Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis

• Published in: The Lancet (British edition) Vol. 370; no. 9581; pp. 59 - 67
• Main Authors: Grulich, Andrew E, van Leeuwen, Marina T, Falster, Michael O, Vajdic, Claire M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 07.07.2007; Elsevier Limited
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - complications; Acquired Immunodeficiency Syndrome - immunology; AIDS; Cancer; Cohort Studies; Female; Health risk assessment; Health risks; HIV; Human immunodeficiency virus; Humans; Immunosuppression - adverse effects; Incidence; Internal Medicine; Lymphoma; Male; Medical research; Meta-analysis; Neoplasms - epidemiology; Neoplasms - etiology; Neoplasms - immunology; Organ Transplantation - adverse effects; Population studies; Risk Factors; Studies; Systematic review; Transplants & implants
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(07)61050-2

Only a few types of cancer are recognised as being directly related to immune deficiency in people with HIV/AIDS. Large population-based studies in transplant recipients have shown that a wider range of cancers could be associated with immune deficiency. Our aim was to compare cancer incidence in population-based cohort studies of people with HIV/AIDS and people immunosuppressed after solid organ transplantation. Two investigators independently identified eligible studies through searches of PubMed and reference lists. Random-effects meta-analyses of log standardised incidence ratios (SIRs) were calculated by type of cancer for both immune deficient populations. Seven studies of people with HIV/AIDS (n=444 172) and five of transplant recipients (n=31 977) were included. For 20 of the 28 types of cancer examined, there was a significantly increased incidence in both populations. Most of these were cancers with a known infectious cause, including all three types of AIDS-defining cancer, all HPV-related cancers, as well as Hodgkin's lymphoma (HIV/AIDS meta-analysis SIR 11·03, 95% CI 8·43–14·4; transplant 3·89, 2·42–6·26), liver cancer (HIV/AIDS 5·22, 3·32–8·20; transplant 2·13, 1·16–3·91), and stomach cancer (HIV/AIDS 1·90, 1·53–2·36; transplant 2·04, 1·49–2·79). Most common epithelial cancers did not occur at increased rates. The similarity of the pattern of increased risk of cancer in the two populations suggests that it is immune deficiency, rather than other risk factors for cancer, that is responsible for the increased risk. Infection-related cancer will probably become an increasingly important complication of long-term HIV infection.