Infection-related and -unrelated malignancies, HIV and the aging population. HIV Medicine
Shepherd et al. on behalf of EuroSIDA in EuroCOORD determined the impact of aging on future infection-related malignancies (IRM) and infection-unrelated malignancies (IURM) incidence. Out of 15’648 persons contributing to 95’033 person-years of follow-up, a total of 610 people (3.9%) developed 643 malignancies, of which 60.3% were IRMs and the remaining 39.7% were IURMs. The most common IRMs were non-Hodgkin lymphoma (n = 116), anal cancer (85), Kaposi sarcoma (62) and Hodgkin lymphoma (43). Lung (n = 55), prostate (28), colorectal (23) and breast (22) cancers were common IURMs.
A higher IRM incidence was strongly associated with traditional HIV factors such as a higher HIV-viral load and a lower CD4 cell count and, to a lesser extent, older age. The incidence of IRMs steadily increased with lower CD4 count category. For IURM, older age was the largest contributor with a twofold higher IURM incidence for a 10-years increase in age. Smoking was associated with IURMs compared with never smokers in people aged ≥ 50 years only, and not with IRMs.
In sum, these findings suggest the need for targeted preventive measures and evaluation of the cost-benefit of screening for IURMs in HIV-infected populations.