased over time as it is live long enough for the development of malignancies.
Michael Silverberg of Kaiser Permanente Northern California, and colleagues researchers evaluated trendsCumulative incidence of common cancers in people with HIV positive status among the participants in the greatNorth American AIDS Cohort Collaboration Research and Design (NA-ACCORD).
The study included 86.620 16 people with HIV cohorts in the US and Canada as well as 196.987 HIV-negative adult patients 5 cohorts selected to be similar in terms of age, gender and race / ethnicity. Participants were followed between 1996 - when ART started to become widely available - and 2009.
About 85% of HIV-positive patients NA-ACCORD were men, about 40% were white and 40% were black, and the average age was approximately 45 years. About 40% were men who have 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 part of HAART increased 39% in 1996-1999 74% for the period during 2005-2009, and the average score for deCD4 increased 309 382 cells / mm3.
The researchers analyzed the cumulative incidence (new cases) to 9 types of cancer 75 years old, and the timetabletrends in the cumulative risk of incidence rates, according to the condition of people living with HIV and taking into account the competition risk of death from other causes.
- All-cause mortality decreased over time for the group of people with HIV, and that is expected to fall in 5140 by 100.000 person-years during 1996-1999 period 2844 during 2005-2009, but remained more than 3 times higher than HIV-negative (863 during (2005-2009).
- Cumulative Incidence of 75 year old 2º AIDS-related cancers remained higher for people with HIV as compared to the HIV-negative cohorts:
Kaposi's sarcoma: 4,4 0,01% vs%.
The non-Hodgkin lymphoma: 4,5 0,7% vs%.
- For cases of cancer not defining AIDS, some had higher rates among HIV-positive patients compared to HIV-negative, while others were about the same:
Lung cancer: 3,4 2,8% vs%.
Anal Cancer: 1,5 0,05% vs%.
Colorectal cancer: 1,0 1,5% vs%.
Cancer of the liver: only 1,1 0,4% vs%.
Hodgkin's Lymphoma: 0,9 0,09% vs%.
Oral or mouth and throat cancer cavity: 0,8 0,8% vs%.
Melanoma: 0,5 0,6% vs%.
- Anal, colorectal, and liver cancer showed increased cumulative incidence over time, but the risk rate trends were stable, so that the researchers attributed the increase of cancer cases that decreased mortality rate, allowing more opportunity being diagnosed with cancer.
- Lung cancer, Hodgkin's lymphoma, and melanoma showed decreasing risk rates trends, but the cumulative incidence trends were observed with a view to offset the effects of declining mortality.
- Lung cancer (incidence) decreased over time among HIV positive and negative people, probably due to a decline in smoking.
"In the days before antiretroviral therapy, people infected with HIV were dying of AIDS. Now that the use of this therapy is greatly increasing the life of HIV-infected patients, the risk of developing other diseases, like cancer, has increased, "Silverberg said in aKaiser Permanente press release. "These patients have a higher incidence of cancer compared with 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 of other risk factors for cancer," Silverberg said. "For example, we found that longevity was the main contribution to the increased risk over time for anal cancer, colorectal and liver. The risk of other cancers, such as lung cancer, melanoma and Hodgkin's lymphoma, do not appear to increase over time. This was possible because the increased risk with longevity was offset by other factors such as, for example, reducing smoking or due to adverse behaviors to sun exposure. "
Non-defining cancers of AIDS in this study were a mixture of those caused by viruses - including anal cancer (HPV) and liver cancer (HBV and HCV) - as well as those where it was not confirmed viral cause, such as melanoma and lung cancer. Many individuals co-infected with HIV / HCV are reaching the age at which Hepatocellular carcinoma associated with HCV, a type of liver cancer, which generally develops in old age.
The reasons for an increased risk of non-infectious causes of cancer in seropositive patients in people on ART is not fully understood, however, residual damage to the immune system that can not reverse even with treatment and chronic inflammation due to low but persistent level of HIV infection may play a role. Translator's note (I suffered in life dusa pulmonary embolisms and the first doctor who treated me with respect to this, Dr. Vanessa, who wore with typical sandals of Greek slaves, translated with extreme ease my propensity to clot, given that views , besides the two TEPs, I had about six thrombophlebitis in the legs and arms, due to the invescção HIV that for her, caused a perennial vasculitis that brought the propensity to clot. I take two injections of Clexane and a children AAS all the night before bed; nevertheless, I did a small surgery to place a filter in the vena cava and try to come on, you see, approaches zero risk index.
"The cumulative high incidence by age group 75 years for Kaposi's sarcoma, non-Hodgkin lymphoma and lung cancer apoiaim rapid and sustained antiretroviral therapy and smoking cessation," concluded the study authors.
In their discussions the researchers suggest that smokers seropositive can benefit from new guidelines for lung cancer and annual screening with low-dose contrast, computed tomography, as well as expand efforts aimed at smoking cessation. Translator's note. I would buy champix if he could. But the thousand three hundred real !!! People with HIV may also need more frequent screening for colon cancer.
About infectious cancer, they stressed the importance of vaccination against universal HBV expanded HPV vaccination to antiviral treatment for hepatitis B and hepatitis C - the latter of which can now be cured with effective and well tolerated treatment with interferon therapies of free drug distribution. The higher risk of anal cancer highlights the need for further research about the harms and benefits of anal dysplasia screening (p. Ex. Pap tests). An early therapy antirretrovial sustained and perhaps the only known approach is able to prevent Kaposi's sarcoma and non-Hodgkin's lymphoma, and it can also play a role in the reduction of other cancers related to immunosuppression or inflammation.
Written by Liz Highleyman Published on Tuesday, October 06 2015 00 to: 00h
Translated from originalPeople with HIV Are at Higher Risk for Several Types of Cancer, Large Study Findsby Claudio Souza. Reviewed by Mara Macedo