Módulo 2 – Curso pós-graduado – VIH e Envelhecimento

Non-AIDS Defining Cancers Among HIV Infected People

Risk factors for non-AIDS defining malignancies

Autor: Prof. Doutor Mark Bower, MD PhD (National Centre for HIV malignancy Chelsea & Westminster Hospital, London, UK)

Prevalence of cancer and HIV infection

Nowadays, the global prevalence of cancer and people living with HIV are similar, with 32.5 million people having cancer in 2012, while 35.3 million people had HIV infection. However, in the same year, the estimated deaths from cancer were six times higher than the number of deaths from AIDS (8.2 vs. 1.6 million deaths).

In 2012, the overall incidence of cancer in Portuguese men was similar to the average for the European Union (EU) overall incidence, and the most common cancer was prostate cancer followed by colorectal cancer and lung cancer, a similar pattern to most of Europe. In addition, the overall cancer mortality in Portugal was lower than in most European countries(1).

Regarding cancers in women, the incidence in Portugal was lower than the EU average. The most common cancers were breast cancer, colorectal and (unusually) endometrial cancer. Mortality was also lower compared to other European countries1.

There are three AIDS-defining malignancies: Kaposi sarcoma, non-Hodgkin lymphoma (including primary cerebral lymphoma) and cervical cancer, all caused by oncogenic viruses Kaposi’s sarcoma-associated herpesvirus (KSHV), EBV and HPV, respectively. The first two were the first identified AIDS-defining malignancies and the association with low CD4+ cell count has been well established, with an increased relative risk as the CD4+ count falls2. With the introduction of antiretroviral drugs in the late 1990’s, the incidence of these malignancies declined3. Nowadays, we are aiming to achieve a world without AIDS where nobody should present with AIDS- defining illnesses4.

In fact, AIDS-defining malignancies have been declining from 1991 until 2005. However, in contrast to the AIDS-defining malignancies, the incidence of non-AIDS defining malignan- cies (NADM), overall, has remained reasonably stable with an increased number of cases. In addition, while only 20% of the NADM occurred in patients over the age of 50 in the early 1990’s, nowadays around 60% of cases are occurring in peo- ple older than 50 years3.

The D:A:D cohort study followed around 50,000 people living with HIV between 1999 and 2011, corresponding to al- most 305 million patient-years of follow-up. There were 3,802 deaths, and a decline in all cause overall mortality between 2000 and 20105. Nevertheless, the D:A:D study also verified that the incidence of NADMs remained stable over the last decade but that NADMs contributed to 8% of deaths in the year 2000 rising to 20% of deaths in the year 2010.

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