In general, the high incidence and strong persistence of HPV infections among HIV-infected patients are a result of immunosuppression.
Ana Patricia Ortiz, MPH, PhD
Hispanic adults in the US who are infected with human immunodeficiency virus face a greater risk of cancers caused by human papillomavirus (HPV) than Hispanics in the general public, a new study has found.
“We confirmed that consistent to what has been seen in other racial/ethnic groups, HIV-infected Hispanics in the United States also have higher rates of most HPV-related cancers than Hispanics from the general population,” lead author Ana Patricia Ortiz, MPH, PhD, of the University of Puerto Rico’s Comprehensive Cancer Center, told MD Magazine®.
The highest excess risk was observed for anal cancer, Ortiz said, highlighting the increased burden of this malignancy among HIV-infected individuals.
In general, the high incidence and strong persistence of HPV infections among HIV-infected patients are a result of immunosuppression. This, in turn, leads to carcinogenesis and tumor development.
To zero in on Hispanics, Ortiz and colleagues from the National Cancer Institute and other US cancer centers reviewed data from the HIV/AIDS Cancer Match Study collected by state registries. Investigators considered both the incidence and survival rates among Hispanics, non-Hispanic whites (NHW) and non-Hispanic blacks (NHB).
Among Hispanics living with HIV, there were 502 HPV-related cancer diagnoses during 864,067 person-years of follow-up. Except for oropharyngeal cancer, the risk of HPV-related cancers was higher among HIV-infected Hispanics than in the general population, investigators noted.
When the researchers compared Hispanics with HIV to NHWs and NHBs with HIV, they found that the Hispanics had higher rates of cervical and penile cancer.
“This is interesting as you could expect that given immunosuppression in HIV-infected individuals, disparities in HPV-related cancer rates across racial/ethnic groups could diminish,” Ortiz said. “But in fact, study findings showed that independent of HIV infection, disparities in cervical and penile cancer rates among Hispanics persist among HIV-infected individuals.”
At the same time, HIV-infected Hispanic women had lower risks of vulvar cancer than the 2 non-Hispanic groups. And Hispanic men had lower risk of anal cancer than their non-Hispanic counterparts.
There were no major differences in survival rates among race or ethnic groups. About half of HIV-infected patients across all HPV-related cancer types survived at least 5 years, the data showed.
“Similar to what is observed among other racial/ethnic groups in the US, HIV-infected Hispanics have elevated rates of most HPV-related malignancies as compared to Hispanics from the general population,” Ortiz said.
Ortiz suggested that, although disparities in the incidence rates of HPV-related cancers among HIV-infected individuals across patient groups in the US could reflect real-life disparities, their causes warrant further research.
“Biological and/or social factors, beyond HPV and HIV infection, may contribute to these disparities,” she noted.
For one thing, Hispanic people living with HIV (PLWH) face suboptimal care as do Hispanics in the general population, the authors wrote. In addition, the use of antiretroviral therapy (ART) and the prevalence of viral suppression are lower among HIV-infected Hispanics and non-Hispanic blacks in the US.
Ortiz stressed the value of vaccination and screening.
“HIV-infected patients should talk to their doctor about the HPV vaccine and available screening methods for the prevention of HPV-related cancers, and request these within their clinical regimen,” she said.
Physicians should make the same suggestions to their HIV patients.
“Given the excess risk of anal cancer in HIV-infected individuals, it is very important to continue to develop and implement appropriate anal cancer screening for this population,” she said.
The study, "Disparities in human papillomavirus—related cancer incidence and survival among human immunodeficiency virus–infected hispanics living in the United States," was published online in Cancer.