METHODS: Data were linked using methods similar to those described in the US HIV Cancer Match Study. Georgia HIV surveillance data from January 1, 2004 to December 31, 2012 were analyzed to describe the characteristics of Georgia PLWH. Incidence of ADC and NADC in the GA HIV infected population was calculated and expressed per 100,000 person-years of follow-up. Cancer incidence was stratified by sex, current age, and HIV-only vs AIDS population. Changes in crude cancer incidence were evaluated between 2004-2007 and 2008-2012.
RESULTS: From 2004-2012, 347,892 person-years of follow-up were contributed by PLWH in Georgia and 2,354 HIV-infected individuals were diagnosed with malignant cancer. Incidence rates of cancer in PLWH was higher in males (rate [r] =735.5, n=1,897), whites (r=899.0, n=683) and 60+ years age group (r=1742.3, n=362). The highest incidence of cancers in PLWH were non-Hodgkins lymphoma (r=142.0, n=494), Kaposis Sarcoma (r=125.6, n=437), breast (female only) (r=78.1, n=69), lung (r=76.8, n=267), prostate (r=66.3, n=171), cervical (r=46.4, n=41), anal (r=44.6, n=155), colorectal (r=26.4, n=92) and liver cancers (r=23.9, n=83). From 2004-2007 there were 126,113 person-years of follow-up, while from 2008-2012 there were 221,716. Incidence of AIDS defining cancers decreased from 2004-2007 to 2008-2012 (r=319.6 to r=256.6 p-value: <.001). However, NADC incidence increased, but not significantly (r=353.7 to r=380.7 p-value: 0.21) and was primarily driven by increases in the number of breast, colorectal, liver, prostate, and vulvar cancers.
CONCLUSIONS: ADCs are decreasing in PLWH, likely a result of expanded uptake of HAART. Changes in NADC were heterogeneous, similar to trends seen in national analyses. Further analysis accounting for the changing age distribution of PLHW and increasing viral suppression is needed to better understand the changes observed. Cancer trends in the HIV population are complex and our results support efforts for ongoing linkage of these data to monitor trends. As the HIV population ages, data linkages become essential for determining cancer burden in this special population, to assist in the development of targeted screenings, interventions, and survivor care plans.