Acquired immunodeficiency syndrome, also known as AIDS, is caused by infection with the human immunodeficiency virus (HIV). HIV affects and weakens the immune system, which defends the body from infection and disease over time. People who have a compromised immune system are more likely to contract additional illnesses and develop some types of cancer.
Researchers from Case Western Reserve University discovered that men living with HIV (MLWH) suffer roughly twice as many cancers as men who do not have the human immunodeficiency virus. Cancer rates are considerably greater in men with symptomatic HIV.
The researchers based their findings on national Medicaid data, which comprised more than 82,000 MLWH and more than 7 million HIV-free men. Anal cancer was the most common type of cancer in both symptomatic and asymptomatic MLWH. The highest incidence of cancer in MLWH were found in Hispanic MLWH.
The study, “Excess Cancer Prevalence in Men with HIV: A Nationwide Analysis of Medicaid Data,” was funded by the Case Comprehensive Cancer Center and was published earlier this week in the online early view issue of Cancer, an American Cancer Society publication. The report was accompanied by an editorial titled “An ounce of prevention: Medicaid’s contribution in decreasing the burden of cancer in HIV-infected males.”
Our findings underline the relevance of the Medicaid program’s efforts to promote healthy behaviors and immunization against human papillomavirus in children and adolescents, as well as customized cancer screening.
Siran Koroukian
“Medicaid plays a critical role in insuring people with HIV,” said Siran Koroukian, a professor in the Department of Population and Quantitative Health Sciences at Case Western Reserve University School of Medicine and the director of the Case Comprehensive Cancer Center’s Population Cancer Analytics Shared Resource. “Our findings underline the relevance of the Medicaid program’s efforts to promote healthy behaviors and immunization against human papillomavirus in children and adolescents, as well as customized cancer screening.”
Koroukian was joined as co-lead author in this study by Guangjin Zhou, PhD, doctoral candidate in the CWRU Clinical Translational Science program, Center for Clinical Investigation, and also joined by co-authors Johnie Rose, MD, PhD, co-director of the Case Comprehensive Cancer Center’s Population Cancer Analytics Shared Resource, and Gregory S. Cooper, MD, MA, professor in CWRU’s Department of Medicine and co-leader, Case Comprehensive Cancer Center’s Cancer and Prevention Program.
Human immunodeficiency virus (HIV) infection is a risk factor for cancer. HIV-associated malignancies are classified as either AIDS-defining cancers (ADC) or non-AIDS-defining cancers (NDC) (NADC). The advent of efficient antiretroviral medication (ART) has reduced the incidence of cancer, but it has also increased the life expectancy of those living with HIV. As a result, the overall incidence of cancer and AIDS-defining malignancy has stabilized over the previous two decades (save for invasive cervical cancer), despite an absolute increase in NADC. HIV-associated malignancy is one of the top causes of death among HIV patients.
In addition to anal cancer, scientists discovered an increase in the prevalence of lymphoma and rectal malignancies. They observed that excess cancer prevalence is owing in part to HIV-related rapid aging, as well as the prevalence of other (non-HIV) cancer risk factors, such as smoking and exposure to oncogenic viruses known to cause particular cancers, such as human papillomavirus (HPV).
The accompanying editorial, written by Cathy J. Bradley of the Colorado School of Public Health and Lindsay M. Sabik of the University of Pittsburgh School of Public Health, emphasizes the importance of addressing known risk factors, the need for continued use of antiretroviral therapies, and promoting HPV vaccination, even later in life. It also underlines the necessity of using these data to influence policy measures such as programs to assure ongoing Medicaid enrollment, physician reimbursement policies to improve cancer screening, and reducing the cost of pricey pharmaceuticals used to treat both disorders.
According to the authors, the excess cancer prevalence in MLWH should be viewed with the awareness that many persons enroll in Medicaid after being diagnosed with a catastrophic illness such as cancer. They stress the significance of supplementing Medicaid data with cancer registry data in order to understand more about when cancer is diagnosed in relation to Medicaid enrollment and HIV diagnosis. They suggest that such a robust data infrastructure would facilitate the investigation of the cancer stage at diagnosis and related survival outcomes.
