Módulo 2 – Curso pós-graduado – VIH e Envelhecimento

Non-AIDS Defining Cancers Among HIV Infected People

The epidemiology of non-AIDS defining cancers among HIV infected patients

Autor: Prof. Doutor Julian Falutz, MD, FRCP (McGill University Hospital Center, Montreal, Canada)

Immunosuppression and the risk of NADCs and all cancers

Prosperi et al.23 have reported that low CD4+ cell count (<200 cells/mm3), either current CD4+ count or nadir CD4+ count, was associated with higher incidence of all cancers, being higher for AIDS-defining cancers compared with NADCs. At higher CD4+ counts, there was a similar incidence for AIDS-defining cancers and NADCs23.

Results from the Athena cohort have also shown that immunodeficiency (either determined by the low latest CD4+ count, cumulative exposure to low CD4+ counts, or nadir CD4+ counts), was associated with an increased risk of NADCs among HIV treated patients24. Furthermore, having a state of immunodeficiency as determined by low CD4+ cell count increases risk of infectionrelated NADCs but not the non-infection related NADCs24.or AIDS-defining cancers and NADCs23.

Grulich et al.25 compared cancer incidence among HIV patients to that in immunosuppressed transplant patients, and verified that the increased risk of many cancers were similar in both population, thus suggesting that immunodeficiency may explain similar spectrum and pattern of increased cancer risk.

In fact, when considering cancers related with infections (with EBV, herpes virus-8, HBV/HCV and Helicobacter pylori), Grulich et al. have observed that the incidence rates for HL, non-Hodgkin lymphoma and Kaposi’s sarcoma were higher among HIV patients vs. transplant patients but that the incidence of hepatocellular carcinoma was similar between these groups.

Considering cancers related to HPV, the risk of anal cancer was increased in HIV patients but it was also increased among transplant patients. However, regarding common epithelial cancers in patients immunosuppressed with HIV or patients immunosuppressed because having received a transplant, there were no differences in the incidence of prostate cancer, colorectal cancer, and lung cancer (even though transplant recipients do not have the same prevalence of cigarette smoking as in HIV patients)25.

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