CONHIV14 - HIV-related Infections, Co-infections and Cancers, etc. – Part three - page 2

Barnes E
1
, Saxon C
2
, Ahmad S
1
1. University Of Manchester, Medicine, Manchester, United Kingdom
2. University Hospitals of South Manchester Foundation NHS Trust, Department of Sexual Medicine & HIV, Manchester, United Kingdom
Background:
Morbidity and mortality rates from AIDs defining
cancers have fallen significantly since the introduction of highly
active antiretroviral therapy (HAART). Patients are now living
longer with HIV and are at a greater risk of other HIV- and non-
HIV related malignancies. We report what we believe to be the
first UK cancer prevalence study in the modern HAART era.
Cancer prevalence in a metropolitan
HIV clinic
Methods:
A retrospective review of electronic clinic letters
was performed for all patients receiving (‘
active
’) and those
whom had died whilst receiving their HIV care at our clinic.
Letters from patients previously under care at our clinic but
had since transferred to another centre (‘
transferred
’) were
also reviewed. Demographics of patients with pre-cancerous
changes, an active or previous cancer were recorded.
Results:
In April 2014 there were records for 438 active
patients (369 male [M], 69 female [F]), 145 transferred (122
male, 23 female) and 18 deceased patients (12 male, 6 female)
at our clinic. A total of 45/601 (7%) cancer diagnoses were
found, 31/438 (7%) diagnoses in active patients (27 M, 4 F),
9/145 (6%) in transferred patients and 5/18 (28%) in deceased
patients (4 M, 1 F). More than half of those diagnosed with
cancer had an AIDs defining cancer (25/45 [55%]) and similarly
were aged 50 or over (23/45 [55%]) (table 1 and figure 1).
In
active
patients 17/31 (55%) were AIDs defining cancers.
Kaposi’s sarcoma (KS) was the most common cancer overall
(12/31 [39%]). There were 5/31 (16%) cases of non-Hodgkin's
lymphoma (NHL). The most common non-AIDs defining cancer
was basal cell carcinoma (BCC) of which there were 5/31
(16%) cases, followed by squamous cell carcinoma (SCC)
(3/31 [10%]) and testicular cancer (3/31 [10%]). Other cancers
included colorectal (2/31 [6%]) and prostate cancer (1/31 [3%]).
In
active
patients all cancers have occurred since HIV
diagnosis with the exception of 1 colorectal cancer. One patient
with BCC and 2 patients with testicular cancer had their first
episodes pre-diagnosis but have had recurrences since. One
patient developed KS despite being on anti-retroviral therapy
with sustained virological suppression for many years.
In
active
female patients 18/69 (26%) were found to have at
least mild dyskariosis on cervical screening. Anal intraepithelial
neoplasia was diagnosed in 4/438 (1%) of
active
patients.
Discussion:
Cancer prevalence in our HIV cohort was 7% overall. Non-AIDS defining malignancies account for almost half of the
cancers in our cohort. This number may rise further as patients live longer with HIV. AIDs defining cancers still represent a
significant burden in our population and are often linked to late diagnosis. Interestingly one case of KS developed in a virologically
suppressed patient in keeping with similar recent reports elsewhere.
R
There were a high number of BCCs in our cohort perhaps
reflecting health related behaviour (i.e. sun exposure). Interestingly no liver cancers were found in our clinic despite hepatitis B
and C co-infections, this may be due to annual screening with alpha-fetoprotein and liver ultrasounds in those affected. Some
patients were transferred to a different HIV centre to enable co-located management of their malignancy which may account for
the high proportion of AIDs defining malignancies in
transferred
patents. Overall cancer remains a significant co-morbidity for HIV
patients. Good communication between oncologists and HIV physicians is paramount to manage the complex interactions of HIV
and cancer, increase HIV testing in cancer services and address cancer risk factors in existing HIV patients.
Type of Cancer
No of
people
% Clinic
Prevalence
AIDs defining Cancers
Kaposi Sarcoma
17
2.8
Non Hodgkin Lymphoma
7
1.2
Cervical Cancer
1
0.2
Other Cancers
Basal Cell Carcinoma
5
0.8
Squamous Cell Carcinoma
5
0.8
Testicular Cancer
3
0.5
Colorectal Cancer
2
0.3
Bladder Ca / Prostate Ca /
Lung Ca / Glioma / Leukaemia
1 each
0.2 each
Total
45
7.5
In
transferred
patients, AIDs defining cancers were more
common at 78% (7/9). The majority of cases were Kaposi’s
Sarcoma (5/9, 56%), and the remainder were Non-Hodgkin's
lymphoma (2/9, 22%). The two non-AIDs defining cancers
were SCCs of the anus.
Figure 1. Number of patients with each type of cancer
(Ca – Cancer)
Table 1. Clinic Prevalence of Cancer Type
(Ca – Cancer)
In all 5
deceased
patients cancer
was the cause of death. There
were 4 acute presentations with
an aggressive glioma, Burkitt's
leukaemia, an undiagnosed
primary lung malignancy and a
late diagnosed cervical cancer.
The 5th patient died following the
recurrence of a transitional cell
cancer of the bladder after an
initial diagnosis 7 years earlier.
Reference: von Braun A, Braun DL, Kamarachev J, Gunthard HF. New onset of Kaposi Sarcoma in a human
immunodeficiency virus-1-infected homosexual man, despite early antiretroviral treatment, sustained viral suppression, and
immune restoration. Open Forum Infect Dis 2014: 1 (1): doi: 10.1093/ofid/ofu005.
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