AUGUSTA, GA — Patients with HIV and/or end-stage renal disease receiving dialysis appear to have an increased risk of developing malignancies, but little research has been conducted on cancer in patients with both conditions.
A study in Clinical Kidney Journal sought to determine the incidence of selected malignancies and identify their potential risk factors in HIV-infected dialysis patients.
Researchers from the Charlie Norwood VAMC and the Medical College of Georgia at Augusta University conducted a nationwide cohort analysis using the U.S. Renal Data System. Participants included all HIV-infected patients starting dialysis from 2005 to 2011. HIV status, comorbidities and malignancies were identified using International Classification of Diseases, Ninth Revision codes, while descriptive statistics and generalized linear models quantifying risk factors were performed for the overall cohort and the three most common malignancies. Ultimately, 6,641 HIV-infected dialysis patients were identified, with 543 (8.2%) having been diagnosed with a malignancy. Most common were non-Hodgkin’s lymphoma (NHL, 25%), Kaposi sarcoma (KS, 16%) and colorectal cancer (13%).
The researchers determined that factors increasing the risk of any malignancy diagnosis included:
- history of cancer [adjusted relative risk (aRR) = 5.37],
- two or more acquired immunodeficiency syndrome-defining opportunistic infections (ADOIs) (aRR = 3.11),
- one ADOI (aRR = 2.23),
- cirrhosis (aRR = 2.20),
- male sex (aRR = 1.54) and
- hepatitis B (aRR = 1.52).
For NHL and colorectal cancer, history of cancer (aRR = 7.05 and 9.80, respectively) were the most significant risk factors, according to the report. For KS, meanwhile, two or more ADOIs (aRR = 6.78) was the largest risk factor.
“Over 8% of HIV-infected dialysis patients developed a malignancy,” the authors concluded. “History of cancer and ADOIs were major risk factors, underscoring the significance of immune dysregulation in malignancy development.”
Background information in the article noted that HIV patients are at increased risk of developing NHL, KS, and invasive cervical cancer, collectively termed as AIDS-defining cancers (ADCs).
“With the advent of more effective combination antiretroviral therapy (cART) and the associated increases in survival, non-AIDS-defining cancers, including anal cancer, Hodgkin’s lymphoma, hepatocellular carcinoma, renal carcinoma and lung cancer, have emerged as threats among HIV-infected people,” the authors explained.
Patients on dialysis also have an increased risk of malignancy, according to the study, renal carcinoma, bladder carcinoma, breast cancer, NHL, and colorectal cancer. “Although HIV and ESRD have clearly distinct pathophysiologies, connections between the two have been established,” researchers pointed out. “Kidney dysfunction is a common complication of HIV infection, attributable to both the adverse renal effects of commonly prescribed antiretroviral therapy as well as the direct nephrotoxic effects of the virus. Moreover, ESRD is a potential late-stage complication of HIV infection usually secondary to HIV-associated nephropathy.”
The study emphasized that a sizeable cohort of HIV-infected patients live on dialysis, “We theorized that concurrent HIV infection and ESRD requiring dialysis may interact synergistically to potentiate the risk of malignancy. To address this question, we investigated the incidence and risk factors for specific malignancies among a large national cohort of HIV-infected dialysis patients. The results of this work may heighten awareness and improve screening efforts and management strategies of common cancers within this at-risk group.”
- Mihir Patel, Jennifer L Waller, Stephanie L Baer, Vanessa Spearman, Mufaddal Kheda, Lufei Young, Stan Nahman, Rhonda E Colombo, Cancer incidence and risk factors in dialysis patients with human immunodeficiency virus: a cohort study, Clinical Kidney Journal, , sfz191, https://doi.org/10.1093/ckj/sfz191