Increased incidence of skin cancers among HIV-infected persons
Objectives: Skin cancer occurs at higher rates among immunosuppressed patients such as transplant recipients, but data are limited in HIV-infected persons. We determined the rate and predictors for skin cancer development among a large HIV cohort.
Methods: A prospective observational database (1987-2006) was evaluated for incident skin cancers among HIV-infected persons. Skin cancers were defined as cutaneous Kaposi’s sarcoma (KS), melanoma, basal cell or squamous cell carcinoma. Statistical analysis included Fisher’s exact, rank sum testing, and multivariate logistic regression.
Results: Of the 4,507 participants with 24,380 person-years follow-up, 260 (5.8%) developed skin cancer. The participants’ mean age was 29 years (range 17-75), 44% Caucasian and 45% African American. There were 201 incident cases of KS, 48 basal cell carcinoma, 13 melanoma, and 7 squamous cell; 9 patients developed more than one type of skin cancer. The incidence rate of KS significantly declined (1,590/100,000 PYs to 180/100,000 PYs) after HAART (p=0.001). The rate of non-KS skin cancers has not significantly changed since HAART (300 vs. 220/100,000 PYs, p>0.05). The overall basal carcinoma rate was 200/100000 PYs, a 2.3-fold higher rate than age, race, and sex-adjusted rates in the general population; the incidence rate of melanoma (SIR 3.1), but not squamous cell cancer (SIR 0.9), was elevated. In the multivariate model, predictors of non-KS skin cancers were male sex, white/non-Hispanic race, and increasing age (p<0.001) with a trend towards a history of HPV infection (p=0.08); CD4 counts (median 432 cells/mm3), VL, and ART were not predictive.
Conclusions: Skin cancers were predominantly due to KS in the pre-HAART era, but now are mostly basal carcinomas and melanomas, which occur at higher rates among HIV infected persons than the general population. Implementation of skin cancer screening should be considered given the aging HIV population.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
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Increased incidence of skin cancers among HIV-infected persons.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention: