Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology:
The Second National AIDS Malignancy Conference
1Department of Research and Evaluation, Southern California Kaiser Permanente, 2Departments of Hematology and Oncology, University of Southern California.
Background. HIV seropositive individuals are living longer due to better antiretroviral therapy and prophylaxis for opportunistic infections. They may therefore be at greater cumulative risk for malignancy.
Methods. We linked electronic HIV and cancer registry databases in the Southern California Kaiser Permanente Medical Care Program (SCKP) for the period 1991-1995 to retrospectively assess trends in diagnoses of non AIDS defining (NAD) malignancies.
Results. Of 5,574 SCKP members identified with HIV infection, 429 (7.7%) were diagnosed with a malignancy between 1991 and 1995, of which 57 (13.3%) were non AIDS defining (NAD). Although cohort member census declined slightly in successive study years, the number of NAD malignancies diagnosed tended to increase over time, with six, eight, 13, 15, and 15 such neoplasms occurring in 1991-1995, respectively. The most frequent NAD cancers included anorectal (14); Hodgkin's disease (9); lung/intrathoracic cancer (9); and melanoma (8). Less frequently seen malignancies included leukemias (2); testicular seminoma (2); prostate cancer (2); urinary tract cancer (ureters) (1); vaginal cancer (1); multiple myeloma (1); and "other and unspecified" malignancies (3). CD4 counts were significantly higher among members diagnosed with a NAD cancer compared to those diagnosed with Kaposi's sarcoma, non Hodgkin's lymphoma or cervical cancer (309.9 ± 331.8 versus 167.7 ± 105.5, p < 0.001). In addition, members diagnosed with a NAD cancer were significantly older than those whose malignancy was AIDS defining (46.8 ± 11.4 years versus 38.4 ± 11.6 years, p < 0.02). We intend to calculate incidence rates of NAD malignancies in both the HIV seropositive cohort and in all HIV seronegative SCKP members (N = 2.5 million).
Standardized incidence ratios will then be computed for NAD cancers using both SCKP and Surveillance, Epidemiology and End Results (SEER) rates as standards.
Conclusions. Though preliminary, these data suggest that the incidence and spectrum of NAD malignancies may be increasing among HIV seropositive individuals, and may occur more frequently among such individuals with relatively preserved CD4 counts.
Bethesda, Maryland April 6-8, 1998
Sponsored by the National Cancer Institute