# Presentation: 509368

## CANCER IN PERSONSWITH HIV/AIDSCurrent status

**James J. Goedert, M.D.**
**Viral Epidemiology Branch**
**National Cancer Institute, NIH, DHHS**

## Outline

**Incidence of KS**
**The HIV/AIDS epidemic**
**AIDS Cancer Match Registry (ACMR)**
**Cancer in the HAART era**
**Future implications**

## Initial Report of AIDS-KS

## Eltom MA, et al. J Natl Cancer Inst 2002; 94:1204-1210.

**Eltom MA, et al. J Natl Cancer Inst 2002; 94:1204-1210.**

- Centers for Disease Control and Prevention

## AIDS-Cancer Match Registry(ACMR)

**Background, funding**
**NCI intramural (VEB), 1992 – present**
**Objectives**
**Cancer risk in PWHA**
**Clues to cancer etiology from patterns**

## ACMRmethods developed*

**Matching**
**Prevalence (pre-AIDS risk)**
**Trend (AIDS-relative time)**

***Lancet 1998;351:1833; J Natl Cancer Inst 2000;92:1500; JAMA 2001;285:1736.**

## AIDS: KS, NHL, cervix (?)
Increased, unclear why:
Anal
Hodgkin lymphoma
Liver, lung, oral
Testis, myeloma, lip
Hypotheses
Immunosuppression?
Lifestyle?    Other?

**Increased, unclear why:**
**Anal**
**Hodgkin lymphoma**
**Liver, lung, oral**
**Testis, myeloma, lip**
**Hypotheses**
**Immunosuppression?**
**Lifestyle?    Other?**

***Lancet 1998;351:1833;**
**J Natl Cancer Inst 2000;92:1500;**
**JAMA 2001;285:1736.**

***ACMR results****

## ACMR current

**465,708 PWA matched in 2003-2005**
**NYC, LA, SF, OC, San Diego, Seattle**
**	****FL, NJ, GA, MA, CO, CT, MI**
**PWH also matched**
**81% male**
**39% White, 39% Black, 21% Hispanic**
**43% MSM, 27% IDU, 11% heterosexual**
**Year of AIDS**
**Pre-90 (19%), 90-95 (42%), 96+ (39%)**

## AIDS-Cancer Match RegistryAge distribution

**AIDS-Cancer Match Registry****Age distribution**

## AIDS-Cancer Match RegistryAge distribution

**AIDS-Cancer Match Registry****Age distribution**

## Objective: Effect of HAART

**Changes in cancer spectrum**
**Persistent excesses**
**Emerging malignancies**
**Novel associations in subpopulations, long-term survivors**
**Survival with both cancer & AIDS**

## AIDS-Cancer Match RegistryAnalysis challenges

**Calendar year**

**1996**

**1980**

**2003**

**HAART era**

**AIDS**

**AIDS**

**AIDS**

**AIDS**

## Goedert JJ, et al. Proc Am Assoc Cancer Res 2005:abstract 506.

**Goedert JJ, et al. Proc Am Assoc Cancer Res 2005:abstract 506.**

## * N=76 cancer cases

**Goedert JJ, et al. Proc Am Assoc Cancer Res 2005:abstract 506.**

## Cancer in the HAART Era*

**KS and NHL risk greatly reduced**
**NHL reduction less than KS**
**KS and NHL still greatly above the population**
**Hodgkin risk may be increasing**
**Unexplained.**
**Continued excess with known causes**
**Lung Ca, smoking**
**Liver Ca, hepatitis**
**Cervix & anus Ca, HPV**
**Short follow-up, many open issues**

***Engels EA, Goedert JJ.**
**J Natl Cancer Inst 2005; 97:407-409.**

## Increasing cancer mortality*

**Pre-HAART, 10% of deaths from cancer**
**Year 2000, 28% of 964 deaths from cancer**
**11% NHL**
**4% KS**
**0.5% cervix**
**5% lung**
**2% liver**
**1.2% Hodgkin**

***Bonnet  F, et al. Cancer 2004; 101:317-324.**

## Future issues - 1

**AIDS-Cancer Match Registry **
**Re-match every 3-4 years**
**Collaborative studies of selected cancers**
**AIDS-Cancer epidemic in Africa, Asia**
**KS most common malignancy in Uganda & South Africa**
**Kampala, Uganda AIDS-Cancer Match completed, in analysis**

## Future issues - 2

**Long-term HAART with aging**
**Persistent immune perturbation**
**Increasing risk of common cancers**
**HIV & aging interaction**
**Areas of emphasis**
**Diagnosis & treatment**
**Cancer prevention **
**smoking cessation, vaccination, cervix screening**
**Carcinogenesis research**
**Novel treatments**

## Keys to cancer prevention

**Prevent HIV transmission**
**Diagnose and treat HIV infection**

## Prognosis

**The population of people with both HIV/AIDS and cancer will continue to increase and to present complex challenges.**