Non-AIDS-defining Cancer Is an Increasingly Common Cause of Death among HIV Patients

By Liz Highleyman

Antiretroviral therapy (ART) has dramatically reduced overall mortality among people with HIV, especially deaths related to opportunistic illnesses. As HIV positive people survive longer, however, they are more prone to progressive diseases that develop over time, including liver disease and non-AIDS-defining cancers.

As reported in the March 1, 2009 issue of Clinical Infectious Diseases, Fabrice Bonnet and colleagues with the French ANRS EN19 Mortalité Study Group and the Mortavic Study Group analyzed the distribution and characteristics of cancer-related deaths among some 78,000 HIV positive hospital patients, comparing data obtained from national surveys conducted in France in 2000 and 2005. Causes of death were documented using a standardized questionnaire completed by French hospital wards and networks that treat HIV patients.

Results

1042 total deaths were reported in 2005 (1013 with adequate information for further analysis), compared with 964 in 2000.

Overall, the most common cause of death in 2005 remained AIDS-related illnesses, at 36% (down from 47% in 2000).

344 deaths (34%) in 2005 were attributable to any type of cancer, a significant increase from 29% in 2000 (P = 0.02).

134 of the cancer-related deaths (39%) were due to classic AIDS-related malignancies and 210 (61%) were not considered AIDS-related.

The proportion of cancer deaths due to malignancies not attributable to either AIDS or hepatitis rose from 38% in 2000 to 50% in 2005 (P = 0.01); in 2005, such cancers accounted for 17% of all deaths.

Among the AIDS-related malignancies, the proportion of deaths due to Kaposi sarcoma (KS) (3% in 2000, 4% in 2005) and non-Hodgkin lymphoma (NHL) (11% and 10%, respectively) remained stable over time.

Mortality due to cervical cancer was very low (< 1%); there were more deaths due to anal cancer -- caused by the same human papillomavirus (HPV) strains -- but the proportion remained stable over time.

Among all cancer-related deaths, the proportion related to hepatitis -- that is, hepatocellular carcinoma -- rose from 6% in 2000 to 11% in 2005 (P = 0.03).

A majority of liver cancer deaths in 2005 were associated with hepatitis C virus (HCV) coinfection, while hepatitis B virus (HBV) made a smaller contribution in 2005 compared with 2000.

The proportion of deaths due to gastrointestinal malignancies (including pancreas cancer), breast cancer, and skin cancer also increased, but not as steeply.

Deaths due to lung cancer and nose/mouth/throat cancers remained stable (5% combined in 2005 vs 6% in 2000).

In this study, the investigators concluded, "an increasing proportion of lethal non-AIDS-related cancers was demonstrated from 2000 to 2005; meanwhile, the proportion of lethal AIDS-related cancers remained stable among HIV-infected patients."

Thus, they recommended, "cancer prophylaxis, early diagnosis, and improved management should be included in the routine long-term follow-up of HIV-infected patients."

Institut National de la Santé et de la Recherche Médicale (Inserm), U593, Centre Hospitalier Universitaire, Université Victor Segalen Bordeaux, Institut de Santé Publique, d'Epidémiologie et de Développement, Bordeaux, Centre Hospitalier Universitaire Brabois, Vandouvre-lès-Nancy, Inserm, U720, Université Pierre et Marie Curie, Centre Hospitalier Universitaire Pitié-Salpêtrière, and Centre Hospitalier Universitaire Cochin-Tarnier, Paris; Centre Hospitalier Universitaire L'Archet, Nice; Inserm, CépiDc, Le Vésinet, France.

4/07/09

References

F Bonnet, C Burty, C Lewden, and others. Changes in Cancer Mortality among HIV-Infected Patients: The Mortalité 2005 Survey. Clinical Infectious Diseases 48(5): 633-639. March 1, 2009.
Free full text.

A d'Arminio Monforte. Malignancy-Related Deaths among HIV-Infected Patients (Editorial commentary). Clinical Infectious Diseases 48(5): 640-641. March 1, 2009. Free full text.