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The Human Immunodeficiency Virus Connection

Bhuvanesh Singh, MD; Atul N. Balwally, MD; Ashok R. Shaha, MD; Richard M. Rosenfeld, MD, MPH; Gady Har-El, MD; Frank E. Lucente, MD

Arch Otolaryngol Head Neck Surg. 1996;122(6):639-643.

Abstract
Objective
To evaluate the incidence, distribution, and course of squamous cell carcinoma (SCC) of the upper aerodigestive tract in patients infected with the human immunodeficiency virus (HIV) and compare it to SCC in non—HIV-infected patients.

Design
Case-control study of all patients with SCC during a 9.5-year period from January 1985 through June 1994.

Setting
Two academic tertiary care centers in a metropolitan location.

Participants
Five hundred thirty-nine patients (18 to 95 years old) with SCC of the upper aerodigestive tract.

Results
Infection with HIV was present in 4.5% of the patients with SCC of the upper aerodigestive tract. Patients infected with HIV were significantly younger than noninfected patients (P<.001), accounting for 21.3% of those patients younger than 45 years (P<.001). No significant difference in tumor location was present between HIV-infected and noninfected patients; however, HIV-infected patients had larger tumors (P=.004) and a more advanced tumor stage (TNM classification) at presentation (P=.05). Tumor-related survival was significantly poorer in patients with HIV infection (P=.01), with 57% at 1 year and 32% at 2 years, compared with 74% and 59%, for non—HIV-infected patients. The detrimental effect of HIV infection on survival remained significant after adjusting for the confounding effects of age, tumor stage, and location of the tumor. All study patients with HIV infection had cancer risk factors such as tobacco and/or alcohol abuse.

Conclusions
Infection with HIV possibly accelerates the development of SCC in patients with significant risk factors, presumably by impairing normal immune surveillance mechanisms. The decreased survival rates among these patients suggests that the SCC may be more aggressive or that other cofactors assume greater importance. A history of tobacco and/or alcohol abuse in patients with HIV infection warrants aggressive screening and early detection, to allow for early detection, which may help increase survival.

(Arch Otolaryngol Head Neck Surg. 1996;122:639-643)

Author Affiliations
From the Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, Brooklyn, NY (Drs Singh, Balwally, Rosenfeld, Har-El, and Lucente), and the Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY (Dr Shaha).

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