CANCER IN PERSONS WITH HIVAIDS Current status

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CANCER IN PERSONSWITH HIV/AIDSCurrent status
James J. Goedert, M.D. Viral Epidemiology
Branch National Cancer Institute, NIH, DHHS
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Outline

• Incidence of KS
• The HIV/AIDS epidemic
• AIDS Cancer Match Registry (ACMR)
• Cancer in the HAART era
• Future implications

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Initial Report of AIDS-KS
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Eltom MA, et al. J Natl Cancer Inst 2002
941204-1210.
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Centers for Disease Control and Prevention
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AIDS-Cancer Match Registry(ACMR)

• Background, funding
• NCI intramural (VEB), 1992 present
• Objectives
• Cancer risk in PWHA
• Clues to cancer etiology from patterns

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ACMRmethods developed

• Matching
• Prevalence (pre-AIDS risk)
• Trend (AIDS-relative time)

Lancet 19983511833 J Natl Cancer Inst
2000921500 JAMA 20012851736.
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ACMR results

• AIDS KS, NHL, cervix (?)
• Increased, unclear why
• Anal
• Hodgkin lymphoma
• Liver, lung, oral
• Testis, myeloma, lip
• Hypotheses
• Immunosuppression?
• Lifestyle? Other?

Lancet 19983511833 J Natl Cancer Inst
2000921500 JAMA 20012851736.
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ACMR current

• 465,708 PWA matched in 2003-2005
• NYC, LA, SF, OC, San Diego, Seattle
• FL, NJ, GA, MA, CO, CT, MI
• PWH also matched
• 81 male
• 39 White, 39 Black, 21 Hispanic
• 43 MSM, 27 IDU, 11 heterosexual
• Year of AIDS
• Pre-90 (19), 90-95 (42), 96 (39)

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AIDS-Cancer Match RegistryAge distribution
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AIDS-Cancer Match RegistryAge distribution
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Objective Effect of HAART

• Changes in cancer spectrum
• Persistent excesses
• Emerging malignancies
• Novel associations in subpopulations, long-term
  survivors
• Survival with both cancer AIDS

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AIDS-Cancer Match RegistryAnalysis challenges
HAART era
AIDS
AIDS
AIDS
AIDS
2003
1996
1980
Calendar year
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Goedert JJ, et al. Proc Am Assoc Cancer Res
2005abstract 506.
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N76 cancer cases
Goedert JJ, et al. Proc Am Assoc Cancer Res
2005abstract 506.
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Cancer in the HAART Era

• KS and NHL risk greatly reduced
• NHL reduction less than KS
• KS and NHL still greatly above the population
• Hodgkin risk may be increasing
• Unexplained.
• Continued excess with known causes
• Lung Ca, smoking
• Liver Ca, hepatitis
• Cervix anus Ca, HPV
• Short follow-up, many open issues

Engels EA, Goedert JJ. J Natl Cancer Inst 2005
97407-409.
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Increasing cancer mortality

• Pre-HAART, 10 of deaths from cancer
• Year 2000, 28 of 964 deaths from cancer
• 11 NHL
• 4 KS
• 0.5 cervix
• 5 lung
• 2 liver
• 1.2 Hodgkin

Bonnet F, et al. Cancer 2004 101317-324.
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Future issues - 1

• AIDS-Cancer Match Registry
• Re-match every 3-4 years
• Collaborative studies of selected cancers
• AIDS-Cancer epidemic in Africa, Asia
• KS most common malignancy in Uganda South
  Africa
• Kampala, Uganda AIDS-Cancer Match completed, in
  analysis

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Future issues - 2

• Long-term HAART with aging
• Persistent immune perturbation
• Increasing risk of common cancers
• HIV aging interaction
• Areas of emphasis
• Diagnosis treatment
• Cancer prevention
• smoking cessation, vaccination, cervix screening
• Carcinogenesis research
• Novel treatments

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Keys to cancer prevention

• Prevent HIV transmission
• Diagnose and treat HIV infection

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Prognosis
The population of people with both HIV/AIDS and
cancer will continue to increase and to present
complex challenges.