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

Crum-Cianflone, Nancya,b; Hullsiek, Katherine Hupplera,c; Marconi, Vincenta,d; Weintrob, Amya,e; Ganesan, Anuradhaa,f; Barthel, R Vincenta,g; Fraser, Susana,h; Agan, Brian Ka,d; Wegner, Scotta

doi: 10.1097/QAD.0b013e328317cc2d
Clinical Science

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 4498 HIV-infected US 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 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, noncancer AIDS diagnosis, and lack of HAART. NADCs were predicted by increasing age and white race (due to skin cancers).

Conclusion: 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 use is protective for ADCs, but did not significantly impact NADCs.

aTriService AIDS Clinical Consortium, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

bInfectious Disease Clinic, Naval Medical Center San Diego, San Diego, California, USA

cDivision of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA

dInfectious Disease Clinic, San Antonio Military Medical Center, San Antonio, Texas, USA

eInfectious Disease Clinic, Walter Reed Army Medical Center, Washington, District of Columbia, USA

fInfectious Disease Clinic, National Naval Medical Center, Bethesda, Maryland, USA

gInfectious Disease Clinic, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA

hInfectious Disease Clinic, Tripler Army Medical Center, Honolulu, Hawaii, USA.

Received 14 May, 2008

Revised 29 July, 2008

Accepted 3 August, 2008

Correspondence to Dr Nancy Crum-Cianflone, MD, MPH, Clinical Investigation Department (KCA), Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste. 5, San Diego, CA 92134-1005, USA. Tel: +1 619 532 8134/40; fax: +1 619 532 8137; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.