Background: HPV is associated to cancer of the cervix, anus, vulva, vagina, penis, oral cavity and oro-pharynx. Studies in Puerto Rico (PR) and in the United States (US) have documented that HPV infection and HPV-related cancers are higher in persons living with HIV/AIDS (PLHA) than in the general population. After 30 years of the HIV/AIDS epidemic, cancer research in the HIV/AIDS population is highly warranted. However, in PR, a minority population with a disproportionate burden of HIV/AIDS as compared to the US, data on the burden of HPV-related cancers among HIV/AIDS patients is still limited. Primary aim: This study estimated the hazard ratio of death among PLHA in PR, by sex, age at AIDS diagnosis and cancer status.

Methods: A total of 29,535 (96%) of all the AIDS cases reported to the PR AIDS Surveillance system between 1985 and 2005, aged ≥15 years, were eligible for analysis. The PR AIDS Surveillance and PR Central Cancer Registry databases were linked using Link Plus v.2.0 software. Invasive cancers were coded according to the ICD-O3 and analyzed using the SEER programs. Only invasive cancer cases that was developed > 3 months after AIDS diagnosis were considered. Survival by age at AIDS diagnosis, sex and cancer status (no cancer, HPV-related cancer, non-HPV related cancer) was estimated using Kaplan-Meier method, and survival curves were compared using the Long-Rank test. A Cox-proportional hazards model was used to estimate the hazard ratio of death with 95% CI. Confounding and interaction assessment was performed in this model. In addition, the proportional hazards assumption was tested. The STATA System release 11.0 (STATA Corp, College Station, TX, USA) was used for the statistical analysis.

Results: Women (median: 39 months, 95% CI: 35–42) had a longer observed survival than men (median: 21 months, 95% CI: 20–22) (p<0.001). Median survival time differed by cancer status, being high among persons who did not developed cancer (median: 25 months, 95% CI: 24–26), than among those with HPV-related (median: 16 months, 95% CI: 11–26) and non-HPV related cancers (median: 7 months, 95% CI: 6–9) (p<0.001). Among males, the hazard ratio of death was higher among those with non-HPV related cancers (HR: 1.62, 95% CI: 1.46–1.79) and those with HPV-related cancers (HR: 1.22, 95% CI: 0.85–1.76), after adjusting for age at AIDS diagnosis. Among women, a higher risk of death was only observed for those with non-HPV related cancers (HR: 1.97, 95% CI: 1.53–2.54) as compared to those without cancer.

Conclusions: As expected, our study provides evidence of decreased survival of PLHA patients who develop cancer, as compared to those who do not develop any malignancies. This supports the important of strengthening cancer screening as well as behavioral and clinical interventions in this population, in order to have an impact on disease survival, and potentially in the quality of life of PLHA populations in PR.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A77.

Copyright © September 18, 2011, American Association for Cancer Research
2011