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Title: HIV infection and non-melanoma skin cancer risk
Authors: Silverberg MJ,  Leyden W,  Warton E,  Engels EA,  Asgari MM
Journal: J INVEST DERMATOL
Date: 2011 Apr
Branches: IIB
PubMed ID:
PMC ID: not available
Abstract: HIV patients have a higher risk of several cancers, particularly those with known viral etiology, such as Kaposi sarcoma and anal cancer. However it is unknown whether non-melanoma skin cancers (NMSCs) are also increased since cancer registries typically do not record these cancers. We identified all adult HIV+ members of white race (n=6,567)and age-, sex- and race-matched HIV individuals (n=36,887) enrolled in Kaiser Permanente Northern California (KPNC), an integrated health system caring for over 3 million Californians. NMSC diagnoses, identified through review of KPNC pathology records, included the first biopsy-proven basal cell carcinoma (BCC, n=2,078) and squamous cell carcinoma (SCC, n=626) from 1996-2008. The cohort was followed from first KPNC enrollment after 1996 until the earliest skin cancer diagnosis, loss to follow-up, or 12/31/2008. Adjusted rate ratios (aRR) were obtained from Poisson regression models with adjustment for age, sex, tobacco use, obesity and census-based median household income. The HIV+ cohort was 89% male, 72.2% men who have sex with men, with a mean age of 42.2 years. BCC occurrence per 100,000 person-years was 1,188 for HIV+ subjects and 661 for HIV- subjects, corresponding to an aRR of 2.0 (95% CI: 1.8-2.3; P<0.001). SCC occurrence was 410 for HIV+ subjects and 186 for HIVsubjects, yielding an aRR of 2.6 (95% CI: 2.1-3.1; P<0.001). SCC risk was increased in HIV+ men and women equally (p-interaction = 0.90), but BCC risk was increased in HIV+ men only (p-interaction = 0.041). The higher rate of NMSCs in HIV+ individuals may be due, in part, to alterations in the immune system, although other explanations such as a screening bias, or differential risk behaviors, such as increased sun exposure, need further exploration.