Persons living with HIV (PLWH) have an elevated risk for certain types of cancer. With modern antiretroviral therapy, PLWH are aging and cancer rates are changing.
To project cancer incidence rates and burden (number of new cancer diagnoses) among adult PLWH in the United States through 2030.
HIV/AIDS Cancer Match Study to project cancer rates and HIV Optimization and Prevention Economics model to project HIV prevalence.
Projected cancer rates and burden among HIV-infected adults in the United States by age during 2006 to 2030 for AIDS-defining cancer (ADC)—that is, Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer—and certain types of non–AIDS-defining cancer (NADC). All other cancer types were combined.
The proportion of adult PLWH in the United States aged 65 years or older is projected to increase from 8.5% in 2010 to 21.4% in 2030. Age-specific rates are projected to decrease through 2030 across age groups for Kaposi sarcoma, non-Hodgkin lymphoma, cervical cancer, lung cancer, Hodgkin lymphoma, and other cancer types combined, and among those aged 65 years or older for colon cancer. Prostate cancer rates are projected to increase. The estimated total cancer burden in PLWH will decrease from 8150 cases in 2010 (2730 of ADC and 5420 of NADC) to 6690 cases in 2030 (720 of ADC and 5980 of NADC). In 2030, prostate cancer (n = 1590) and lung cancer (n = 1030) are projected to be the most common cancer types.
Projections assume that current trends in cancer incidence rates, HIV transmission, and survival will continue.
The cancer burden among PLWH is projected to shift, with prostate and lung cancer expected to emerge as the most common types by 2030. Cancer will remain an important comorbid condition, and expanded access to HIV therapies and cancer prevention, screening, and treatment is needed.
Primary Funding Source:
National Cancer Institute.
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Author, Article, and Disclosure Information
Meredith S. Shiels,
National Cancer Institute, Rockville, Maryland (M.S.S., P.S.R., E.A.E.)
National Cancer Institute, Rockville, Maryland, and University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina (J.Y.I.)
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (H.I.H., E.J.)
Presented at the American Association for Cancer Research Annual Meeting, Washington, DC, 1–5 April 2017; at the Society for Epidemiologic Research Annual Meeting, Seattle, Washington, 20–23 June 2017; and as a plenary session at the 16th International Conference on Malignancies in HIV/AIDS, Bethesda, Maryland, 23–24 October 2017.
Disclaimer: The findings, conclusions, and views in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the National Cancer Institute, participating HIV/AIDS or cancer registries, or their contractors.
Acknowledgment: The authors thank individuals at the following state HIV/AIDS and cancer registries for their support and assistance: Colorado, Connecticut, Georgia, Maryland, Michigan, New Jersey, New York, Puerto Rico, and Texas. They also thank Timothy McNeel at Information Management Services for programming support.
Financial Support: In part by the Intramural Research Program of the National Cancer Institute. The following cancer registries were supported by the SEER Program of the National Cancer Institute: Connecticut (HHSN261201300019I) and New Jersey (HHSN261201300021I; N01-PC-2013-00021). The following cancer registries were supported by the National Program of Cancer Registries of the Centers for Disease Control and Prevention: Colorado (NU58DP006347-01), Georgia (5U58DP003875-01), Maryland (5NU58DP003919-05-00), Michigan (17NU58DP006334), New Jersey (NU58/DP003931-05-00), New York (U58/DP003879), and Texas (1NU58DP006308). The New Jersey State Cancer Registry was also supported by the state of New Jersey, the Maryland Cancer Registry was also supported by the state of Maryland and the Maryland Cigarette Restitution Fund, and the New York State Cancer Registry was also supported by the state of New York. The following HIV registries were supported by the National HIV Surveillance System of the Centers for Disease Control and Prevention HIV Incidence and Case Surveillance Branch: Colorado (NU62PS003960), Connecticut (5U62PS001005-05), Michigan (U62PS004011-02), and New Jersey (U62PS004001-2).
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2499.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available from Dr. Shiels (e-mail, shielsms@mail.
Corresponding Author: Meredith S. Shiels, PhD, MHS, National Institutes of Health, National Cancer Institute, 9609 Medical Center Drive, Room 6E218, MSC 9767, Bethesda, MD 20892; e-mail, shielsms@mail.
Current Author Addresses: Dr. Shiels: 9609 Medical Center Drive, Room 6E218, MSC 9767, Bethesda, MD 20892.
Ms. Islam: 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435.
Dr. Rosenberg: 9609 Medical Center Drive, Room 7E130, Bethesda, MD 20892.
Dr. Hall: 1600 Clifton Road, Mailstop D-21, Atlanta, GA 30329.
Dr. Jacobson: 1600 Clifton Road, Mailstop E-48, Atlanta, GA 30333.
Dr. Engels: 9609 Medical Center Drive, Room 6E226, MSC 9767, Bethesda, MD 20892.
Author Contributions: Conception and design: M.S. Shiels, P.S. Rosenberg, E.A. Engels.
Analysis and interpretation of the data: M.S. Shiels, J.Y. Islam, P.S. Rosenberg, H.I. Hall, E. Jacobson, E.A. Engels.
Drafting of the article: M.S. Shiels, J.Y. Islam, P.S. Rosenberg, E. Jacobson.
Critical revision of the article for important intellectual content: M.S. Shiels, J.Y. Islam, P.S. Rosenberg, H.I. Hall, E.A. Engels.
Final approval of the article: M.S. Shiels, J.Y. Islam, P.S. Rosenberg, H.I. Hall, E. Jacobson, E.A. Engels.
Provision of study materials or patients: M.S. Shiels.
Statistical expertise: M.S. Shiels, P.S. Rosenberg, E. Jacobson.
Collection and assembly of data: M.S. Shiels, H.I. Hall, E. Jacobson, E.A. Engels.
This article was published at Annals.org on 8 May 2018.