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Brief Report: Malignancies in Adults Living With HIV in Asia

Jiamsakul A 1 , Polizzotto M 1 , Wen-Wei Ku S 2 , Tanuma J 3 , Hui E 4 , Chaiwarith R 5 Show all authors , Kiertiburanakul S 6 , Avihingasanon A 7 , Yunihastuti E 8 , Kumarasamy N 9 , Ly PS 10 , Pujari S 11 , Ditangco R 12 , Do CD 13 , Merati TP 14 , Kantipong P 15 , Zhang F 16 , Van Nguyen K 17 , Kamarulzaman A 18 , Choi JY 19 , Sim BLH 20 , Ng OT 21 , Ross J 22 , Wong W 2

Affiliations 

  • 1 The Kirby Institute, UNSW, Sydney, NSW, Australia
  • 2 Taipei Veterans General Hospital, Taipei, Taiwan
  • 3 National Center for Global Health and Medicine, Tokyo, Japan
  • 4 Queen Elizabeth Hospital, Hong Kong, China
  • 5 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 6 Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
  • 7 HIV-NAT, The Thai Red Cross AIDS Research Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 8 Working Group on AIDS, Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
  • 9 YRGCARE Medical Centre, Chennai, India
  • 10 National Center for HIV/AIDS, Dermatology & STDs, University of Health Sciences, Phnom Penh, Cambodia
  • 11 Institute of Infectious Diseases, Pune, India
  • 12 Research Institute for Tropical Medicine, Manila, Philippines
  • 13 Bach Mai Hospital, Hanoi, Vietnam
  • 14 Sanglah Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia
  • 15 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 16 Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 17 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 18 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 19 Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  • 20 Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • 21 Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
  • 22 TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
J Acquir Immune Defic Syndr, 2019 03 01;80(3):301-307.
PMID: 30531303 DOI: 10.1097/QAI.0000000000001918

Abstract

BACKGROUND: Hematological malignancies have continued to be highly prevalent among people living with HIV (PLHIV). This study assessed the occurrence of, risk factors for, and outcomes of hematological and nonhematological malignancies in PLHIV in Asia.

METHODS: Incidence of malignancy after cohort enrollment was evaluated. Factors associated with development of hematological and nonhematological malignancy were analyzed using competing risk regression and survival time using Kaplan-Meier.

RESULTS: Of 7455 patients, 107 patients (1%) developed a malignancy: 34 (0.5%) hematological [0.08 per 100 person-years (/100PY)] and 73 (1%) nonhematological (0.17/100PY). Of the hematological malignancies, non-Hodgkin lymphoma was predominant (n = 26, 76%): immunoblastic (n = 6, 18%), Burkitt (n = 5, 15%), diffuse large B-cell (n = 5, 15%), and unspecified (n = 10, 30%). Others include central nervous system lymphoma (n = 7, 21%) and myelodysplastic syndrome (n = 1, 3%). Nonhematological malignancies were mostly Kaposi sarcoma (n = 12, 16%) and cervical cancer (n = 10, 14%). Risk factors for hematological malignancy included age >50 vs. ≤30 years [subhazard ratio (SHR) = 6.48, 95% confidence interval (CI): 1.79 to 23.43] and being from a high-income vs. a lower-middle-income country (SHR = 3.97, 95% CI: 1.45 to 10.84). Risk was reduced with CD4 351-500 cells/µL (SHR = 0.20, 95% CI: 0.05 to 0.74) and CD4 >500 cells/µL (SHR = 0.14, 95% CI: 0.04 to 0.78), compared to CD4 ≤200 cells/µL. Similar risk factors were seen for nonhematological malignancy, with prior AIDS diagnosis showing a weak association. Patients diagnosed with a hematological malignancy had shorter survival time compared to patients diagnosed with a nonhematological malignancy.

CONCLUSIONS: Nonhematological malignancies were common but non-Hodgkin lymphoma was more predominant in our cohort. PLHIV from high-income countries were more likely to be diagnosed, indicating a potential underdiagnosis of cancer in low-income settings.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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