Patients with HIV infection have an increased risk for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), according to the results of a prospective, matched, nationwide, population-based Danish HIV cohort study published in the Journal of the American Academy of Dermatology.
The investigators sought to determine the risk for various forms of skin cancer among HIV-infected individuals and to compare it with the risk in a background population.
A total of 4280 patients with HIV from the Danish HIV cohort study were compared with a matched background population cohort (n=21,399), based on level of immunosuppression and route of transmission. The primary outcomes of the study were time to development of first BCC, SCC, or malignant melanoma (MM).
An increased risk for BCC and SCC was observed among HIV-infected patients, with incidence risk ratios (IRRs) of 1.79 (95% CI, 1.43-2.22) and 5.40 (95% CI, 3.07-9.52), respectively, compared with the background population. No increased risk for MM was reported among HIV-infected individuals.
The increased risk for SCC among HIV-infected individuals was associated with low nadir, but not current, CD4 cell counts as a marker of immunosuppression. In contrast, the increased risk for BCC among HIV-infected individuals was restricted to men who had sex with men; in other words, to the route of infection.
The risk for development of MM was not increased among HIV-infected individuals (IRR, 0.60; 95% CI, 0.28-1.31) or their siblings (n=5647; IRR, 0.95; 95% CI, 0.55-1.61) compared with the matched background cohort and siblings of the matched background cohort (n=26,875), respectively.
Limitations of the present study include the fact that it was observational in design and enrolled a small number of patients with MM. The investigators concluded that the risk for SCC among HIV-infected patients seems to increase with an increasing level of immunosuppression, whereas the increased risk for BCC was restricted to individuals who reported MSM as the route of HIV infection.
Omland SH, Ahlström MG, Gerstoft J, et al. Risk of skin cancer in HIV-infected patients: a Danish nationwide cohort study [published online March 26, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.03.024