Differing Pattern of HIV-Associated Cancers Seen in India

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Differing Pattern of HIV-Associated Cancers Seen in India

By C. Vidya Shankar, MD

CHENNAI, India (Reuters Health) Apr 03 - The spectrum of AIDS-

defining and non-defining cancers in HIV patients is different in

India as compared to the west, according to the results of a study

published in the March issue of Cancer Causes & Control.

The paucity of data from India on HIV-associated cancers prompted Dr.

Aruna Dhir and her team from the Tata Memorial Hospital, Mumbai to

examine the distribution of disease among 251 HIV-positive cancer

patients treated in their hospital between 2001 and 2005.

The proportional incidence ratio (PIR), a measure of the excess

incidence of cancers among HIV-infected patients as compared to

reference standards, was calculated for the various cancers.

Unlike in the Western countries, there were no patients with Kaposi's

sarcoma in their series, Dr. Dhir and her colleagues report. Non-

Hodgkin's lymphoma and cervical cancer among AIDS-defining cancers

and cancers of testes, vagina, colon, anal canal, head and neck among

non-AIDS-defining cancers were more common among HIV-positive

patients.

The incidence of breast cancer was not higher among HIV-positive

patients, they add.

Specifically, among the 110 patients with AIDS-defining cancers, the

PIR for non-Hodgkin's lymphoma was 17.1 and 10.3 among males and

females respectively, while the PIR for cervical cancer was 4.1, the

researchers observed.

Access to antiretrovirals may explain the lower incidence of non-

Hodgkin's lymphoma in the USA, they explain.

Unlike in the United States, the prevalence of non-AIDS-defining

cancers was greater than the AIDS-defining cancers, the researchers

note, and a majority of the 141 patients with non-AIDS-defining

cancers were not immunosuppressed. " Lifestyle habits and coinfections

with viruses like human papilloma virus may play a more important

role in the development of non-AIDS-defining cancers than HIV-induced

immune suppression, " Dr. Dhir's team postulates.

As for the absence of Kaposi's sarcoma, " The Indian population

probably has a low prevalence of HHV-8, " Dr. Dhir told Reuters

Health, " thus explaining the low incidence of Kaposi's sarcoma in our

patients with HIV. "

When asked about the need for universal cancer screening of HIV-

infected individuals, Dr. Dhir said, " The screening of cancer in

HIV/AIDS patients is not justified based on the current data. "

However, the role of selective screening for cervical cancer and use

of the human papilloma virus vaccine among HIV-positive women needs

further evaluation, the researchers conclude.

Cancer Causes Control 2008;19:147-153.

http://www.medscape.com/viewarticle/572497