Smoking Linked to Higher Risk of Non-AIDS Malignancies and Anal Cancer in Men with HIV

		SUMMARY: HIV positive men who smoke tobacco or did so in the past have elevated rates of non-AIDS cancers overall, and of anal cancer and pre-cancerous anal cell abnormalities in particular, but clinicians often fail to ask patients about their smoking habits, according to a study of U.S. veterans reported last month at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2010) in Boston. Three years after quitting, ex-smokers' cancer rates approached those of lifetime non-smokers, but anal dysplasia remained common.

By Liz Highleyman

Use of tobacco is a known risk factor for non-AIDS malignancies including lung and mouth cancers.

The 3 AIDS-defining malignancies are Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL), and invasive cervical cancer. Although anal cell abnormalities (dysplasia, neoplasia, and squamous intraepithelial lesions) and anal cancer are caused by the same high-risk human papillomavirus (HPV) types as cervical cancer, it is not officially classified as AIDS-related.

Angelike Liappis and colleagues conducted a study of cancer rates among HIV positive men receiving care at the Washington, DC, Veterans Affairs Medical Center (VAMC). A total of 200 participants were prospectively surveyed about their use of tobacco over 6 months.

Clinical data -- including information on smoking history recorded by providers -- were collected from the VAMC's VistaCPRS computerized medical record system. The researchers correlated tobacco use with non-AIDS malignancies overall, anal cancer, and anal dysplasia, or abnormal and potentially pre-cancerous cell changes.

Results

	Among the 200 surveyed patients, 82% reported ever smoking tobacco.
	A majority (63%) reported active tobacco use within the past 30 days.
	25% quit smoking at least 3 years ago.
	Just 19% had never smoked.
	Rates of non-AIDS malignancies were higher among smokers -- especially current smokers -- compared with lifetime non-smokers and those who quit:
	Ever smoked: 13%; Smoked during past 30 days: 14%; Quit 3 or more years ago: 10%; Never smoked: 8%.
	Anal cancer was also more common among smokers, though overall numbers were small:
	Ever smoked: 4%; Smoked during past 30 days: 5%; Quit 3 or more years ago: no cases; Never smoked: no cases.
	Anal dysplasia was common among smokers, and rates did not fall back toward those of non-smokers even after 3 years:
	Ever smoked: 82%; Smoked during past 30 days: 92%; Quit 3 or more years ago: 71%; Never smoked: 25%.
	Only 49% of participants had smoking mentioned in their electronic medical records.
	The researchers calculated that tobacco use among 54% of screened patients would have been missed by providers using electronic medical records alone.

"In those patients surveyed, we improved tobacco use documentation by 40% and were able to further distinguish use as remote or active," the researchers said.

When screening for anal cell abnormalities, they recommended, "HIV [care] providers should strive to document smoking history and factor in the risk due to tobacco, particularly active use, in addition to sexual risk and presence of HPV related pathology."

Investigator affiliations: VA Medical Center, Washington, DC; George Washington University, Washington, DC.

10/5/10

Reference
AP Liappis, H Cohen-Blair, CA Reisen, and others. Identification of Tobacco Use in HIV-Infected Patients: The Added Role in Screening for Malignancy and Anal Dysplasia. 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2010). Boston, September 12-15, 2010. Abstract H-224.