[Viva] Fwd: Ontario study looks at trends in cancer in people with HIV

Thu Sep 15 09:10:18 PDT 2022

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From: CATIE News <mailer at catie.ca>
Date: Thu, Sep 15, 2022 at 7:56 AM
Subject: Ontario study looks at trends in cancer in people with HIV
To: Denise Wozniak <deniseswozniak at gmail.com>

Despite decreases in AIDS-related cancers, people with HIV had a 20%
greater risk of cancer
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Ontario study looks at trends in cancer in people with HIV

   - *Researchers reviewed 23 years of healthcare information from more
   than 19,000 people with HIV in Ontario*
   - *Despite decreases in AIDS-related cancers, people with HIV had a 20%
   greater risk of cancer*
   - *The researchers underscored the need for cancer screening and
   prevention strategies*

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When initiated and used as directed, after a few months, HIV treatment
(ART) usually reduces the level of HIV in the blood to the point whereby it
cannot be detected with routine laboratory tests. Continued use of ART
helps keep HIV levels suppressed. As a result of this suppression of HIV,
the immune system can begin to make repairs. Subsequently, the risk of
AIDS-related infections becomes very rare. The effect of ART is so profound
that researchers project that many ART users will have near-normal life
expectancy.

However, ART cannot resolve all health issues related to chronic HIV
infection. For instance, multiple studies have found that while ART can
significantly reduce the level of excess immune activation and inflammation
in the blood, it cannot restore them to normal levels. Some research
suggests that persistent immune activation and inflammation can contribute
to subtle defects in immunity.

As people with HIV live longer, thanks to ART, their immune systems
gradually weaken as they age, just like everyone else’s. Also, according to
some scientists, the combination of persistent excess immune activation and
inflammation may increase the risk for cancer in people with HIV.
Cancers and HIV

Since the early 1980s, researchers noted that people with HIV were at
heightened risk for some cancers, including the following:

   - Kaposi’s sarcoma (KS) – caused by a virus called human herpes virus-8
   (HHV-8)
   - non-Hodgkin’s lymphoma – in some cases this has been linked to
   infection with Epstein-Barr Virus (EBV)
   - invasive cervical cancer – caused by some strains of human
   papillomavirus (HPV)

Subsequent research has found that some people with HIV are co-infected
with hepatitis B virus (HBV) and hepatitis C virus (HCV), which both
increase the risk for developing liver cancer.

Some people with HIV also smoke and drink alcohol, which can also increase
the risk for certain cancers.

Taken together, a number of factors such as viral co-infections, certain
activities and immune suppression caused by HIV all can play a role in
increasing the risk for some cancers in this population.
The Ontario study

A team of researchers in Ontario reviewed health-related information
collected from 19,403 adults with HIV between January 1997 and November
2020. The researchers focused on cancer-related issues.

Over the course of the study, cases of AIDS-related cancer fell
significantly. However, the level of cancers unrelated to AIDS remained
stable. Initially, there were proportionally fewer cancer diagnoses in
women with HIV than in men. However, in the latter years of the study,
rates of cancer had reached similar levels in women and men.
Study details

For the purposes of their study, the researchers grouped cancers as follows:

*AIDS-related cancers*

   - Kaposi’s sarcoma
   - non-Hodgkin’s lymphoma
   - cervical cancer

*Non-AIDS-related cancers caused by viral infections*

   - HPV-related cancers of the anus, penis, throat, tongue, vagina and
   vulva
   - *H. pylori*-related cancer of the stomach (H. pylori is a bacterium
   that can cause persistent stomach ulcers)
   - liver cancer caused by HBV or HCV
   - Hodgkin’s lymphoma and cancer of the nasal passages/throat (these can
   be caused by EBV)

*Cancers unrelated to infections*

   - such as cancers of the breast, lungs, thyroid and many others

According to the researchers, participants (79% men, 21% women) were around
36 years old when they entered the study. Most were born in Canada and
lived in urban areas.
Results

Over the course of the study, there were 1,275 new cases of cancer. Men
were more likely to have AIDS-related cancers, while women tended to have
cancers unrelated to infectious causes.

The five most commonly diagnosed cancers distributed by gender and in
decreasing frequency were as follows:

*Among men*

   - non-Hodgkin’s lymphoma
   - Kaposi’s sarcoma
   - prostate cancer
   - lung cancer
   - anal cancer

*Among women*

   - breast cancer
   - non-Hodgkin’s lymphoma
   - lung cancer
   - thyroid cancer
   - uterine or ovarian cancer

Trends

Over the course of the study, cancer diagnoses fell among men. According to
the researchers, this was due to a decrease in AIDS-related cancers.

Among women, cancer diagnoses increased over time, driven by cancers
unrelated to infections.
Proportions of people with cancer

By the end of the study in November 2020, 17,181 participants were alive.
Among these people, the proportions with a cancer diagnosis in specific
periods were as follows:

   - 0.8% had a cancer diagnosis in the past two years
   - 1.8% had a cancer diagnosis in the past five years
   - 3% had a cancer diagnosis in the past 10 years

Bear in mind

The researchers estimated that, overall, people with HIV had a risk for
cancer that was 20% higher than that in people without HIV. However, they
cautioned that other studies have found that people with HIV are not
screened for cancer as frequently as people without HIV. As a result, it is
possible that a proportion of people with HIV in the Ontario study had
cancer but were undiagnosed (and subsequently died). Thus, the overall
cancer risk for people with HIV is likely higher than what was estimated.

The researchers found that 3% of people with HIV in the study were cancer
survivors.

Although the risk for AIDS-related cancers fell during the study, the
researchers found that there was little change in rates of new cancers
unrelated to AIDS.

As the researchers estimated that cancer is more likely among people with
HIV, they encouraged doctors and nurses to “incorporate cancer prevention
strategies as part of comprehensive HIV care.” The researchers stated that
such strategies should include the following:

   - discussing cancer risk with patients
   - encouraging risk reduction such as smoking cessation
   - encouraging certain interventions for cancer prevention, such as HPV
   vaccination, hepatitis C treatment and screening for HPV-related cancers
   and colorectal cancer

*—Sean R. Hosein*

*Resources*

North American study finds low CD4/CD8 ratio can help predict cancer risk
in people with HIV
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=4a93278a75&e=14dd36bd6f>
 – *CATIE News*

French researchers investigate second cancers in people with HIV who
survived a first cancer
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=4171e86c06&e=14dd36bd6f>
 – *CATIE News*

Second cancer risk after surviving Hodgkin's lymphoma in people with HIV
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=e03d11f202&e=14dd36bd6f>
 – *CATIE News*

Changes in CD4+ cell count after cancer treatment linked to survival among
HIV-positive people
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=439bd81aa4&e=14dd36bd6f>
 – *CATIE News*

Canadian Cancer Society
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=cdfa6a2281&e=14dd36bd6f>

Cancer
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–
Government of Canada

Cancer
<https://catie.us16.list-manage.com/track/click?u=89abcbccf295c7b8d9a92cf09&id=8a1f2b41c2&e=14dd36bd6f>
–
Government of Quebec

REFERENCES:

   1. Nicolau IA, Antoniou T, Brooks JD, et al. The burden of cancer among
   people living with HIV in Ontario, Canada, 1997-2020: a retrospective
   population-based cohort study using administrative health data. *CMAJ
   Open*. 2022 Jul 19;10(3):E666-E674.
   2. Caccuri F, Messali S, Zani A, et al. HIV-1 mutants expressing B cell
   clonogenic matrix protein p17 variants are increasing their prevalence
   worldwide. *Proceedings of the National Academy of Sciences USA*. 2022
   Jul 5;119(27):e2122050119.
   3. Isaguliants M, Bayurova E, Avdoshina D, et al. Oncogenic effects of
   HIV-1 proteins, mechanisms behind. *Cancers* (Basel). 2021 Jan
   15;13(2):305.
   4. Poizot-Martin I, Lions C, Delpierre C, et al. Prevalence and spectrum
   of second primary malignancies among people living with HIV in the French
   Dat’AIDS cohort. *Cancers*. *2022 Jan 13;14(2):401.*
   5. Poizot-Martin I, Lions C, Allavena C, et al. Determinants of second
   primary cancer type in survivors of virus-related and non-virus-related
   cancer living with HIV in the French Dat’AIDS Cohort. *Cancer
Control.* 2021;
   28:1-7.
   6. Furman D, Campisi J, Verdin E, et al. Chronic inflammation in the
   etiology of disease across the life span. *Nature Medicine*. 2019
   Dec;25(12):1822-1832.
   7. Medzhitov R. The spectrum of inflammatory responses. *Science*. 2021
   Nov 26;374(6571):1070-1075.
   8. Frasca D, Pallikkuth S, Pahwa S. Effects of aging on metabolic
   characteristics of human B cells. *JAIDS*. 2022 Feb 1;89(Suppl
   1):S23-S28.

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