NEW YORK—Non-AIDS defining cancers are increasingly important contributors to health outcomes for aging persons with HIV (PWH), according to a recent conference presentation which also pointed out that, although prostate cancer is prevalent in aging men, the impact of HIV infection on prostate cancer risk remains unclear and could be obscured by less screening in PWH.
To help determine if that is the case, the study presented at the 2019 Conference on Retroviruses and Opportunistic Infections, held in Seattle, sought to determine longitudinal prostate cancer screening, incidence, and disease characteristics in the Veterans Aging Cohort Study, a national cohort of PWH and uninfected controls.1
The study team, led by researchers from Yale University but with results presented by researchers from Icahn School of Medicine at Mt. Sinai, used data from VACS (2000-2015) to identify a cohort of 119,336—36,333 PWH and 83,003 controls—men 45 and older.
Researchers determined PSA testing and prostate biopsy rates using relevant procedure codes, as well as incident prostate cancer diagnoses using linked cancer registry data. Mean age at enrollment was 50 years, and patients were followed for a median of 15 years. Most received at least one screening PSA test in the study period, including PWH, 85% ever tested, and controls, 92% ever tested. Prostate cancer was diagnosed in 966 PWH and 2,778 controls, according to the study.
Results indicated that the adjusted incidence of PSA testing over the study period was lower among PWH (IRR 0.80, 95% CI 0.79-0.81). Among PSA tested persons, HIV infection was associated with similar incidence of subsequent prostate biopsy (IRR 0.97, 95% CI 0.93-1.00).
At the same time, researchers noted, The incidence of prostate cancer was lower in PWH (IRR 0.86, 95% CI 0.77-0.91), including upon restriction to only individuals who received PSA testing (IRR 0.90, 95% CI 0.82-0.98). Among patients diagnosed with prostate cancer, there was a trend toward higher Gleason grade (p=0.10) and distant disease (p=0.09) among PWH that did not reach predefined thresholds for statistical significance.
“In longitudinal follow-up, there was a lower incidence of prostate cancer among PWH compared with matched controls but some suggestion of differences in grade and stage at diagnosis,” study authors concluded. “Further study is warranted to understand the role of HIV status on prostate cancer treatment and outcome.”
1 Leapman MS, Park LS, Stone K, et al. Prostate cancer screening and incidence in aging veterans with HIV. Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2019. Seattle. Abstract 1072.