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

Daniel C Beachler; Alison G Abraham; Michael J Silverberg; Yuezhou Jing; Carole Fakhry; M John Gill; Robert Dubrow; Mari M Kitahata; Marina B Klein; Ann N Burchell; P Todd Korthuis; Richard D Moore; Gypsyamber D'Souza; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA

doi:10.1016/j.oraloncology.2014.09.011

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

Oral Oncol. 2014 Dec;50(12):1169-76. doi: 10.1016/j.oraloncology.2014.09.011. Epub 2014 Oct 6.

Authors

Collaborators

North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA:
G Kirk, C Benson, R Bosch, A Collier, K Gebo, R Hogg, M Horbberg, J Goedert, L Jacobson, M Klein, S Rourke, A Rachlis, B Rodriguez, L Calzavara, S Deeks, J Martin, M Saag, A Justice, K Anastos, S Gange, R Moore, M Saag, S Gange, M Kitahata, R McKaig, A Freeman, A Abraham, K Althoff, E Golub, Y Jing, B Lau, P Rebeiro, A Mendes, S Modur, J Zhnag, S Van Rompaey, E Webster, B Simon

Affiliations

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, USA. Electronic address: dbeachl1@jhu.edu.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, USA. Electronic address: aabraham@jhsph.edu.
³ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA. Electronic address: Michael.j.silverberg@kp.org.
⁴ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, USA. Electronic address: yjing@jhsph.edu.
⁵ Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 601 N. Caroline St., Baltimore, MD, USA. Electronic address: cfakhry@jhmi.edu.
⁶ Department of Medicine, University of Calgary, 3330 Hospital Dr. NW., Calgary, Canada. Electronic address: john.gill@albertahealthservices.ca.
⁷ Cancer Prevention and Control Program, Yale School of Public Health and Yale School of Medicine, P.O. Box 208034, 60 College Street, New Haven, CT, USA. Electronic address: Robert.dubrow@yale.edu.
⁸ University of Washington, 325 9th Ave, Seattle, WA, USA. Electronic address: kitahata@uw.edu.
⁹ Division of Medicine, McGill University, 3655 Sir William Osler, Montreal, Quebec, Canada. Electronic address: marina.klein@mcgill.ca.
¹⁰ Division of Oncology, Ontario HIV Treatment Network, 1300 Yong St. Suite 600, Toronto, Ontario, Canada. Electronic address: ann.burchell@mail.mcgill.ca.
¹¹ Department of Public Health/Preventive Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, USA. Electronic address: korthuis@ohsu.edu.
¹² Department of Medicine, Johns Hopkins University, 1830 E. Monument St., Baltimore, MD, USA. Electronic address: rdmoore@jhmi.edu.
¹³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, USA. Electronic address: gdsouza2@jhu.edu.

Abstract

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 11.4per 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.

Keywords: CD4 T cell count; HIV; HPV; Head and Neck Squamous Cell Carcinoma; NA-ACCORD; Oropharyngeal cancer.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
CD4 Lymphocyte Count
Carcinoma, Squamous Cell / epidemiology*
Case-Control Studies
Female
HIV Infections / epidemiology*
Head and Neck Neoplasms / epidemiology*
Humans
Incidence
Male
Middle Aged
North America / epidemiology
Papillomavirus Infections / epidemiology*
Poisson Distribution
Prospective Studies
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding