Malignancy‐related causes of death in human immunodeficiency virus–infected patients in the era of highly active antiretroviral therapy

Abstract

BACKGROUNDBefore the introduction of highly active antiretroviral therapy (HAART), malignancies accounted for less than 10% of all deaths among human immunodeficiency virus (HIV)‐infected patients. This figure may have increased, and the observed types of malignant disease may have been modified, as a result of decreased occurrence of opportunistic infections, the chronicity of HIV infection, the possible oncogenic role of HIV itself, and the aging of the HIV‐infected population.METHODSAll French hospital wards involved in the management of HIV infection were asked to prospectively document the deaths of HIV‐infected patients in the year 2000. Underlying causes of death were defined using a standardized questionnaire.RESULTSOf a total of 964 deaths, 269 (28%) were attributable to malignancies. Acquired immunodeficiency virus (AIDS)‐related malignancies were the underlying cause of 149 deaths (15%); among these malignancies were non‐Hodgkin lymphoma (n = 105 [11%]), noncerebral lymphoma (n = 78 [median CD4 count, 86 × 106 per liter; interquartile range [IQR], 35–231 × 106 per liter), and primary cerebral lymphoma (n = 27 [median CD4 count, 20 × 106 per liter; IQR, 4–109 × 106 per liter). Kaposi sarcoma was associated with 40 deaths (4%), and cervical carcinoma was associated with 5 (0.5%). Non‐AIDS‐related malignancies were the underlying cause of 120 deaths (13%); these non‐AIDS‐related malignancies included 103 solid tumors (50 respiratory tumors, 19 hepatocarcinomas, 9 digestive tumors, and 6 anal tumors; median CD4 count, 218 × 106 per liter; IQR, 108–380 × 106 per liter) and 17 hemopathies (12 Hodgkin lymphomas, 4 myeloid leukemias, and 1 myeloma; median CD4 count, 113 × 106 per liter; IQR, 56–286 × 106 per liter). Compared with patients who died of other causes, patients who died of solid tumors were more likely to be male, to smoke, to be older, and to have higher CD4 counts.CONCLUSIONSMalignant disease has been a major cause of death among HIV‐infected patients in industrialized nations since the introduction of HAART. Whereas lethal hemopathies and Kaposi sarcoma are associated with advanced immunosuppression, lethal solid tumors can occur in patients with controlled HIV infection. Cancer 2004. © 2004 American Cancer Society.

HIV Infection in the Etiology of Lung Cancer: Confounding, Causality, and Consequences

“…The mechanism suggested is that, until the competing risks for AIDS-related death have been reduced (due to effective ART), few HIV-infected persons would survive long enough to develop lung cancer. Earlier studies had limited follow-up experience during the ART era, but numerous subsequent studies have suggested that lung cancer risk has increased during the ART era (23,26,30,31,41,53). Few of these studies took age into account, and ART era differences in rates in a large Italian study were obviated after age adjustment (27).…”

Infecção VIH e Neoplasias Não Definidoras de SIDA: Experiência de um Centro

“…24 Tal como na maioria das séries 1,12,16,[25][26][27] também aqui houve um predomínio no sexo masculino e em doentes fumadores, sendo o adenocarcinoma e o carcinoma pavimento-celular os tipos histológicos mais frequentes, o que aliado a uma tendência para um diagnóstico tardio e já com evidênca de metastização à distância, condicionou um mau prognóstico com alta taxa de mortalidade. Também prevalentes neste estudo foram as neoplasias gé-nito-urinárias (bexiga, próstata e rim).…”

Neoplasias en pacientes con infección por VIH: Estudio descriptivo de 129 casos en el período 1993-2010

“…A pesar de las limitaciones inherentes al carácter retrospectivo del mismo, los resultados no difieren en gran medida de otras series descritas previamente. Aunque los tumores más frecuentemente encontrados son el LNH y el SK, ambos NDS, en el cómputo global, más de la mitad de pacientes tuvo un NNDS, lo cual refleja la tendencia actual al aumento de este tipo de tumores en detrimento de los NDS, tal y como han reflejado estudios previos [35][36][37][38][39] , desde la introducción del tratamiento anti-retroviral, disminuyendo la incidencia hasta cinco veces respecto a la era pre-TARGA. De manera global, en nuestra serie hemos documentado poco más de 3 tumores/año antes del año 2000 con un predominio claro de los NDS (65 vs 35%) y casi 9 tumores/año después de este año con más NNDS (58%) que NDS (42%), datos que son muy significativos.…”

“…Al igual que otras series [33][34][35][36] , los pacientes con NDS tenían una carga viral más elevada y un número de linfocitos T CD4 (en el momento del diagnostico del cáncer) menor que en el grupo de pacientes con NNDS. Es significativo que en 36% de los NDS, la neoplasia ha llevado al diagnóstico de la infección por VIH, lo que traduce cierto retraso en el diagnóstico de la infección, probablemente de carácter multifactorial.…”