Comparing Risk For Cancer Among Persons With Aids And General Population: Results From São Paulo, Brazil

Luana TANAKA, School of Public Health, University of São Paulo, Brazil

1 Department of Epidemiology, School of Public Health, University of São Paulo, Brazil
2 Center for International Health, Medical Center of the University of Munich, Munich, Germany
3 Population-based Cancer Registry of São Paulo, Department of Epidemiology, University of São Paulo, São Paulo, Brazil
4 Programa Municipal DST-AIDS, Secretaria Municipal de Saúde, São Paulo, Brazil
5 Institute of Statistics, University of Munich, Munich, Germany
6 Department of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany

Purpose: Several studies have shown increased risk for cancer among people with HIV/AIDS when compared to the general population. The aim of this study was to compare risk for cancer in persons with AIDS and the general population in São Paulo, Brazil, between 1997 and 2012.
Methods: We conducted a population-based registry linkage study. We linked the Population-based Cancer Registry of São Paulo (496,276 cancer cases) and the AIDS notification database (81,889 AIDS cases) to identify persons with AIDS who had cancer. To compare cancer risk, we calculated the standardized incidence ratio (SIR) and its 95% confidence intervals.
Results: Among persons with AIDS, 2,074 cancer cases were diagnosed (1,510; 72.8% in men).    In men with AIDS the highest risks were found for anal cancer (SIR=33.0; 95%CI=24.9; 41.2), non-Hodgkin-lymphoma (NHL; SIR=13.4; 95%CI=11.9; 14.9), Hodgkin lymphoma (HL; SIR=5.8; 95%CI= 4.2; 7.5), eye cancer (SIR= 4.9; 95%CI=1.7; 8.1) and liver cancer (SIR=4.3; 95%CI= 2.3; 6.3). Cancers of the male genital organs (penis, prostate and testis) did not have increased risk. In women with AIDS, NHL (SIR=13.9; 95%CI= 11.1; 16.6), anal cancer (SIR=11.2; 95%CI= 4.3; 18.2), vulvar cancer (SIR=8.6; 95%CI=3.7; 13.5), cervical cancer (SIR=5.4; 95%CI= 4.4; 6.4) and oral cavity and oropharynx cancer (SIR= 2.8; 95%CI=1.1; 4.6) occurred in excess. Risk for ovarian and breast cancers did not differ from the general population, whereas, thyroid cancer occurred at lower rates in women with AIDS (SIR=0.5; 95%CI=0.3; 0.7).
Conclusions: Increased risk for cancer was not only restricted to AIDS-defining cancers. Other infection-related cancers such as HL, anal and liver cancer occurred at higher rates in the AIDS population.
Funding source: Conselho Nacional de Desenvolvimento Científico e Tecnológico and the German Ministry for Economic Cooperation and Development through the German Academic Exchange Service and the Higher Education Excellence in Development Cooperation.