Abstract
Background
Data on colorectal cancer (CRC) in HIV-positive patients are limited. The objective of this study was to investigate the incidence, presentation, and outcome of CRC in HIV patients.
Materials and methods
Clinical data on patients diagnosed with CRC and concurrent HIV/AIDS infection between 1994 and 2003 were retrieved from the institutional records. Each identified patient was randomly matched with two HIV-negative CRC patients based on age, sex, race, and TNM stage at cancer diagnosis. Presentation, treatment toxicities, recurrence, and overall survival rates were assessed. Data were further compared with those of the published international Surveillance Epidemiology and End Results (SEER) data.
Results
Out of 3,951 CRC patients, 12 HIV CRC patients (0.3%) were identified. Median age at cancer diagnosis was 41 years (29–52), revealing a 3:1 ratio between patients younger and older then 50 years, compared to a 1:33 ratio in the general population. Compared to 57% in the general population, 90% of the patients had advanced stages (III–IV) at diagnosis. The median follow-up time for both cases and controls was 30 months (6–65). HIV-positive patients had a shorter disease-free survival than the controls. No difference in overall survival was demonstrated, however survival was significantly reduced in the HIV-positive patients when only patients who were initially disease-free were compared. Adjuvant therapy was well-tolerated in all patients without chemotherapy-related deaths.
Conclusion
HIV-positive CRC patients tend to have an early and more aggressive presentation with less favorable outcome. Further epidemiology studies to refute or accept our observations may suggest a reduced threshold for screening for CRC in HIV-positive patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 338(13):853–860
Chiao EY, Krown SE (2003) Update on non-acquired immunodeficiency syndrome-defining malignancies. Curr Opin Oncol 15(5):389–397
Cooksley CD, Hwang LY, Waller DK, Ford CE (1999) HIV-related malignancies: community-based study using linkage of cancer registry and HIV registry data. Int J STD AIDS 10(12):795–802
Spina M, Sandri S, Serraino D, Gobitti C, Fasan M, Sinicco A, Garavelli PL, Ridolfo A, Tirelli U (1999) Therapy of non-small-cell lung cancer (NSCLC) in patients with HIV infection. GICAT. Cooperative Group on AIDS and Tumors. Ann Oncol 10(Suppl 5):S87–S90
Singh B, Carew JF, Shaha AR (1998) Laryngeal cancer in patients with acquired immunodeficiency syndrome. Am J Clin Oncol 21(6):623–624
Hurley J, Franco S, Gomez-Fernandez C, Reis I, Velez P, Doliny P, Harrington W Jr, Wilkinson J, Kanhoush R, Lee Y (2001) Breast cancer and human immunodeficiency virus: a report of 20 cases. Clin Breast Cancer 2(3):215–220
Jemal A, Thomas A, Murray T, Thun M (2002) Cancer statistics, 2002. CA Cancer J Clin 52(1):23–47
Frisch M, Biggar RJ, Engels EA, Goedert JJ, AIDS–Cancer Match Registry Study Group (2001) Association of cancer with AIDS-related immunosuppression in adults. JAMA 285(13):1736–1745
Goedert JJ, Cote TR, Virgo P, Scoppa SM, Kingma DW, Gail MH, Jaffe ES, Biggar RJ (1998) Spectrum of AIDS-associated malignant disorders. Lancet 351(9119):1833–1839
Surveillance Epidemiology and End Results (SEER) (2005) National Cancer Institute, Bethesda, Maryland. Available at: http://seer.cancer.gov. Accessed July
Klugman AD, Schaffner J (1994) Colon adenocarcinoma in HIV infection: a case report and review. Am J Gastroenterol 89(2):254–256
Cappell MS, Yao F, Cho KC (1988) Colonic adenocarcinoma associated with the acquired immune deficiency syndrome. Cancer 62(3):616–619
Yeguez JF, Martinez SA, Sands DR, Sands LR, Hellinger MD (2003) Colorectal malignancies in HIV-positive patients. Am Surg 69(11):981–987
Berretta M, Tirelli U (2006) Colorectal cancer screening in HIV-infected patients 50 years of age and older: missed opportunities for prevention. Am J Gastroenterol 101(4):907
Bini EJ, Park J, Francois F (2006) Use of flexible sigmoidoscopy to screen for colorectal cancer in HIV-infected patients 50 years of age and older. Arch Intern Med 166(15):1626–1631
Reinhold JP, Moon M, Tenner CT, Poles MA, Bini EJ (2005) Colorectal cancer screening in HIV-infected patients 50 years of age and older: missed opportunities for prevention. Am J Gastroenterol 100(8):1805–1812
Rodrigues LK, Klencke BJ, Vin-Christian K, Berger TG, Crawford RI, Miller JR 3rd, Ferreira CM, Nosrati M, Kashani-Sabet M (2002) Altered clinical course of malignant melanoma in HIV-positive patients. Arch Dermatol 138(6):765–770
Nguyen P, Vin-Christian K, Ming ME, Berger T (2002) Aggressive squamous cell carcinomas in persons infected with the human immunodeficiency virus. Arch Dermatol 138(6):758–763
Singh B, Carew JF, Shaha AR (1998) Laryngeal cancer in patients with acquired immunodeficiency syndrome. Am J Clin Oncol 21(6):623–624
Tirelli U, Spina M, Sandri S, Serraino D, Gobitti C, Fasan M, Sinicco A, Garavelli P, Ridolfo AL, Vaccher E (2000) Lung carcinoma in 36 patients with human immunodeficiency virus infection. The Italian Cooperative Group on AIDS and Tumors. Cancer 88(3):563–569
Gallagher B, Wang Z, Schymura MJ, Kahn A, Fordyce EJ (2001) Cancer incidence in New York State acquired immunodeficiency syndrome patients. Am J Epidemiol 154(6):544–556
Mbulaiteye SM, Biggar RJ, Goedert JJ, Engels EA (2003) Immune deficiency and risk for malignancy among persons with AIDS. J Acquir Immune Defic Syndr 32(5):527–533
Blazy A, Hennequin C, Gornet JM, Furco A, Gerard L, Lemann M, Maylin C (2005) Anal carcinomas in HIV-positive patients: high-dose chemoradiotherapy is feasible in the era of highly active antiretroviral therapy. Dis Colon Rectum 48(6):1176–1181
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wasserberg, N., Nunoo-Mensah, J.W., Gonzalez-Ruiz, C. et al. Colorectal cancer in HIV-infected patients: a case control study. Int J Colorectal Dis 22, 1217–1221 (2007). https://doi.org/10.1007/s00384-007-0285-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-007-0285-z