Human immunodeficiency virus and cancer. A population of HIV-infected patients at Hospital de Santa Maria and predictors of cancer.

backgroundCancer has become a growing burden on morbidity and mortality in human immunodeficiency virus (HIV)-infected individuals in the era of highly active antiretroviral therapy (HAART). The objectives of this study were to determine the rates and cancer predictors of a population of HIV-infected individuals and to draw some recommendations for cancer screening in these patients.

methodsThis retrospective case-control study describes malignant cancers diagnosed in HIV-infected subjects at Hospital de Santa Maria and assesses cancer predictors in HIV-infected subjects using HIV-infected controls without cancer. A total of 225 patients were included in this study: 25 cancer cases and 200 controls. Eight HIV-infected controls without cancer diagnosis were selected for each cancer case. Besides cancer´s date of diagnosis and its histological type, we also recorded demographic data, medical history and HIV-related information. Cancers were grouped as AIDS-defining cancers (ADCs), and non-ADCs. Non-ADCs were further categorized as being infection related (NADC-IR) and unrelated (NADC-IUR).

resultsThe majority of cancer cases were diagnosed in male patients (84%). The mean age of patients was higher in NADCs, mostly in NADCs-IUR, where almost half (43%) were infected with type 2 HIV. About half (52%) of cancer cases were ADCs (32% Kaposi sarcoma, 16% non-Hodgkin's lymphoma, and 4% cervical cancer). The most common NADCs were: lung, skin and hepatocellular carcinoma (8% each). In univariate analyses, immunosuppression, HBV coinfection, smoking and alcoholism were associated with ADCs. In multivariate analysis, alcoholism and higher HIV viral load remained independent predictors of ADCs. Longer duration of HIV infection, type 2 HIV and a longer history of HAART were associated with NADCs, in univariate analyses.

conclusionsBesides the evident multifactorial etiology, in this study ADCs appeared to be associated with immunosuppression, while NADCs seemed to be correlated by other oncogenic mechanisms such as chronic inflammation. Based on this study, cancer screening should be performed in these patients in Portugal.