Trends in the incidence of cancers among HIV-infected persons and the impact of antiretroviral therapy: a 20-year cohort study

Abstract

Objective To describe trends in incidence rates of AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) during the HIV epidemic and to evaluate predictors, including the impact of antiretroviral therapy, of cancer development. Design Retrospective analysis of a multicenter, prospective natural history study including 4,498 HIV-infected U.S. military beneficiaries with 33,486 person-years of follow-up. Methods Predictors evaluated included demographics, clinical data, time-updated CD4 cell counts, HIV viral loads, and antiretroviral history. Time periods were classified as early pre- (1984-1990), late pre- (1991-1995), early post- (1996-2000), and late post-(2001-2006) HAART eras. Cox proportional hazard models were used to evaluate the association of specific factors with cancer. Results Ten percent of HIV-infected persons developed cancer. ADC rates increased between the early and late pre-HAART eras (7.6 and 14.2 cases per 1000 person years) and have since declined from 5.4 to 2.7 in the early and late HAART eras, respectively (p<0.001). Rates of NADCs have risen over the four time periods (2.9, 2.8, 4.2, 6.7, p=0.0004). During the late HAART era, 71% of cancers were NADCs. Predictors for ADCs included low CD4 cell count, non-cancer AIDS diagnosis, and lack of HAART. NADCs were predicted by increasing age, Caucasian race (due to skin cancers), and lack of HAART. Conclusions Although the rate of ADCs continues to fall, the rate of NADCs is rising and now accounts for the majority of cancers in HIV-infected persons. The development of NADCs is associated with increasing age among HIV patients. HAART is protective for both ADCs and NADCs.

Relationship between current level of immunodeficiency and non‐acquired immunodeficiency syndrome‐defining malignancies

“…28 There was a significant increase in non-AIDS-defining malignancies with increasing calendar year of followup, as reported by previous studies. 3,31,32 There are several potential explanations for the suggested increase in non-AIDS-defining malignancies. Centers participating in the study may have become more aware of the importance of non-AIDS diagnoses and have recorded more non-AIDSdefining malignancies in recent years, although Euro-SIDA has an extensive quality assurance program, and the data on non-AIDS-defining malignancies have been part of the quality assurance exercise since 2003.…”

Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation

“…With this, there has been a shift in distribution of causes of death toward non‐AIDS‐defining events (NADEs) 8, 9, 10, 11, 12. Factors contributing to non‐AIDS mortality include immunodeficiency 13, 14, ART toxicity 15, 16, increasing age 17, 18, 19, 20, 21, 22, and lifestyle factors such as tobacco use and obesity 18, 21, 23. However, chronic inflammation and immune activation produced by chronic HIV infection as well as many AIDS‐defining events (ADEs) are now recognized as significant drivers in the pathogenesis of non‐AIDS‐related deaths 14, 24, 25, 26, 27, 28.…”

Du VIH/sida aux tumeurs malignes associées

“…Cette altération de la réponse immune expose 30 à 40 % des personnes infectées par le VIH à un risque accru de développer un cancer [21]. En effet, les données épidémiologiques montrent que, par rapport à la population générale, la fréquence de certains types néoplasiques est augmentée chez ces sujets [20][21][22][23].…”

“…Ce qui constitue un double défi à relever. Mais, dans les pays du Nord, les thérapeutiques antirétrovirales hautement actives (highly active antiretrovial therapies [HAART]) ont permis de réduire la morbidité associée aux infections opportunistes et l'incidence de certains cancers associés au VIH/sida tels le sarcome de Kaposi ou les LMNH dans une moindre mesure [14,18,22,24].…”

“…En revanche, les résultats sont décevants pour le cancer invasif du col utérin, la maladie de Hodgkin et les cancers anogénitaux [22,27].…”