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

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 po...

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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
Online Access	Get full text
ISSN	0140-6736 1474-547X 1474-547X
DOI	10.1016/S0140-6736(07)61050-2

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Abstract	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.
AbstractList	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. 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=444172) and five of transplant recipients (n=31977) 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. 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. Summary Background 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. Methods 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. Findings 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. Interpretation 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. 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.BACKGROUNDOnly 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.METHODSTwo 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.FINDINGSSeven 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.INTERPRETATIONThe 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.
Author	Vajdic, Claire M van Leeuwen, Marina T Grulich, Andrew E Falster, Michael O
Author_xml	– sequence: 1 givenname: Andrew E surname: Grulich fullname: Grulich, Andrew E email: agrulich@nchecr.unsw.edu.au organization: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia – sequence: 2 givenname: Marina T surname: van Leeuwen fullname: van Leeuwen, Marina T organization: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia – sequence: 3 givenname: Michael O surname: Falster fullname: Falster, Michael O organization: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia – sequence: 4 givenname: Claire M surname: Vajdic fullname: Vajdic, Claire M organization: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/17617273$$D View this record in MEDLINE/PubMed
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Snippet	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... Summary Background Only a few types of cancer are recognised as being directly related to immune deficiency in people with HIV/AIDS. Large population-based...
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SubjectTerms	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
Title	Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis
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