HIV Infection Status, Immunodeficiency, and the Incidence of Non-Melanoma Skin Cancer

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Abstract

Background

The incidence of non-melanoma skin cancers (NMSCs), including basal cell (BCC) or squamous cell carcinoma (SCC), is not well documented among HIV-positive (HIV+) individuals.

Methods

We identified 6560 HIV+ and 36 821 HIV-negative (HIV−) non-Hispanic white adults who were enrolled and followed up in Kaiser Permanente Northern California from 1996 to 2008. The first biopsy-proven NMSCs diagnosed during follow-up were identified from pathology records. Poisson models estimated rate ratios that compared HIV+ (overall and stratified by recent CD4 T-cell counts and serum HIV RNA levels) with HIV− subjects and were adjusted for age, sex, smoking history, obesity diagnosis history, and census-based household income. Sensitivity analyses were adjusted for outpatient visits (ie, a proxy for screening). All statistical tests were two-sided.

Results

The NMSC incidence rate was 1426 and 766 per 100 000 person-years for HIV+ and HIV− individuals, respectively, which corresponds with an adjusted rate ratio of 2.1 (95% confidence interval [CI] = 1.9 to 2.3). Similarly, the adjusted rate ratio for HIV+ vs HIV− subjects was 2.6 (95% CI = 2.1 to 3.2) for SCCs, and it was 2.1 (95% CI = 1.8 to 2.3) for BCCs. There was a statistically significant trend of higher rate ratios with lower recent CD4 counts among HIV+ subjects compared with HIV− subjects for SCCs (Ptrend < .001). Adjustment for number of outpatient visits did not affect the results.

Conclusion

HIV+ subjects had a twofold higher incidence rate of NMSCs compared with HIV− subjects. SCCs but not BCCs were associated with immunodeficiency.

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