Background
Cancer burden among people with HIV (PWH) has shifted from cancers associated with immunodeficiency to cancers common in the general population. Trends in common cancer diagnoses by sex have not been adequately characterized following the introduction of Treat-All policies and modern ART regimens. We examined incidence trends by sex for common cancers in a consortium of PWH in care from 2006-2020 in the US and Canada.
Methods
We estimated sex- and period-specific cancer incidence rates (2006-10; 2011-15; 2016-20) per 100,000 person-years (PY) among PWH participating in the North American AIDS Cohort Collaboration for Research and Design (NA-ACCORD) in cohorts contributing validated cancer diagnoses. We report on the 5 most common cancer diagnoses (excluding non-melanoma skin cancer) by sex: Non-Hodgkin lymphoma (NHL), lung, anal; head/neck and prostate for men; and breast and cervical for women. We age-standardized incidence rates to the US 2000 population.
Results
Among 112,757 PWH (86% men, 14% women) in 20 NA-ACCORD cohorts, we included 4,634 incident cancer diagnoses. Median age at first cancer diagnosis was 60 years (IQR 54, 66) for men and 51 (IQR 44, 58) for women. NHL declined over time in men (111-55 cases per 100,000 PY, p<0.05) and women (80-41 cases per 100,000 PY p <0.05). Head/neck cancers were stable in men (mean: 54 cases per 100,000 PY, p>0.05). Cervical cancer was stable (mean: 53 cases per 100,000 PY, p>0.05) over time. Lung cancer declined in men (151-92 cases per 100,000 PY, p<0.05) but was stable in women (90-95 cases per 100,000 PY, p>0.05). Anal cancer was stable in men over time (65-76 cases per 100,000 PY, p>0.05) but increased in women (11-27 cases per 100,000 PY, p<0.05). Breast and prostate cancers were stable or declined from 2006-10 to 2011-15 but had non-significant (p>0.05) increases from 2011-15 to 2016-20.
Conclusions
Declines in NHL may be due to improved immunity at HIV diagnosis, earlier ART initiation and greater effectiveness over time. Declining lung cancer is observed in other studies of PWH, but drivers for this and sex differences remain unclear (though possibly related to greater decline in smoking rates in men versus women). Increasing breast/prostate cancer merits continued monitoring at the population/individual-level and to further investigate the impact of screening, aging and other factors driving burden of these cancers. Cancer trends in women underscore the need to clarify cancer etiology and improve screening for women with HIV.
Table or Figure
