Incidence and risk factors of HPV-related and HPV-unrelated Head and Neck Squamous Cell Carcinoma in HIV-infected individuals

• Published in: Oral oncology 2014-12, Vol.50 (12), p.1169-1176
• Main Authors: Beachler, Daniel C, Abraham, Alison G, Silverberg, Michael J, Jing, Yuezhou, Fakhry, Carole, Gill, M. John, Dubrow, Robert, Kitahata, Mari M, Klein, Marina B, Burchell, Ann N, Korthuis, P. Todd, Moore, Richard D, D’Souza, Gypsyamber
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Carcinoma, Squamous Cell - epidemiology; Case-Control Studies; CD4 Lymphocyte Count; CD4 T cell count; Female; Head and Neck Neoplasms - epidemiology; Head and Neck Squamous Cell Carcinoma; Hematology, Oncology and Palliative Medicine; HIV; HIV Infections - epidemiology; HPV; Human immunodeficiency virus; Human viral diseases; Humans; Incidence; Infectious diseases; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); NA-ACCORD; North America - epidemiology; Oropharyngeal cancer; Otolaryngology; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Papillomavirus Infections - epidemiology; Poisson Distribution; Prospective Studies; Risk Factors; Tumors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 1368-8375; 1879-0593; 1879-0593
• DOI: 10.1016/j.oraloncology.2014.09.011

Summary Objectives To examine the risk and trends of HPV-related and HPV-unrelated Head and Neck Squamous Cell Carcinoma (HNSCC) in HIV-infected individuals and assess whether immunosuppression (measured through CD4 cell count) and other risk factors impact HNSCC risk. Materials and methods Incident HNSCCs at HPV-related and HPV-unrelated anatomic sites were detected in HIV-infected participants from pooled data from 17 prospective studies in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) between 1996 and 2009. HNSCC cases were validated using chart review or cancer registry matching. Risk factors for incident HPV-related and HPV-unrelated HNSCC were explored using mixed effects Poisson regression in a full prospective analysis, and the effect of CD4 prior to cancer diagnosis was examined in a nested case control analysis. Results 66 HPV-related and 182 HPV-unrelated incident HNSCCs were detected among 82,375 HIV-infected participants. Standardized incidence ratios (SIRs) for both HPV-related (SIR = 3.2, 95%CI = 2.5–3.4) and HPV-unrelated (SIR = 3.0, 95%CI = 2.5–4.1) HNSCC were significantly elevated in HIV-infected individuals compared with the US general population. Between 1996 and 2009, the age-standardized HPV-related HNSCC incidence increased non-significantly from 6.8 to 11.4 per 100,000 person-years ( p -trend = 0.31) while the age-standardized incidence of HPV-unrelated HNSCC decreased non-significantly from 41.9 to 29.3 per 100,000 person-years ( p -trend = 0.16). Lower CD4 cell count prior to cancer diagnosis was significantly associated with increased HPV-related and HPV-unrelated HNSCC risk. Conclusion The standardized incidence of HPV-related and HPV-unrelated HNSCC are both elevated in HIV-infected individuals. Immunosuppression may have a role in the development of both HPV-related and HPV-unrelated HNSCC.