Incidence of Lymphomas and Other Cancers in HIV-Infected and HIV-Uninfected Patients With Hemophilia

Charles S. Rabkin, Margaret W. Hilgartner, Katie W. Hedberg, Louis M. Aledort, Angelos Hatzakis, Sabine Eichinger, M. Elaine Eyster, Gilbert C. White, Craig M. Kessler, Michael M. Lederman, Philippe Moerloose, Gordon L. Bray, Alan R. Cohen, W. Abe Andes, Marilyn Manco Johnson, Wolfgang Schramm, Barbara L. Kroner, William A. Blattner, James J. Goedert

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    Abstract

    Objective.—To determine the types and rates of cancers occurring in excess in the presence of infection with the human immunodeficiency virus type 1 (HIV-1). Design.—Cohort analytic study of HIV-infected and HIV-uninfected subjects followed for up to 12 years. Setting.—Fifteen hemophilia treatment centers. Patients.—A total of 1701 patients with hemophilia, of whom 1065 (63%) were HIV-1 seropositive. Main Outcome Measures.—Morphologic classification and incidence rates of cancers. Main Results.—The incidence of non-Hodgkin’s lymphoma after HIV seroconversion averaged 0.15 case per 100 person-years (95% confidence interval [CI], 0.08 to 0.25) and rose exponentially with increasing duration of HIV infection. Although the greatest absolute risk of lymphoma was in the oldest age group, the relative increase compared with general population rates was 38-fold in subjects 10 to 39 years old and 12-fold in older subjects (P<.05). The CD4+ T-lymphocyte levels for lymphoma cases were similar to HIV-positive subjects without the acquired immunodeficiency syndrome (AIDS) who had been infected for the same length of time. The incidence of Kaposi’s sarcoma was increased 200-fold (95% CI, 20 to 700). The incidence of cancers other than non-Hodgkin’s lymphoma and Kaposi’s sarcoma were not increased in the HIV-positive subjects (ratio of observed to expected cases, 0.9 [95% CI, 0.4 to 1.9]). The HIV-negative subjects had no significant increase in cancer incidence. Conclusions.—HIV infection has restricted effects on cancer incidence that are only partly explained by immunosuppression. Paradoxically, improvements in therapy of HIV infection that prolong survival may lead to further increases in HIVassociated lymphoma.

    Original languageEnglish (US)
    Pages (from-to)1090-1094
    Number of pages5
    JournalJAMA: The Journal of the American Medical Association
    Volume267
    Issue number8
    DOIs
    StatePublished - Feb 26 1992

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    Hemophilia A
    Lymphoma
    HIV
    Incidence
    HIV Infections
    Neoplasms
    Kaposi's Sarcoma
    Confidence Intervals
    Non-Hodgkin's Lymphoma
    HIV-1
    HIV Seropositivity
    Immunosuppression
    Acquired Immunodeficiency Syndrome
    Cohort Studies
    Age Groups
    Outcome Assessment (Health Care)
    T-Lymphocytes
    Survival
    Therapeutics
    Infection

    All Science Journal Classification (ASJC) codes

    • Medicine(all)

    Cite this

    Rabkin, C. S., Hilgartner, M. W., Hedberg, K. W., Aledort, L. M., Hatzakis, A., Eichinger, S., ... Goedert, J. J. (1992). Incidence of Lymphomas and Other Cancers in HIV-Infected and HIV-Uninfected Patients With Hemophilia. JAMA: The Journal of the American Medical Association, 267(8), 1090-1094. https://doi.org/10.1001/jama.1992.03480080060027
    Rabkin, Charles S. ; Hilgartner, Margaret W. ; Hedberg, Katie W. ; Aledort, Louis M. ; Hatzakis, Angelos ; Eichinger, Sabine ; Eyster, M. Elaine ; White, Gilbert C. ; Kessler, Craig M. ; Lederman, Michael M. ; Moerloose, Philippe ; Bray, Gordon L. ; Cohen, Alan R. ; Andes, W. Abe ; Manco Johnson, Marilyn ; Schramm, Wolfgang ; Kroner, Barbara L. ; Blattner, William A. ; Goedert, James J. / Incidence of Lymphomas and Other Cancers in HIV-Infected and HIV-Uninfected Patients With Hemophilia. In: JAMA: The Journal of the American Medical Association. 1992 ; Vol. 267, No. 8. pp. 1090-1094.
    @article{0879f0fe25d24c30a42d942e6ed08bcd,
    title = "Incidence of Lymphomas and Other Cancers in HIV-Infected and HIV-Uninfected Patients With Hemophilia",
    abstract = "Objective.—To determine the types and rates of cancers occurring in excess in the presence of infection with the human immunodeficiency virus type 1 (HIV-1). Design.—Cohort analytic study of HIV-infected and HIV-uninfected subjects followed for up to 12 years. Setting.—Fifteen hemophilia treatment centers. Patients.—A total of 1701 patients with hemophilia, of whom 1065 (63{\%}) were HIV-1 seropositive. Main Outcome Measures.—Morphologic classification and incidence rates of cancers. Main Results.—The incidence of non-Hodgkin’s lymphoma after HIV seroconversion averaged 0.15 case per 100 person-years (95{\%} confidence interval [CI], 0.08 to 0.25) and rose exponentially with increasing duration of HIV infection. Although the greatest absolute risk of lymphoma was in the oldest age group, the relative increase compared with general population rates was 38-fold in subjects 10 to 39 years old and 12-fold in older subjects (P<.05). The CD4+ T-lymphocyte levels for lymphoma cases were similar to HIV-positive subjects without the acquired immunodeficiency syndrome (AIDS) who had been infected for the same length of time. The incidence of Kaposi’s sarcoma was increased 200-fold (95{\%} CI, 20 to 700). The incidence of cancers other than non-Hodgkin’s lymphoma and Kaposi’s sarcoma were not increased in the HIV-positive subjects (ratio of observed to expected cases, 0.9 [95{\%} CI, 0.4 to 1.9]). The HIV-negative subjects had no significant increase in cancer incidence. Conclusions.—HIV infection has restricted effects on cancer incidence that are only partly explained by immunosuppression. Paradoxically, improvements in therapy of HIV infection that prolong survival may lead to further increases in HIVassociated lymphoma.",
    author = "Rabkin, {Charles S.} and Hilgartner, {Margaret W.} and Hedberg, {Katie W.} and Aledort, {Louis M.} and Angelos Hatzakis and Sabine Eichinger and Eyster, {M. Elaine} and White, {Gilbert C.} and Kessler, {Craig M.} and Lederman, {Michael M.} and Philippe Moerloose and Bray, {Gordon L.} and Cohen, {Alan R.} and Andes, {W. Abe} and {Manco Johnson}, Marilyn and Wolfgang Schramm and Kroner, {Barbara L.} and Blattner, {William A.} and Goedert, {James J.}",
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    Rabkin, CS, Hilgartner, MW, Hedberg, KW, Aledort, LM, Hatzakis, A, Eichinger, S, Eyster, ME, White, GC, Kessler, CM, Lederman, MM, Moerloose, P, Bray, GL, Cohen, AR, Andes, WA, Manco Johnson, M, Schramm, W, Kroner, BL, Blattner, WA & Goedert, JJ 1992, 'Incidence of Lymphomas and Other Cancers in HIV-Infected and HIV-Uninfected Patients With Hemophilia', JAMA: The Journal of the American Medical Association, vol. 267, no. 8, pp. 1090-1094. https://doi.org/10.1001/jama.1992.03480080060027

    Incidence of Lymphomas and Other Cancers in HIV-Infected and HIV-Uninfected Patients With Hemophilia. / Rabkin, Charles S.; Hilgartner, Margaret W.; Hedberg, Katie W.; Aledort, Louis M.; Hatzakis, Angelos; Eichinger, Sabine; Eyster, M. Elaine; White, Gilbert C.; Kessler, Craig M.; Lederman, Michael M.; Moerloose, Philippe; Bray, Gordon L.; Cohen, Alan R.; Andes, W. Abe; Manco Johnson, Marilyn; Schramm, Wolfgang; Kroner, Barbara L.; Blattner, William A.; Goedert, James J.

    In: JAMA: The Journal of the American Medical Association, Vol. 267, No. 8, 26.02.1992, p. 1090-1094.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Incidence of Lymphomas and Other Cancers in HIV-Infected and HIV-Uninfected Patients With Hemophilia

    AU - Rabkin, Charles S.

    AU - Hilgartner, Margaret W.

    AU - Hedberg, Katie W.

    AU - Aledort, Louis M.

    AU - Hatzakis, Angelos

    AU - Eichinger, Sabine

    AU - Eyster, M. Elaine

    AU - White, Gilbert C.

    AU - Kessler, Craig M.

    AU - Lederman, Michael M.

    AU - Moerloose, Philippe

    AU - Bray, Gordon L.

    AU - Cohen, Alan R.

    AU - Andes, W. Abe

    AU - Manco Johnson, Marilyn

    AU - Schramm, Wolfgang

    AU - Kroner, Barbara L.

    AU - Blattner, William A.

    AU - Goedert, James J.

    PY - 1992/2/26

    Y1 - 1992/2/26

    N2 - Objective.—To determine the types and rates of cancers occurring in excess in the presence of infection with the human immunodeficiency virus type 1 (HIV-1). Design.—Cohort analytic study of HIV-infected and HIV-uninfected subjects followed for up to 12 years. Setting.—Fifteen hemophilia treatment centers. Patients.—A total of 1701 patients with hemophilia, of whom 1065 (63%) were HIV-1 seropositive. Main Outcome Measures.—Morphologic classification and incidence rates of cancers. Main Results.—The incidence of non-Hodgkin’s lymphoma after HIV seroconversion averaged 0.15 case per 100 person-years (95% confidence interval [CI], 0.08 to 0.25) and rose exponentially with increasing duration of HIV infection. Although the greatest absolute risk of lymphoma was in the oldest age group, the relative increase compared with general population rates was 38-fold in subjects 10 to 39 years old and 12-fold in older subjects (P<.05). The CD4+ T-lymphocyte levels for lymphoma cases were similar to HIV-positive subjects without the acquired immunodeficiency syndrome (AIDS) who had been infected for the same length of time. The incidence of Kaposi’s sarcoma was increased 200-fold (95% CI, 20 to 700). The incidence of cancers other than non-Hodgkin’s lymphoma and Kaposi’s sarcoma were not increased in the HIV-positive subjects (ratio of observed to expected cases, 0.9 [95% CI, 0.4 to 1.9]). The HIV-negative subjects had no significant increase in cancer incidence. Conclusions.—HIV infection has restricted effects on cancer incidence that are only partly explained by immunosuppression. Paradoxically, improvements in therapy of HIV infection that prolong survival may lead to further increases in HIVassociated lymphoma.

    AB - Objective.—To determine the types and rates of cancers occurring in excess in the presence of infection with the human immunodeficiency virus type 1 (HIV-1). Design.—Cohort analytic study of HIV-infected and HIV-uninfected subjects followed for up to 12 years. Setting.—Fifteen hemophilia treatment centers. Patients.—A total of 1701 patients with hemophilia, of whom 1065 (63%) were HIV-1 seropositive. Main Outcome Measures.—Morphologic classification and incidence rates of cancers. Main Results.—The incidence of non-Hodgkin’s lymphoma after HIV seroconversion averaged 0.15 case per 100 person-years (95% confidence interval [CI], 0.08 to 0.25) and rose exponentially with increasing duration of HIV infection. Although the greatest absolute risk of lymphoma was in the oldest age group, the relative increase compared with general population rates was 38-fold in subjects 10 to 39 years old and 12-fold in older subjects (P<.05). The CD4+ T-lymphocyte levels for lymphoma cases were similar to HIV-positive subjects without the acquired immunodeficiency syndrome (AIDS) who had been infected for the same length of time. The incidence of Kaposi’s sarcoma was increased 200-fold (95% CI, 20 to 700). The incidence of cancers other than non-Hodgkin’s lymphoma and Kaposi’s sarcoma were not increased in the HIV-positive subjects (ratio of observed to expected cases, 0.9 [95% CI, 0.4 to 1.9]). The HIV-negative subjects had no significant increase in cancer incidence. Conclusions.—HIV infection has restricted effects on cancer incidence that are only partly explained by immunosuppression. Paradoxically, improvements in therapy of HIV infection that prolong survival may lead to further increases in HIVassociated lymphoma.

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