A Meta-Analysis of the Incidence of Non-AIDS Cancers in HIV-Infected Individuals

Shiels, Meredith S PhD, MHS*; Cole, Stephen R PhD, MPH†; Kirk, Gregory D MD, PhD*; Poole, Charles ScD, MPH†

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 2009 - Volume 52 - Issue 5 - pp 611-622
doi: 10.1097/QAI.0b013e3181b327ca
Epidemiology and Social Science

Objective: To estimate summary standardized incidence ratios (SIRs) of non-AIDS cancers among HIV-infected individuals compared with general population rates overall and stratified by gender, AIDS, and highly active antiretroviral therapy (HAART) era.

Design: A meta-analysis using SIRs from 18 studies of non-AIDS cancer in HIV-infected individuals.

Methods: SIRs for non-AIDS cancers in HIV-infected individuals and 95% confidence limits (CLs) were abstracted from each study. Random effects meta-analyses were used to estimate summary SIRs. Modifications by gender, AIDS, and HAART era were estimated with meta-regression.

Results: Four thousand seven hundred ninety-seven non-AIDS cancers occurred among 625,716 HIV-infected individuals. SIRs for several cancers were elevated. In particular, cancers associated with infections, such as anal (SIR = 28; 95% CL 21 to 35), liver (SIR = 5.6; 95% CL 4.0 to 7.7), and Hodgkin lymphoma (SIR = 11; 95% CL 8.8 to 15) and smoking, such as lung (SIR = 2.6; 95% CL 2.1 to 3.1), kidney (SIR = 1.7; 95% CL 1.3 to 2.2), and laryngeal (SIR = 1.5; 95% CL 1.1 to 2.0). AIDS was associated with greater SIRs for Hodgkin lymphoma, leukemia, lung, brain, and all non-AIDS cancers combined.

Conclusions: HIV-infected individuals may be at an increased risk of developing non-AIDS cancers, particularly those associated with infections and smoking. An association with advanced immune suppression was suggested for certain cancers.

From the *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and †Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Received for publication February 16, 2009; accepted May 22, 2009.

Supported by the National Institute of Health National Research Service Award T32 CA009314 (M.S.S.) and National Institute of Health and National Institute of Allergy and Infectious Diseases P30 AI-50410 (S.R.C.).

Presented at the National Institutes of Health National Graduate Student Research Festival, September 11, 2008, Bethesda, MD; and the American Association for Cancer Research Frontiers in Cancer Research meeting, November 17, 2008, National Harbor, MD.

Correspondence to: Meredith S. Shiels, PhD, MHS, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, EPS 7063, Rockville, MD 20892 (e-mail: shielsms@mail.nih.gov).

© 2009 Lippincott Williams & Wilkins, Inc.