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Cancer Stage at Diagnosis in HIV-infected People and Transplant Recipients
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  • Description:

    It is unknown whether immunosuppression results in more aggressive, advanced stage cancers. As cancer stage is influenced both by tumor biology and medical surveillance, we assessed cancer stage in HIV-infected individuals and solid organ transplant recipients, two immunosuppressed groups with differences in healthcare utilization.


    We used data on all cases of 15 cancer types, diagnosed during 1996–2010 in two studies that linked U.S. cancer registries to HIV and transplant registries. Odds ratios (ORs) for advanced (vs. local) disease were estimated comparing HIV and transplant populations to immunocompetent people in polytomous logistic regression models, adjusted for age, sex, race, registry and year.


    A total of 8,411 of 4.5 million cancer cases occurred in HIV-infected people, and 7,322 of 6.4 million cancer cases occurred in transplant recipients. Compared to immunocompetent people with cancer, HIV-infected people were more likely to be diagnosed with distant stage lung (OR=1.13), female breast (OR=1.99), and prostate cancers (OR=1.57), while transplant recipients had fewer distant stage lung (OR=0.54), female breast (OR=0.75) and prostate cancers (OR=0.72). Both immunosuppressed populations had a shift toward advanced stage melanoma (ORs: HIV=1.97; transplant=1.82) and bladder cancer (ORs: HIV=1.42; transplant=1.54).


    Bladder cancer and melanoma were more likely to be diagnosed at non-local stage in both HIV-infected people and transplant recipients, suggesting a role of immunosuppression in their progression. Additionally, we observed a shift for some common cancers toward later stages in HIV-infected individuals and toward earlier stages in transplant recipients, consistent with differential access to medical care or surveillance.

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    01000024C/PHS HHS/United States
    1U58 DP000807-01/DP/NCCDPHP CDC HHS/United States
    5458DP003920/DP/NCCDPHP CDC HHS/United States
    5U58/DP003931-02/DP/NCCDPHP CDC HHS/United States
    5U58DP000824-04/DP/NCCDPHP CDC HHS/United States
    5U58DP003875-01/DP/NCCDPHP CDC HHS/United States
    5U58DP003883-03/DP/NCCDPHP CDC HHS/United States
    5U58DP003921-03/DP/NCCDPHP CDC HHS/United States
    5U62PS001005-0/PS/NCHHSTP CDC HHS/United States
    5U62PS004011-02/PS/NCHHSTP CDC HHS/United States
    5U62PS004015/PS/NCHHSTP CDC HHS/United States
    HHSH234200537009C/PHS HHS/United States
    HHSH250201000018C/PHS HHS/United States
    HHSN2612/PHS HHS/United States
    HHSN2612010000/PHS HHS/United States
    HHSN261201000034C/PHS HHS/United States
    HHSN261201000035C/PHS HHS/United States
    HHSN261201000036C/PHS HHS/United States
    HHSN261201000037C/PHS HHS/United States
    HHSN261201300021I/PHS HHS/United States
    HSN261201000032C/PHS HHS/United States
    N01-PC-2013-00021/PC/NCI NIH HHS/United States
    N01-PC-35137/PC/NCI NIH HHS/United States
    N01-PC-35139/PC/NCI NIH HHS/United States
    N01-PC-35142/PC/NCI NIH HHS/United States
    N01-PC-35143/PC/NCI NIH HHS/United States
    U58 DP000848-04/DP/NCCDPHP CDC HHS/United States
    U58DP000832/DP/NCCDPHP CDC HHS/United States
    U58DP003879/DP/NCCDPHP CDC HHS/United States
    U58DP12-1205 3919-03/DP/NCCDPHP CDC HHS/United States
    U62PS004001-2/PS/NCHHSTP CDC HHS/United States
    Z99 CA999999/Intramural NIH HHS/United States
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