Abstract 5302: Projections of cancer incidence and burden among the HIV-positive population in the United States through 2030
Authors: Islam Jessica Y. , Rosenberg Philip S. , Hall H Irene , Jacobson Evin U. , Engels Eric A. , Shiels Meredith S. 
Published: July 2017

Background: People living with HIV (PLWH) are at an elevated risk of several cancer types. With widespread use of highly active antiretroviral therapy (HAART) to treat HIV, survival has improved among PLWH, resulting in an aging U.S. HIV population. Though HAART use has reduced the risk of certain cancers, in the near future, a larger fraction of PLWH will reach age groups where cancer risks are further elevated, potentially shifting the distribution of cancers in the population. Here, we projected cancer incidence rates and burden among U.S. PLWH through 2030 for Kaposi sarcoma, non-Hodgkin lymphoma (NHL) and cervical cancer (3 AIDS-defining cancers [ADCs]), and anal, breast, colon, lung, liver, prostate and oral cancers, Hodgkin lymphoma and all other cancers combined (all non-AIDS-defining cancers [NADCs]).

Methods: We used cancer incidence data (2000-12) collected from the HIV/AIDS Cancer Match Study, a record linkage study of HIV and cancer registries. Using Poisson regression, we estimated cancer incidence rates in PLWH stratified by age group and, for some cancers, risk group (e.g., men who have sex with men, people who inject drugs) during 2013-30. The number of PLWH in the U.S. by age, risk group and calendar year (2006-30) was estimated using a dynamic compartmental model. To estimate cancer burden, observed and projected incidence rates and HIV population counts were multiplied.

Results: The proportion of the total U.S. HIV population that is aged ≥65 years is projected to increase from 4.1% (of 1.06 million) in 2006 to 21.4% (of 1.09 million) in 2030. Based on significant declines during 2000-12, age-specific rates are projected to decrease across age groups for NHL, cervical cancer, lung cancer and all other cancers, and for some age groups for KS, Hodgkin lymphoma and colon cancer. All other age-specific rates did not change significantly, with the exception of prostate cancer rates, which are projected to continue to increase. We estimated that the total cancer burden in PLWH will decrease from 7908 cases in 2010 (2719 ADC and 5190 NADC) to 6495 cases in 2030 (701 ADC and 5794 NADC), indicating a strong decrease in ADCs and a slight increase in NADCs. In 2030, the most common cancers among PLWH will include: prostate (n=1624), lung (n=786), liver (n=498) and anal cancers (n=447) and NHL (n=429).

Conclusions: Though cancer rates are generally decreasing, cancer will remain an important co-morbidity as the U.S. HIV population ages. If recent trends in cancer incidence continue into the future, the burden of NADCs, particularly prostate, lung, liver and anal cancers, will far exceed the burden of ADCs in 2030. Targeted cancer prevention, early detection and control efforts are needed for PLWH in the U.S., including smoking cessation, treatment of hepatitis C and B viruses, cancer screening and continued widespread treatment with HAART.

Citation Format: Jessica Y. Islam, Philip S. Rosenberg, H Irene Hall, Evin U. Jacobson, Eric A. Engels, Meredith S. Shiels. Projections of cancer incidence and burden among the HIV-positive population in the United States through 2030 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5302. doi:10.1158/1538-7445.AM2017-5302