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Epidemiology of Head and Neck Squamous Cell Cancer Among HIV-Infected Patients

D'Souza, Gypsyamber PhD*; Carey, Thomas E. PhD; William, William N. Jr MD; Nguyen, Minh Ly MD§; Ko, Eric C. MD, PhD; Riddell, James IV MD; Pai, Sara I. MD, PhD#; Gupta, Vishal MD; Walline, Heather M. MS**; Lee, J. Jack PhD††; Wolf, Gregory T. MD; Shin, Dong M. MD§§; Grandis, Jennifer R. MD‖‖; Ferris, Robert L. MD, PhD‖‖

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15th, 2014 - Volume 65 - Issue 5 - p 603–610
doi: 10.1097/QAI.0000000000000083
Epidemiology and Prevention

Background: HIV-infected individuals have a higher incidence of head and neck cancer (HNC).

Methods: Case series of 94 HIV-infected HNC patients (HIV-HNC) at 6 tertiary care referral centers in the US between 1991 and 2011. Clinical and risk factor data were abstracted from the medical record. Risk factors for survival were analyzed using Cox proportional hazard models. Human papillomavirus (HPV) and p16 testing was performed in 46 tumors. Findings were compared with Surveillance Epidemiology and End Results HNC (US-HNC) data.

Results: This study represents the largest HIV-HNC series reported to date. HIV-HNC cases were more likely than US-HNC to be male (91% vs. 68%), younger (median age, 50 vs. 62 years), nonwhite (49% vs. 18%), and current smokers (61% vs. 18%). Median HIV-HNC survival was not appreciably lower than US-HNC survival (63 vs. 61 months). At diagnosis, most cases were currently on highly active antiretroviral therapy (77%) but had detectable HIV viremia (99%), and median CD4 was 300 cells per microliter (interquartile range = 167–500). HPV was detected in 30% of HIV-HNC and 64% of HIV-oropharyngeal cases. Median survival was significantly lower among those with CD4 counts ≤200 than >200 cells per microliter at diagnosis (16.1 vs. 72.8 months, P < 0.001). In multivariate analysis, poorer survival was associated with CD4 <100 cells per microliter [adjusted hazard ratio (aHR) = 3.09, 95% confidence interval (CI): 1.15 to 8.30], larynx/hypopharynx site (aHR = 3.54, 95% CI: 1.34 to 9.35), and current tobacco use (aHR = 2.54, 95% CI: 0.96 to 6.76).

Conclusions: Risk factors for the development of HNC in patients with HIV infection are similar to the general population, including both HPV-related and tobacco/alcohol-related HNC.

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*Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;

Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, MI;

Department of Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX;

§Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA;

Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY;

Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI;

#Department of Otolaryngology/Head and Neck Surgery, Johns Hopkins University, Baltimore, MD;

**Cancer Biology Program, University of Michigan, Ann Arbor, MI;

††Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, TX;

§§Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; and

‖‖Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Correspondence to: Gypsyamber D'Souza, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E6132, Baltimore, MD 21205 (e-mail:

Supported by Head and Neck SPORE Consortium NCI supplement: University of Michigan: Grant P50 CA097248, PI: G.T.W.; University of Michigan Cancer Center: Core Grant P30 CA46592 and M. D. Anderson: Grant 5P50CA097007, PI: Jeffrey Myers; University of Pittsburgh: Grant P50 CA097190, PI: J.G.; Johns Hopkins University: Grant P50 DE019032, PI: David Sidransky; Emory University: Grant P50CA128613, PI: D.M.S.; Emory University Center for AIDS research: Grant P30 AI050409, PI: James Curran and Grant R01DE021395, PI: G.D'.S.

The authors have no conflicts of interest to disclose.

The SPORE HNC network contributed collectively to this study. Biospecimens were provided by the sites and processed by the centralized testing laboratory. In addition to the leading contributions of the writing team authors listed above, other important contributions were made by the following: Tumor Testing and Pathology Contributors: Martin P. Graham, Christine M. Komarck, Lisa A. Peterson, Jonathan B. McHugh (University of Michigan), Raja Seethala, Simion Chiosea (University of Pittsburgh), Marina Mosunjac (Emory University), Adel K. Adel El-Naggar (M. D. Anderson Cancer Center), William H. Westra (Johns Hopkins University). Data Coordinating Center: Jeff Lewis (M. D. Anderson Cancer Center), Nicole Kluz, Alicia Wentz (Johns Hopkins School of Public Health). Additional Clinical Contributors: Belinda Akpeng (Johns Hopkins University), Marshall Posner (Mount Sinai Medical Center), Li Mao (University of Maryland Dental School), Sharon Riddler (University of Pittsburgh).

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Received November 22, 2013

Accepted November 22, 2013

© 2014 by Lippincott Williams & Wilkins