People with AIDS Face Higher Risks of Esophageal, Stomach Malignancies

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(ChemotherapyAdvisor) – People with AIDS are at increased risk for developing esophageal and stomach carcinomas, including an elevated risk of gastric mucosa-associated lymphoid tissue (MALT) lymphoma, a National Cancer Institute study reported in the October 2012 issue of Gastroenterology.

“We found that people with AIDS have 69% and 44% increased risks of esophageal and stomach carcinomas, respectively, compared with the general population,” noted lead author E. Christina Persson, PhD.

Since highly active antiretroviral therapy (HAART) was introduced in 1996, survival among people with HIV has improved markedly, leading to an increase in non-AIDS-defining cancers in these individuals. Most esophageal and stomach cancers are diagnosed in those ≥65 years; therefore, investigating rates of these malignancies in individuals infected with HIV is important “in the context of the aging of the HIV population.”

Using the HIV/AIDS Cancer Match Study, which links data collected from 1980 to 2007 for 16 US population-based HIV and AIDS and cancer registries, they compared risks of stomach and esophageal malignancies in 596,955 people with AIDS with those of the general population.

People with AIDS had an increased risk of carcinoma of the esophagus (standardized incidence ratio [SIR] 1.69; 95% CI, 1.37–2.07; n=95) and stomach (SIR 1.44; 95% CI, 1.17–1.76; n=96). Risk was also increased for esophageal adenocarcinoma (SIR, 1.91; 95% CI, 1.31–2.70) and squamous cell carcinoma (SIR, 1.47; 95% CI, 1.10 –1.92), the investigators reported.

Compared with the general population, people with AIDS had greater risks of carcinomas of the gastric cardia (SIR, 1.36; 95% CI, 0.83–2.11) and noncardia (SIR, 1.53; 95% CI, 1.12–2.05).

“Although most stomach and esophageal non-Hodgkin lymphomas (NHL) that developed in people with AIDS were diffuse large B-cell lymphomas, these individuals also had an increased risk of stomach MALT lymphoma (SIR, 5.99; 95% CI, 3.19–10.2; n=13),” Dr. Persson stated.

Incidence of carcinomas remained fairly constant over time; however, NHL rates decreased from 1980 to 2007 (Ptrend <0.0001).

“…The incidence of esophageal and stomach carcinomas has not declined with the introduction of HAART,” they concluded. In the clinical setting, additional efforts to implement tobacco cessation and moderation of alcohol use may have an effect in reducing the occurrence of esophageal and stomach carcinomas."

“Further research on the epidemiology of H pylori infection in HIV-infected people, and its relation to HAART use, would also be of value.”

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