Trends in cancer diagnoses and survival among persons with AIDS in a high HIV prevalence urban area

Abstract

Washington, DC (DC), has among the highest AIDS prevalence and cancer incidence in the USA. This study compared cancer diagnoses and survival among AIDS cases with AIDS-defining cancers (ADCs) to those with non-AIDS-defining cancers (NADCs) in DC from 1996 to 2006. Survival by cancer type and time period was also examined for 300 individuals diagnosed with AIDS who developed cancer; 49% of AIDS cases developed an ADC. ADC cases were younger at both AIDS and cancer diagnosis and had significantly lower median CD4 counts at AIDS diagnosis than NADC cases. The most frequent cancers were non-Hodgkin lymphoma (NHL; 44% of ADC), Kaposi's sarcoma (40% of ADC), and lung cancer (20% of NADC). There was no significant difference in distribution of cancers when comparing ADCs to NADCs, or over time (1996–2001 vs. 2002–2006). Survival among NHL, oral cavity, and lung cancer cases was 0.4, 0.8, and 0.3 years, respectively; the risk of death was approximately two times higher for each of these cancers when compared to other cancers. Given the high burden of cancer and HIV in DC, early highly active antiretroviral therapy initiation, routine cancer screening, and risk reduction through behavioral modification should be emphasized to prevent cancer among HIV-infected persons.

Keywords:

• HIV
• AIDS
• cancer
• survival
• mortality

Acknowledgments

The authors would like to acknowledge Dr Joanne Lynn, Dr Shannon Hader, and Dr Eric Engels for their assistance with the conduct of this study and analysis. They would also like to acknowledge Kristin Roha, Heather Jordan, and Edmund Weisberg for their assistance in the formating and preparation of the article.

Disclosure statement

None of the District of Columbia Department of Health co-authors have any competing interests to declare.

This study was conducted as a part of the Public Health/Academic Partnership between the District of Columbia Department of Health/HIV-AIDS Administration and The Milken Institute School of Public Health at the George Washington University, Department of Epidemiology and Biostatistics, Contract Number POHC-2011-C-0073 and that under this contract the District of Columbia Department of Health had the right to review and approve the final version of the manuscript.

Additional information

Funding

None of the District of Columbia Department of Health co-authors have any competing interests to declare.