Risk of Skin Cancers in Older Persons Living With HIV: A Systematic Review.
Howa Yeung, Vijay Balakrishnan, Kevin Man Hin Luk and 1 others
PMID 30586085WHAT IT FOUND
Two studies did not show higher melanoma risk in older people with HIV.
One study found higher subsequent skin cancers called keratinocyte carcinomas in older patients with prior keratinocyte carcinoma, especially squamous cancers with low CD4+ count or high HIV viral load.
Key findings
01Two included studies did not show a significantly increased melanoma risk in older people living with HIV.
02In the Swiss HIV Cohort of 9,429 people living with HIV, among adults between 45 and 69 years, the standardized incidence ratio of BCC and SCC was not statistically higher than that for the general population.
03One private health plan cohort found higher subsequent primary keratinocyte carcinoma risk in older people living with HIV who already had keratinocyte carcinoma (HR, 1.15; 95% CI, 1.02-1.31), especially subsequent primary SCC with CD4+ T-cell count less than 200 cells/mL (HR, 2.22; 95% CI, 1.42-3.48) or viral load greater than 10,000 copies/mL (HR, 2.28; 95% CI, 1.39-3.75).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The review searched only PubMed and did not duplicate the initial search, so some relevant studies may have been missed. Only four studies were included, and meta-analysis was not performed because the studies were heterogeneous, so the review cannot combine their results into a single estimate. Two melanoma studies had limited power or follow-up in older people with HIV: one had only 0.13% of the population with HIV history, and another had only 2% to 3% of the population with follow-up after age 70 years. The review was restricted to people older than 50 years and to studies with age-specific skin cancer risk data, so it does not address younger people living with HIV. The review included studies of risk associations, not trials of screening or prevention, so it does not show that skin examination, counseling, photoprotection, or tanning avoidance reduce cancer risk. One positive finding came from a cohort of non-Hispanic White persons with a history of keratinocyte carcinoma, so it may not apply to all older people living with HIV.
Declared interests
The authors report no real or perceived vested interests that could be construed as a conflict of interest.
The easy way to misread this
Do not conclude that older people living with HIV have a proven increased risk of all skin cancers. The review found no significantly increased melanoma risk in two studies, and only one study found higher subsequent keratinocyte carcinoma risk in older people who already had a keratinocyte carcinoma. Do not treat the recommendation for skin examination and counseling as evidence that these actions prevent cancer.