Cancer in HIV-positive patients

Most HIV-positive patients die of cancer. In the latest issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108[8]: 117-22), Manfred Hensel's research group presents epidemiological data.

The authors surveyed all German hospital outpatient clinics and ambulatory care centers specializing in the treatment of HIV patients in the period from 2000 to 2007 and were thus able to analyze the largest collection of data on the incidence of cancer in HIV patients ever assembled in Germany. It first became clear in the early 1980s that HIV infection is associated with malignancies. Kaposi sarcoma, cervical cancer, and non-Hodgkin's lymphoma were found particularly often in immune-deficient populations. These "Aids-defining" tumors have since become less frequent, but other types of cancer such as anal carcinoma, Hodgkin's lymphoma, lung cancer, and skin cancer are coming to the fore. Because most patients infected with HIV die of these malignancies, the authors recommend tumor screening for HIV-positive persons.

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Background: Cancer is now the leading cause of death in persons with HIV. In this study, we gathered current epidemiological data on Aids-defining (AD) and non-Aids-defining (NAD) malignancies among HIV-positive patients in Germany.

Methods: From 2000 to 2007, all 35 specialized HIV outpatient clinics and 189 HIV ambulatory care centers in Germany were contacted and asked to fill out a structured questionnaire on the incidence of malignancies in HIV-positive patients during multiple periods of observation.

Results: 552 evaluable data sets were reported. 253 (45.8%) of the reported malignancies were AD. Among the 299 cases (54.2%) of NAD malignancies, there were 214 solid tumors, including 71 anal carcinomas (23.7% of all NAD malignancies), and 85 hematopoietic malignancies, including 29 cases of Hodgkin's lymphoma (9.7% of all NAD malignancies). The high percentage of NAD malignancy remained constant throughout the entire period of the study. Only a single case of primary cerebral lymphoma was reported after 2001. The number of patients with Hodgkin's lymphoma rose steadily from 2000 to 2007.

Conclusion: The spectrum of HIV-associated malignancies has changed since the early days of the HIV epidemic. In Germany, NAD malignancies have become more common than AD malignancies. In particular, anal carcinoma and Hodgkin's lymphoma are much more common among persons with HIV than in the general population. Persons with HIV need more intensive preventive care for cancer than noninfected persons do.

Cite this as:

Hensel M, Goetzenich A, Lutz T, et al.: HIV and cancer in Germany.
Dtsch Arztebl Int 2010; 107(8): 117–22. DOI: 10.3238/arztebl.2010.0117

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The association between human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (Aids) and cancer has been known since the early 1980s (e1). Particularly Kaposi sarcoma, invasive cervical carcinoma, and non-Hodgkin's lymphoma (NHL) have been found more frequently in HIV- infected and immune-deficient patients. The introduction of combined antiretroviral therapy (cART) in 1996 was followed by dramatic changes in the morbidity and mortality of HIV infection and especially in the spectrum of malignancies observed in HIV-infected patients. The incidence of Aids-defining (AD) malignancies has steadily declined, while the incidence of other malignancies, such as Hodgkin's lymphoma, invasive anal carcinoma, lung cancer, skin cancer, and hepatocellular carcinoma presents new challenges to those responsible for the treatment of these patients (1).