Incidence and Characteristics of Cancers Among Patients (Adults) living with Human Immunodeficiency Virus Infection: A 10-Year Population-Based Cohort Study in Surin Hospital

Abstract

Background: Undoubtedly, people with human immunodeficiency virus (HIV) have an increased incidence of acquired immunodeficiency syndrome (AIDS)-defining cancers (Kaposi’s sarcoma [KS], non-Hodgkin lymphomas [NHL], and invasive cervical cancer) and non-ADIS-defining cancers when compared with the general population. The mortality rate is also higher due to an immunocompromised state, delayed diagnosis, and advanced cancer stage. We aim to reveal the incidence and characteristics of cancer in a patient with HIV, which will lead to proper screening and evaluation to detect the early stage of cancer. Eventually, that improves overall survival.
Methods: A retrospective observation study study among HIV-positive patients with cancer diagnosed between January 2012 and October 2022 and aged over 15 years old at Surin hospital was conducted. Clinical and laboratory data were collected from diagnosed HIV infection to cancer diagnosis. The data about the disease with descriptive statistics presented with frequency, percentage, range, average, and mean ± SD. Chi-squared and T-tests were used to evaluate the outcome. The Surin Hospital's IRB approved this study.
Results: Between January 2012 and October 2022, 22,514 patients had confirmed cancer diagnoses, and 3,967 patients had with HIV. Among these, there were 55 eligible patients with HIV who were diagnosed with cancer later. The cancer incidence in a patient with HIV was 1.4% (1,386 per 100,000). There were female 56.4%, with a mean age during cancer diagnosed of 42.1 years. The incidence was higher when compared with the general population (1,386 vs. 259 per 100,000). There are AIDS-defining cancer, 30.9%, composed of 4 KS, 5 NHL, and eight invasive cervical cancer. 6 of 17 patients diagnosed AIDS with AIDS-defining cancer were the first presentation. The average time from the diagnosis of HIV infection to an AIDS-defining cancer diagnosis was 4.2 years (SD ±4.5). Almost all of them were viral suppression. The average CD4 count at the time of the diagnosis of an AIDS-defining cancer was 289.5 (±226.2) cells/mm3 %CD4 18.8, and the average decline of CD4 after the diagnosis and treatment of cancer was 38.3 cells/mm3, %CD4 1.1. On the other hand, non-AIDS-defining cancers were 69.1%. All of them were solid tumors; the top three were colorectal, breast, and anal cancer, with 14.5%, 12.7%, and 7.3%, respectively. The average time from the diagnosis of HIV infection to a non-AIDS-defining cancer diagnosis was 8.9 years (±5.7)
Conclusions: As expected, the higher incidence of cancer in people with HIV was 1,386 per 100,000, composed of AIDS-defining cancer at 30.9% and non-ADIS-defining cancer at 69.1%. The top three cancers among people with HIV are cervical cancer, colorectal cancer, and breast cancer. If we properly screen and evaluate these cancers, we will better detect the early cancer stage. Finally, that improves overall survival