HIV infection is
associated with an increased risk of melanoma, according to the results of a
meta-analysis published in PLOS ONE.
Overall, people living with HIV had a 26% increase in their relative risk of
melanoma compared to the general population, the risk increasing by 50% for
white-skinned people with HIV. The increased risk was statistically significant in white-skinned people diagnosed with HIV and of borderline statistical significance for all people diagnosed with HIV.
recommend that fair-skinned people living with HIV should be regularly
screened for suspicious skin lesions and should also be warned about the
dangers of prolonged exposure to the sun.
Melanoma (skin cancer)
diagnoses have increased markedly in the UK and many other countries in recent
years. There is also evidence suggesting that people living with HIV have a
higher risk of developing this skin cancer compared to individuals in the
general population. Studies conducted before effective antiretroviral
therapy became available in the mid-1990s showed that having HIV increased
the relative risk of melanoma by approximately a quarter.
However, it is
uncertain whether people living with HIV continue to have an increased risk of melanoma
in the era of effective antiretroviral treatment.
A team of
Australian and UK investigators therefore conducted a systematic review and
meta-analysis, looking at the association between HIV and the relative risk of
melanoma in the periods before and after potent HIV therapy became available.
analysis included cohort studies involving adult patients.
A total of 21
studies met their inclusion criteria. These were conducted between 1999 and
2013. Most (twelve) were conducted in the United States, eight in Europe and
one in Australia. Most of the studies reported on cohorts of patients with HIV
and those diagnosed with AIDS, but six studies defined their study population
as patients with AIDS. The majority of studies (16) were population based, most
of the patients being men (76-92%). One study included only men who have sex
with men; one study included women only; a single study was restricted to
veterans and two studies reported on single-clinic patient cohorts.
duration of follow-up ranged between two and ten years.
presented melanoma estimates for the period before effective HIV therapy became
available, the others gave estimates for the period after potent antiretroviral
treatment was introduced. Overall, the standard of research was high and 57% of
the studies were assessed as high quality and the others were of moderate
quality. The most common limitation was a failure to control for ethnicity.
showed that, in the era of effective antiretroviral treatment, HIV or AIDS was
associated with an increase of borderline significance in the relative risk of
melanoma (1.26; 95% CI, 0.97-1.64). This was significant in studies that
considered ethnicity (1.50; 95% CI, 1.12-2.01). There was significant
heterogeneity between the findings of these studies (p = 0.004).
data from the pre-therapy era showed that HIV or AIDS significantly increased the
overall risk (1.26; 95% CI, 1.11-1.43) of melanoma and that the risk was also
significantly increased in studies that controlled for ethnicity (1.28; 95% CI,
remained robust in sensitivity analyses.
account the potential confounding effects of ethnicity, our findings show that
risk of melanoma in those with HIV/AIDS remains elevated in the HAART [highly
active antiretroviral therapy] era, with a 50% increased risk,” comment the authors.
“The increased risk of melanoma in populations with HIV/AIDS may be related to
effects of HIV infection on the immune system although these are complex,
including not only immunodeficiency, but also chronic immune activation and
inflammation, and immune dysfunction and senescence [ageing].”
“white skinned people with HIV/AIDS would benefit from regular screening of the
skin for suspicious pigmented lesions, and since they also have a significantly
increased risk of developing keratinocyte skin cancers (at least two-fold) they
should be counselled to avoid excessive sun exposure.”