ArticlesSpectrum of AIDS-associated malignant disorders
Introduction
Cancer risk is increased with most types of immune deficiency, including congenital disorders and iatrogenic treatments to prevent allograft rejection.1 With AIDS, cancer risk is extraordinarily high and has an unusual spectrum.1, 2 An understanding of this spectrum may clarify the interplay between immunity, viruses, and other carcinogenic agents, and indirect carcinogenic mechanisms, including regulators of mitosis and growth. Kaposi's sarcoma (KS) and high-grade B-cell non-Hodgkin lymphoma (NHL) are the prototypical AIDS-defining malignant diseases, with 2419 and 1030 cases, respectively, reported to the Centers for Disease Control and Prevention during 1996.3 However, many other neoplasms have been reported among people with AIDS. Causal relations between AIDS and these other cancers have not been defined because of potential confounding by sexual and other lifestyle variables, and because of ascertainment bias from the intensive diagnostic scrutiny of people with AIDS. To clarify these issues we established the AIDS-Cancer Match Registry, and developed methods to examine the relation between AIDS—defined as the initial life-threatening opportunistic illness—and the prevalence and incidence of 38 histologically defined malignant disorders reported to population-based cancer registries in the USA and Puerto Rico.
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Matching and linkage of AIDS and cancer data
The National Cancer Institute collaborated with the population-based cancer registries and AIDS registries in Puerto Rico and in seven regions in the USA (New Jersey, Florida, Atlanta, San Francisco, Los Angeles, San Diego, and Sacramento). Records were linked by computer with a probabilistic algorithm that matched social-security numbers in those registries in which they were available (San Francisco and Los Angeles).4 For the other regions, the matching algorithm incorporated two critical
Results
The AIDS-Cancer Match Registry compared the records of 98 336 people with AIDS with the records of 1 125 098 people with cancer. For the cohort analysis, there were 40 733 post-AIDS person-years at risk, including 26 398 person-years (65%) for white or Hispanic homosexual men, 3336 (8%) for black homosexual men, 7386 (18%) for other males, and 3612 (9%) for females.
Discussion
This study expands the known spectrum of AIDS-related malignant disorders and also shows that most cancers are not related to immunodeficiency. The experiences of patients with AIDS and other immunodeficiencies help elucidate the cause of some tumours. Nearly all immunodeficiency states have in common an extraordinary risk of NHL that roughly parallels the intensity of immune stimulation and the severity of immune deficiency. For kidney-transplant recipients, NHL risk is increased most within
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