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Reduced Cancer Survival Among Adults With HIV and AIDS-Defining Illnesses Despite No Difference in Cancer Stage at Diagnosis

Grover, Surbhi MD, MPH*; Desir, Fidel MPH; Jing, Yuezhou MS; Bhatia, Rohini K. BA; Trifiletti, Daniel M. MD§; Swisher-McClure, Samuel MD*; Kobie, Julie PhD; Moore, Richard D. MD, MHS; Rabkin, Charles S. MD, MSc#; Silverberg, Michael J. PhD, MPH**; Salters, Kate PhD††; Mathews, William Christopher MD, MSPH‡‡; Gill, Michael John MB, ChB, MS§§; Thorne, Jennifer E. MD, PhD†,║║; Castilho, Jessica MD, MPH¶¶; Kitahata, Mari M. MD, MPH##; Justice, Amy MD, PhD***; Horberg, Michael A. MD†††; Achenbach, Chad J. MD, MPH‡‡‡; Mayor, Angel M. MD§§§; Althoff, Keri N. PhD, MPH for the North American AIDS Cohort Collaboration on Research and Design

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2018 - Volume 79 - Issue 4 - p 421–429
doi: 10.1097/QAI.0000000000001842

Background: It is not known whether immune dysfunction is associated with increased risk of death after cancer diagnosis in persons with HIV (PWH). AIDS-defining illness (ADI) can signal significant immunosuppression. Our objective was to determine differences in cancer stage and mortality rates in PWH with and without history of ADI.

Methods: PWH with anal, oropharynx, cervical, lung cancers, or Hodgkin lymphoma diagnoses from January 2000 to December 2009 in the North American AIDS Cohort Collaboration on Research and Design were included.

Results: Among 81,865 PWH, 814 had diagnoses included in the study; 341 (39%) had a history of ADI at time of cancer diagnosis. For each cancer type, stage at diagnosis did not differ by ADI (P > 0.05). Mortality and survival estimates for cervical cancer were limited by n = 5 diagnoses. Adjusted mortality rate ratios showed a 30%–70% increase in mortality among those with ADI for all cancer diagnoses, although only lung cancer was statistically significant. Survival after lung cancer diagnosis was poorer in PWH with ADI vs. without (P = 0.0001); the probability of survival was also poorer in those with ADI at, or before other cancers although not statistically significant.

Conclusions: PWH with a history of ADI at lung cancer diagnosis had higher mortality and poorer survival after diagnosis compared to those without. Although not statistically significant, the findings of increased mortality and decreased survival among those with ADI (vs. without) were consistent for all other cancers, suggesting the need for further investigations into the role of HIV-related immune suppression and cancer outcomes.

*Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA;

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

University of Rochester School of Medicine and Dentistry, Rochester, NY;

§Department of Radiation Oncology, University of Virginia, Charlottesville, VA;

Department of Biostatics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;

Department of Medicine, Johns Hopkins University, Baltimore, MD;

#National Cancer Institute, National Institutes of Health, Bethesda, MD;

**Kaiser Permanente Northern California, Oakland, CA;

††BC Centre for Excellence in HIV/AIDS, Simon Fraser University, Vancouver, British Columbia, Canada;

‡‡University of California San Diego School of Medicine, San Diego, CA;

§§Southern Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada;

║║Department of Ophthalmology, Johns Hopkins University, Baltimore, MD;

¶¶Vanderbilt University Medical Center, Nashville, TN;

##University of Washington School of Medicine, Seattle, WA;

***VA Connecticut Healthcare System and Yale School of Medicine, New Haven, CT;

†††Kaiser Permanente Mid-Atlantic States, Rockville, MD;

‡‡‡The Feinberg School of Medicine, Northwestern University, Chicago, IL; and

§§§Department of Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico.

Correspondence to: Surbhi Grover, MD, MPH, Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104 (e-mail:

Supported by National Institutes of Health Grants U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01CA165937, R01DA011602, R01DA012568, R01AG053100, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, and Z01CP010176; Contracts CDC-200-2006-18797 and CDC-200-2015-63931 from the Centers for Disease Control and Prevention, USA; Contract 90047713 from the Agency for Healthcare Research and Quality, USA; Contract 90051652 from the Health Resources and Services Administration, USA; Grants CBR-86906, CBR-94036, HCP-97105 and TGF-96118 from the Canadian Institutes of Health Research, Canada; Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada.

The authors have no funding or conflicts of interest to disclose.

The members of North American AIDS Cohort Collaboration on Research and Design are listed in Appendix 1.

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Received March 20, 2018

Accepted August 03, 2018

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