- HIV infection in male veterans was associated with increased risk for oesophageal squamous cell carcinoma (ESCC), especially among patients with low CD4 count (≤200).
- Risk factors for oesophageal and stomach cancers were similar between HIV-infected and non-infected patients.
- Results suggest that endoscopic screening may be considered among HIV infected patients with low CD4 count and tobacco/alcohol use.
Among people living with HIV/AIDS, the proportion of deaths due to invasive non-AIDS-defining cancers has increased. Many reasons like co-infections, premature ageing or high rates of tobacco and alcohol use lead an excess risk in these individuals, especially for oesophageal and stomach cancers. Results of previous studies are inconsistent and no prior research examined the association between HIV and risk of specific subtypes of these cancers.
This retrospective study used individual-level patient data from the U.S. Veterans Health Administration.
HIV-infected male veterans (n=44,075; ≥18 years) were matched on age and HIV-index date (4:1) with HIV-uninfected individuals (n=157,705).
Cox regression models were used to analyse the association between HIV infection and the risk of ESCC, oesophageal adenocarcinoma (EAC), gastric cardia cancer (GCC) and gastric non-cardia cancer (GNCC).
Potential risk factors for developing each type of cancer were examined in the HIV-infected cohort.
Due to the small number of outcomes, women were excluded from analyses.
The mean duration of follow-up from index date (first diagnosis) was 8.96 years (SD, 5.66) for the HIV-infected patients and 9.96 years (SD, 5.73) for the controls.
HIV infection was associated with increased risks of ESCC (HR 2.21; 95% CI 1.47-3.13) and GCC (HR 1.69; 95% CI 1.00-2.85) and with a lower risk of EAC (HR 0.48; 95% CI 0.31-0.74).
In adjusted models (age, race/ethnicity, smoking and alcohol use) HIV infection remained statistically significantly associated with elevated risk for ESCC (aHR, 1.58; 95% CI 1.02-2.47). The magnitude of this association was stronger when CD4 count was ≤200 (aHR, 2.20; 95% CI, 1.35-3.60).
HIV infection was not associated with risks of EAC (aHR, 0.82; 95% CI, 0.53-1.26), GCC (aHR, 0.80; 95% CI, 0.33-1.94) and GNCC (aHR, 1.06; 95% CI, 0.61-1.84).
Risk factors in HIV-infected patients were similar to those in the general population.
Further studies are needed with a longer follow-up, in the setting of global populations and with women included in the analysis.
Limitations: probably some HIV-infected patients were not identified; the first HIV diagnosis for patients with dual insurance coverage may not reflect the indexed diagnosis; few cases of cancer occurred during the study.