Higher rate of cancer, all-cause mortality among teens, young adults with perinatally acquired HIV
Teenagers and young adults living with perinatally acquired HIV (PaHIV) have a higher risk of developing malignancies and a higher all-cause mortality rate than their non-HIV-infected peers, according to a study from the UK.
This retrospective cohort study population comprised 290 teenagers and young adults (aged 10–24 years) living with PaHIV who received care at the Imperial College London, UK, between January 2004 and December 2017. Their malignancy and mortality rates were compared with that of their age-matched peers in the general population based on data from the UK Office of National Statistics and Cancer Research UK.
Eight patients (2.8 percent) were diagnosed with malignancy between the ages of 10 and 24 years (median age at diagnosis 19 years, median CD4 count 453 cells/μL, median CD4 nadir 220 cells/μL, 50 percent with viral load <50 copies/mL), seven of whom were male. Six of these cancers were lymphoma (Hodgkin’s lymphoma [n=3], B-cell lymphoma [n=2], and Burkitt lymphoma [n=1]), with the other two patients diagnosed with hepatocellular carcinoma and gastrointestinal adenocarcinoma, respectively. [AIDS 2018, abstract THAB0104]
Malignancy incidence among teenagers and young adults with PaHIV was 3.0 per 1,000 person-years compared with 0.2 per 1,000 person-years in the age-matched general population (incidence rate ratio [IRR], 12.9, 95 percent confidence interval [CI], 5.6–25.5; p<0.0001). The elevated incidence rate was driven primarily by the higher incidence of Hodgkin’s lymphoma (IRR, 33.2, 95 percent CI, 6.8–97.8; p<0.0001) and non-Hodgkin’s lymphoma (IRR, 69.0, 95 percent CI, 14.1–204.8; p<0.0001) among those with PaHIV compared with the age-matched general population.
At time of cancer diagnosis, viral load had been detectable for a median 15 years at a median 16,004 c/mL, with four patients having a detectable viral load at cancer diagnosis. While all patients who developed malignancy had access to antiretroviral therapy (ART), six of them had a history of poor adherence to ART.
Six deaths occurred over the course of the study, three of which were due to malignancy (one each due to non-Hodgkin’s lymphoma, hepatocellular carcinoma, and gastrointestinal adenocarcinoma) with a median age of 17 years at death. The other deaths were due to end-stage HIV related to lack of adherence to ART (n=2, age 19 and 20 years) and cryptococcal meningitis (n=1, age 15 years).
At 2.3 per 1,000 person-years, the overall mortality rate among teenagers and young adults with PaHIV was higher than that of their peers in the general population (0.2 per 1,000 person-years; IRR, 9.4, 95 percent CI, 3.4–20.4; p<0.0001).
“Adolescents are the only age group in which HIV-related mortality continues to rise,” said study author Dr Srishti Chhabra from Imperial College London, who presented the findings at AIDS 2018.
“Adults living with HIV are at increased risk of both AIDS and non-AIDS defining malignancies [with] suppressive ART markedly reduc[ing] the risk of AIDS defining malignancies in adults,” she said. [Lancet HIV 2017;4:e495-e504]
“In our cohort, the incidence of death was nine times and the incidence of malignancy nearly 13 times that of the UK age-matched general population. It is hoped that early, sustained suppressive ART will reduce the excess risk of malignancy in this cohort,” she said.