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Cutaneous Malignancies Among HIV-Infected Persons
Nancy Crum-Cianflone, MD, MPH;
Katherine Huppler Hullsiek, PhD;
Elizabeth Satter, MD;
Vincent Marconi, MD;
Amy Weintrob, MD;
Anuradha Ganesan, MD;
R. Vincent Barthel, MD;
Susan Fraser, MD;
Brian K. Agan, MD
Arch Intern Med. 2009;169(12):1130-1138.
Background As the life expectancy of persons infected with human immunodeficiency virus (HIV) increases, cancers have become an important cause of morbidity and mortality. Although cutaneous cancers are the most common malignant neoplasms in the general population, little data exist among HIV-positive persons, especially regarding the impact of HIV-specific factors.
Methods We evaluated the incidence rates and factors associated with the development of cutaneous malignancies among HIV-infected persons by examining data that were prospectively collected from a large HIV study that included 4490 participants (1986-2006). Poisson regression and Cox proportional hazards models were performed.
Results Six percent of HIV-infected persons (n = 254) developed a cutaneous malignancy during 33 760 person-years of follow-up (mean, 7.5 years). Since the advent of highly active antiretroviral therapy (HAART), the incidence rates of cutaneous non–AIDS-defining cancers (NADCs), in particular basal cell carcinoma, have exceeded the rates of cutaneous AIDS-defining cancers such as Kaposi sarcoma. Factors associated with the development of cutaneous NADCs in the multivariate models included increasing age (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.7-2.6) and race. Compared with the white/non-Hispanic race, African Americans (HR, 0.03; 95% CI, 0.01-0.14) and other races (HR, 0.14; 95% CI, 0.03-0.57) had a lower risk of cutaneous NADCs. There were no significant associations between cutaneous NADCs and time-updated CD4 lymphocyte counts, HIV RNA levels, or receipt of HAART.
Conclusions At present, the most common cutaneous malignancies among HIV-infected persons are NADCs. Cutaneous NADCs do not appear to be significantly associated with immune function or HAART but rather are related to traditional factors such as aging and skin color.
Author Affiliations: Tri-Service AIDS Clinical Consortium, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Drs Crum-Cianflone, Hullsiek, Marconi, Weintrob, Ganesan, Barthel, Fraser, and Agan); Infectious Disease Clinic (Dr Crum-Cianflone) and Department of Dermatology (Dr Satter), Naval Medical Center San Diego, San Diego, California; Division of Biostatistics, University of Minnesota, Minneapolis (Dr Hullsiek); and Infectious Disease Clinics, San Antonio Military Medical Center, San Antonio Texas (Dr Marconi), Walter Reed Army Medical Center, Washington, DC (Dr Weintrob), National Naval Medical Center, Bethesda (Dr Ganesan), Naval Medical Center Portsmouth, Portsmouth, Virginia (Dr Barthel), and Tripler Medical Center, Honolulu, Hawaii (Dr Fraser).
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