Epidemiology & Social
Rates of non-AIDS-defining cancers in people with HIV infection before and after AIDS diagnosis
Grulich, Andrew E.; Li, Yueming; McDonald, Ann; Correll, Patricia K. L.; Law, Matthew G.; Kaldor, John M.
From the National Centre in HIV Epidemiology and Clinical Research, the University of New South Wales, Sydney, Australia.
Correspondence to Dr Andrew Grulich, National Centre in HIV Epidemiology and Clinical Research, Level 2, 376 Victoria St, Sydney, NSW 2010 Australia. Tel: +61 2 9332 4648; fax: +61 2 9332 1837; email: email@example.com
Received: 1 October 2001;
revised: 3 January 2002; accepted: 14 January 2002.
Sponsorship: The National Centre in HIV Epidemiology and Clinical Research is funded by the Commonwealth Department of Health and Ageing.
Objective: To describe the incidence of non-AIDS-defining cancers in people with HIV infection before and after the occurrence of AIDS, and to examine the association of cancer risk with immune deficiency.
Design: Cohort study involving nation-wide linkage of HIV, AIDS and cancer registry data.
Methods: Association of cancer risk with immune deficiency was examined by analysing cancer risks in four periods between HIV diagnosis, AIDS and death.
Results: Linkage identified 196 cases of non-AIDS-defining cancer in 8351 people notified with HIV infection and 8118 registered with AIDS (total of 13 067 individuals). Overall, we found significantly increased rates of cancer of the lip, anus, Hodgkin's disease, myeloma and leukaemia. Of these cancers, in people with HIV infection who did not develop AIDS, or were more than 5 years prior to development of AIDS, only cancer of the anus occurred at increased rates. A significant trend of increasing relative risk of cancer with increasing time since HIV diagnosis was found for Hodgkin's disease and multiple myeloma.
Conclusions: People with HIV with mild immune deficiency prior to AIDS were at increased risk of anal cancer, but this may reflect other risk factors. Other cancers occurred only later in the course of HIV infection. This is reassuring evidence that people with HIV who are only mildly immune deficient may not be at increased risk of non-AIDS-defining cancers, but larger studies with longer periods of follow-up are needed to confirm this.
Studies that have linked AIDS and cancer registries have provided valuable information on the spectrum of malignant disorders associated with advanced HIV infection [1–4]. Since the mid-1990s, the introduction of potent antiretroviral therapy has lead to reductions in AIDS incidence, of more than 70% in treated cohorts [5,6]. Consequently, in countries with good access to antiretroviral therapies, people diagnosed with AIDS now represent an increasing minority of people with HIV, and most people with HIV are now living with only mild to moderate degrees of immune deficiency for extended periods of time without developing AIDS.
To gain a clearer understanding of morbidity, including cancer, that occurs prior to the occurrence of advanced immune deficiency, it is therefore important that studies of people with HIV include both people with and without AIDS. Although large cohort studies of populations with HIV have contributed some data on the spectrum of malignant diseases associated with HIV , linkage studies of HIV and cancer registries have not yet been reported.
In Australia, there has been a nation-wide registration of cancer since 1980 and notification of HIV diagnosis since 1985. We performed a population-based linkage study between databases relating to HIV infection and AIDS and cancer registries to assess the relative risk of non-AIDS-defining cancer in HIV-infected people in Australia. In particular, we aimed to describe cancer incidence in people with early HIV disease, a stage of HIV disease in which cancer incidence has been little studied.
Materials and methods
In Australia, HIV and AIDS are reported with a name code (first two letters of first and last name), date of birth and sex. We attempted linkage for all those individuals who had complete data for these three fields on either the national HIV or AIDS database. The procedure of linkage with the cancer register has been described in detail previously . Briefly, linkage was performed using a modified version of the national cancer register, with full names converted to name codes. A match was accepted if there was an exact match on all three fields, or there was a near match supported by consistency between the registers in dates of death and area of residence. Linkage was performed separately for the HIV and AIDS databases. HIV and AIDS data were available to December 1999, and cancer data until 1995 to 1998 depending on jurisdiction. The sex, age and HIV risk behaviour of individuals included in the analysis is presented in Table 1.
Cancer incidence rates were calculated using the person–years methods. For each type of cancer, person–years at risk were calculated as outlined in Table 2. Exploratory analyses showed that calculated rates of cancer in the 5 years prior to AIDS diagnosis gave cancer rates which were unbiased estimates of cancer rates in people with HIV infection before AIDS diagnosis . For this reason, all people recorded as having AIDS were assumed to have had HIV infection for 5 years before the AIDS diagnosis, and to be under follow-up for the purpose of the estimation of cancer incidence. Thus, for a person with a date of AIDS diagnosis who did not appear on the HIV register, follow-up began 5 years prior to date of AIDS. Standardized incidence ratios (SIRs) were calculated based on age-, sex-, year- and state-specific incidence rates of cancer in the general population. Confidence intervals and time trends were estimated assuming that the observed cancers were Poisson distributed .
To assess the association between cancer incidence and immune deficiency, four time periods were defined based on increasing HIV disease progression. A single individual could contribute to each of the time periods, depending on available follow-up. Period one (least immune deficient) was defined as the period from date of registered HIV infection to 5 years prior to date of AIDS, or the entire period from HIV infection in those who were not recorded as having progressed to AIDS during follow-up. Period two was from 5 years to 6 months prior to AIDS diagnosis. Period three spanned 6 months either side of AIDS diagnosis, and period four (most immune deficient) was from 6 months to 2 years after AIDS diagnosis. Trends in cancer risk over these periods were assessed separately including and excluding the 6-month period around AIDS, to allow for the possibility that diagnostic bias might increase diagnosis of cancer around the time of diagnosis of AIDS.
By August 1999, 46% (8108) of people reported with HIV, and 100% of people with AIDS, had a name code, date of birth and sex recorded and were therefore eligible for linkage with the cancer registry. In total, 1355 cancers, including 196 non-AIDS-defining cancers, were registered in 13 067 people with HIV or AIDS. Results for AIDS-defining cancers have been presented elsewhere .
SIRs in people with HIV and/or AIDS are shown in Table 3. There were significantly increased rates of several cancers, including cancer of lip (10 cases, nine of which were squamous cell carcinoma), anus (10 cases, eight of which were squamous cell carcinoma), connective tissue (20 cases, 10 of which had no histological confirmation, five were haemangiosarcomata, and one sarcoma not specified), Hodgkin's disease (15 cases, of which six were of mixed cellularity, three lymphocyte depleted, one nodular sclerosis, and five were not specified), myeloma, and leukaemia (13 cases including a variety of subtypes with no more than three of each subtype). SIRs were not significantly raised for lung cancer (17 cases, of which six were large cell, four were squamous cell, and three were adenocarcinoma) and cancer of the testis (10 cases, of which seven were seminoma). Rates of colon cancer were significantly decreased (three cases).
Overall, 37% of person–years were in period 1 (least immune deficient), 46% in period 2, 9.0% in period 3, and 7.4% in period 4 (most immune deficient). In period 1, rates were significantly increased only for cancer of the anus, liver and testis (first column of Table 4). Incidence rates of most cancers were increased in period 3 (the period 6 months either side of AIDS). Of the cancers that occurred at increased rates overall, there were significant increasing trends in cancer rates across the four periods for connective tissue cancer, Hodgkin's disease and multiple myeloma. If the period including the 6 months around AIDS was excluded, a significantly increasing trend was only seen for connective tissue cancer.
This study is the first to report linkage between population-based HIV and cancer registers. By separately linking data from both the HIV and AIDS registers, we were able to examine cancer rates across the spectrum of HIV infection from mild to severe immune deficiency, thereby extending the results of previous AIDS–cancer linkage studies. Thirty-seven percent of the total person–years of follow-up were in period one, which consisted of people at a less advanced stage of HIV infection than those included in previous linkage studies. Most of the person–years in this period (92%) were in those who never developed AIDS during follow-up rather than those who were HIV-positive for more than 5 years before AIDS. In this period of early HIV infection, of the cancers that occurred at increased rates overall, incidence was increased only for anal cancer, a disease known to occur at increased rates in HIV-negative homosexual men, who have been estimated to comprise about 85% of people with HIV in Australia . The absence of increases in rates in period one of cancers that were increased in later HIV infection, such as cancer of the lip and Hodgkin's disease, is somewhat reassuring that mild immune deficiency is not associated with increased cancer risk. We demonstrated a significant association of cancer risk with increasing immune deficiency over the four time periods for Hodgkin's disease, multiple myeloma, and connective tissue cancer, but there was reason to believe the association may have been related to diagnostic confusion with Kaposi's sarcoma for connective tissue cancer.
The main limitation of this study is its low power, despite the inclusion of 46% of people with HIV and all people notified with AIDS in Australia. Only 41 cancers were documented in the least immune deficient follow-up period. Another limitation was that our dataset contains very little data on HIV-infected women: in Australia only 7% of all HIV diagnoses to 1999 had been in women . It is likely that linkage identified the great majority of pathologically diagnosed cancers, as we have previously demonstrated that our matching procedure is highly sensitive and specific for identifying non-Hodgkin's lymphoma (NHL) in people with AIDS . It is likely that the matching would be similarly efficient for identifying cancers usually diagnosed pathologically. We have also demonstrated that AIDS registration in Australia is 97% complete for individuals diagnosed with AIDS–NHL , so it is unlikely that a substantial proportion of our cohort had AIDS that had not been registered as such.
Anal cancer is aetiologically related to infection with oncogenic subtypes of human papilloma viruses, and an increased risk in homosexual men was well described before the HIV epidemic . Although risk of anal intra-epithelial neoplasia has been associated with a degree of immune deficiency in cohort studies of homosexual men HIV infection , risk of carcinoma in situ and of invasive cancer was not associated with time before and after AIDS diagnosis in the largest AIDS–cancer linkage study , and did not tend to occur near the time of AIDS diagnosis in a cohort study . In our study, anal cancer rates increased from HIV diagnosis to the time around AIDS diagnosis, but there were no diagnoses more than 6 months after AIDS. Even in people with the mildest degree of immune deficiency rates of this cancer were increased 20-fold above that expected. Thus, our data do not support an independent association between invasive anal cancer and HIV-associated immune deficiency, but it may be that prolonged observation will be necessary. In transplant recipients, anogenital cancers occur at increased rates and appear much later after transplantation than do Kaposi's sarcoma and NHL .
Rates of Hodgkin's disease have been described as occurring at elevated rates in several cohort and linkage studies [1–4,16] and an association of risk with increasing immune deficiency has been previously reported [3,4]. Our finding that there were no cases of Hodgkin's disease in people in period one adds strength to the hypothesis that Hodgkin's disease is related to immune deficiency in people with HIV infection. This is supported by findings in clinical studies that Hodgkin's disease tends to occur at a median CD4 positive T-cell count of 200–300 × 106 cells/l .
Lip cancer occurs at increased rates in immune-suppressed transplant recipients  and shares aetiological risk factors with squamous cell carcinoma of the skin, which occurs at greatly increased rates in transplant recipients . Increased rates of lip cancer in people with AIDS have been described in Australia and the US [3,4]. The fact that rates were not increased in period one in this study is reassuring, but further study is needed to determine whether rates may be increased in long-term survivors of HIV infection. Cohort studies of people with HIV should collect data on lip cancer, and on skin cancers, to help determine whether these cancers will become a long term complication of HIV infection, as they are of long term iatrogenic immune suppression . As data on non-melanoma skin cancers are collected by few cancer registries, it is essential that data on these cancers are collected in cohort studies of people with HIV.
There have been several case series of multiple myeloma occurring in people with AIDS but there are few data from cohort studies. The largest reported AIDS–cancer linkage study found that incidence was raised 2.6-fold but it did not increase significantly from the pre- to post-AIDS period . An AIDS–cancer linkage study in Italy did not find an increased risk of myeloma .
Apart from anal cancer, Hodgkin's disease, lip cancer and multiple myeloma, there were other cancers that occurred at increased rates but there was reason to believe that the increased rates may not have reflected a true increase in incidence. For connective tissue cancers, 50% of registered cancers were not histologically confirmed, and many of those that were confirmed were haemangiosarcomata or unspecified sarcoma, and may have been diagnostically confused with Kaposi's sarcoma. For brain cancer, four of the sven diagnoses occurred around AIDS diagnosis, and as two of these four had no histological confirmation, there may have been diagnostic confusion with NHL.
There have been several cohort studies of cancer incidence in HIV-infected people, some without an AIDS diagnosis [7,16,21], but these have not reported on associations between immune deficiency and cancer, nor have they reported separately on cancer incidence by time period before or after AIDS diagnosis. Previous AIDS–cancer linkage studies [1–4] are unable to contribute data on the incidence of cancer in people with early HIV infection, and the tendency for cancer diagnosis to occur near the time of AIDS diagnosis shown in these and the current study may lead to over-estimation of the overall magnitude of the association between non-AIDS-defining cancers and AIDS.
As the incidence of AIDS has decreased among people with HIV treated with potent antiretroviral therapy, it has become important that other causes of morbidity are documented. The increasingly long-term survival of people with HIV with mild immune deficiency requires us to examine whether or not they will experience increased risk of certain cancers. Data from transplant recipients suggests that certain cancers, in particular cancers of the anogenital region and skin, may occur at increased rates. Although our study provides some reassurance that cancer rates are not markedly increased in early HIV infection, linkage of cancer and HIV registers in larger populations over a long duration of follow-up will be necessary to further document the cancer experience of this population, and the association between mild immune deficiency and cancer.
The authors wish to acknowledge the assistance of the Australian Institute of Health and Welfare, and the South Australian Cancer Register, who undertook the record linkage component of this work, and the National HIV Surveillance Committee. The National HIV Surveillance Committee comprises the following State/Territory and national representatives: Ms Irene Passaris (ACT); Mr Robert Menzies (NSW); Dr Jan Savage (NT); Dr Hugo Ree (QLD); Ms Therese Davey (SA); Mr Neil Cremasco (TAS); Ms Cathy Keenan (VIC); Dr Gary Dowse (WA); Professor John Kaldor (NCHECR) and Ms Ann McDonald (NCHECR).
1. Goedert JJ, Cote TR, Virgo P. et al. Spectrum of AIDS-associated malignant disorders. Lancet 1998, 358: 1833–1839.
2. Franceschi S, Dal Maso L, Arniani S. et al. Risk for cancer other than KS and NHL in persons with AIDS in Italy. Brit J Cancer 1998, 78: 966–970.
3. Grulich A, Wan X, Law M, Coates M, Kaldor J. Cancer incidence rates in people with AIDS in NSW, Australia. AIDS 1999, 13: 839–843.
4. Frisch M, Biggar RJ, Engels EA, Goedert JJ. Association of cancer with AIDS-related immunosuppression in adults. JAMA 2001, 285: 1736–1745.
5. Egger M, Hirschel B, Francioli P. et al. Impact of new anti-retroviral therapies in HIV infected patients in Switzerland: prospective cohort study. BMJ 1997, 315: 1194–1199.
6. Moore RD, Chaisson RE. Natural history of HIV infection in the era of combination antiretroviral therapy. AIDS 1999, 13: 1933–1942.
7. Jones JL, Hanson DL, Dworkin MS, Ward JW, Jaffe HW and the Adult/Adolescent Spectrum of HIV Disease Project Group. Effect of antiretroviral therapy on recent trends in selected cancers among HIV-infected persons. J Acquir Immune Defic Syndr 1999, 21: S11–S17.
8. Grulich AE, Wan X, Coates M, Day P, Kaldor JM. Validation of a non-identifying method of linking cancer and AIDS register data. J Epidemiol Biostat 1996, 1: 207–212.
9. Li Y, Law M, McDonald A, Correll P, Kaldor JM, Grulich AE. Estimation of non-AIDS defining cancer incidence in people with HIV infection prior to the occurrence of AIDS. Am J Epidemiol 2002, 155: 153–158.
10. Breslow NE, Day N. Statistical methods in cancer research, Volume 2- the design and analysis of cohort studies. Lyon: IARC; 1987
11. Grulich AE, Li Y, McDonald A, Correll PK, Law MG, Kaldor JM. Decreasing rates of HIV-associated Kaposi's sarcoma and non-Hodgkin's lymphoma in the era of highly active anti-retroviral therapy: national linkage study. AIDS 2001, 15: 629–633.
12. National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, Hepatitis C and Sexually Transmissible Infections in Australia, Annual Surveillance Report 1999. Sydney: NCHECR, UNSW; 1999.
13. Biggar RJ, Melbye M. Marital status in relation to Kaposi's sarcoma, non-Hodgkin's lymphoma and anal cancer in the pre-AIDS era. J Acquir Immune Defic Syndr Hum Retrovir, 1996, 11: 178–182.
14. Critchlow CW, Surawicz CM, Holmes KK. et al. Prospective study of high grade anal squamous intra-epithelial neoplasia in a cohort of homosexual men: influence of HIV infection, immunosuppression and human papillomavirus infection. AIDS 1995, 9: 1255–1262.
15. Frisch M, Biggar RJ, Goedert JJ. Human papilloma virus- associated cancers in patients with HIV infection and AIDS. JNCI 2000, 92: 1500–1510.
16. Koblin BA, Hessol NA, Zauber AG. et al. Increased incidence of cancer among homosexual men, New York City and San Francisco, 1978–1990. Am J Epidemiol 1996, 144: 916–923.
17. Penn I. Cancers of the anogenital region in renal transplant recipients. Cancer 1986, 58: 611–616.
18. Rabkin CS, Blattner WA. HIV infection and cancers other than non-Hodgkin's lymphoma and Kaposi's sarcoma. Cancer Surveys 1991, 10: 151–163.
19. Birkeland SA, Storm HH, Lamm LU. et al. Cancer risk after renal transplantation in the Nordic countries, 1964–1986. Int J Cancer 1995, 60: 183–189.
20. London NJ, Farmery SM, Will EJ, Davison AM, Lodge PA. Risk of neoplasia in renal transplant recipients. Lancet 1995, 346: 403–406.
21. Serraino D, Boschini A, Carrieri P. et al. Cancer risk among men with, or at risk of, HIV infection in southern Europe. AIDS 2000, 14: 553–559.
This article has been cited 96 time(s).
Bmc CancerAnal cytological abnormalities and epidemiological correlates among men who have sex with men at risk for HIV-1 infectionBmc Cancer
Clinics in Chest MedicineHuman Immunodeficiency Virus-Associated Lung MalignanciesClinics in Chest Medicine
Hiv MedicineCancer, immunodeficiency and antiretroviral treatment: results from the Australian HIV Observational Database (AHOD)Hiv Medicine
Clinical Lymphoma Myeloma & LeukemiaHigh-Dose Chemotherapy and Autologous Stem Cell Transplantation for Multiple Myeloma in HIV-Positive Patients in the Highly Active Antiretroviral Therapy Era: The Myeloma Institute of Research and Therapy ExperienceClinical Lymphoma Myeloma & Leukemia
International Journal of Epidemiology
Commentary: The changing face of AIDS
International Journal of Epidemiology, 31(5):
Scandinavian Journal of Infectious Diseases
Hodgkin's disease in the setting of human immunodeficiency virus infection
Scandinavian Journal of Infectious Diseases, 35(2):
American Journal of EpidemiologyCancer in a population-based cohort of men and women in registered homosexual partnershipsAmerican Journal of Epidemiology
British Journal of CancerRisk of cancer in persons with AIDS in Italy, 1985-1998British Journal of Cancer
Cancer Epidemiology Biomarkers & PreventionRisk of germ cell tumors among men with HIV/acquired immunodeficiency syndromeCancer Epidemiology Biomarkers & Prevention
Bju InternationalHuman immunodeficiency virus-associated prostate cancer: clinicopathological findings and outcome in a multi-institutional studyBju International
Hematology-Oncology Clinics of North AmericaEpidemiology of AIDS-related malignancies - An international perspectiveHematology-Oncology Clinics of North America
Clinical Infectious DiseasesHIV infection is associated with an increased risk for lung cancer, independent of smokingClinical Infectious Diseases
Revue Du Praticien
HIV infection and comorbidities
Revue Du Praticien, 56(9):
Risk of cancers during interrupted antiretroviral therapy in the SMART study
BloodHodgkin lymphoma in the Swiss HIV Cohort StudyBlood
Current Hiv Research
Human immunodeficiency virus-induced apoptosis of human breast cancer cells via CXCR4 is mediated by the viral envelope protein but does not require CD4
Current Hiv Research, 6(1):
Journal of Clinical OncologyMulticenter study of human immunodeficiency virus-related germ cell tumorsJournal of Clinical Oncology
CancerAnal cancer incidence and survival: The surveillance, epidemiology, and end results experience, 1973-2000Cancer
Journal of Clinical OncologyHuman immunodeficiency virus-associated squamous cell cancer of the anus: Epidemiology and outcomes in the highly active Antiretroviral therapy eraJournal of Clinical Oncology
OnkologieMalignant melanoma and HIV infection - Aggressive Course despite Immune ReconstitutionOnkologie
American Journal of EpidemiologyThe impact of highly active antiretroviral therapy on non-AIDS-defining cancers among adults with AIDSAmerican Journal of Epidemiology
Annals of OncologyHighly active antiretroviral therapy (HAART) improves survival in HIV-associated Hodgkin's disease: results of a multicenter studyAnnals of Oncology
Jama-Journal of the American Medical Association
Cancer incidence before and after kidney transplantation
Jama-Journal of the American Medical Association, 296():
Cancer Causes & ControlSpectrum of HIV/AIDS related cancers in IndiaCancer Causes & Control
Journal of the National Cancer InstituteCancer risk in the swiss HIV cohort study: Associations with immunodeficiency, smoking, and highly active antiretroviral therapyJournal of the National Cancer Institute
Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis
Non-AIDS-defining cancers: Should antiretroviral therapy be initiated earlier?
AIDS Reader, 18(1):
National review of deaths among HIV-infected adults
Clinical Medicine, 8(3):
Sexually Transmitted InfectionsAnal human papillomavirus genotype diversity and co-infection in a community-based sample of homosexual menSexually Transmitted Infections
Journal of Clinical OncologyHIV As a Risk Factor for Lung Cancer in Women: Data From the Women's Interagency HIV StudyJournal of Clinical Oncology
American Journal of Epidemiology
Re: "Estimation of risk of cancers before occurrence of acquired immunodeficiency syndrome in persons infected with human immunodeficiency virus" - Reply
American Journal of Epidemiology, 157():
Archives of Internal Medicine
Cirrhosis and hepatocellular carcinoma in HIV-infected veterans with and without the hepatitis C virus - A cohort study, 1992-2001
Archives of Internal Medicine, 164():
AIDS-related malignancies: Emerging challenges in the era of highly active antiretroviral therapy
CancerIncidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individualsCancer
Revue De Medecine InterneCancers and HIV infection. Any association?Revue De Medecine Interne
ThoraxLung cancer in HIV infected patients: facts, questions and challengesThorax
Deutsche Medizinische WochenschriftHigh incidence of non-AIDS-defined cancers among HIV-infected patients in Germany: analysis of data collected over a period of 3 yearsDeutsche Medizinische Wochenschrift
Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Squamous Cell Carcinoma of the Anal Canal
Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 7(4):
International Journal of Std & AIDS
HIV-related testicular cancer
International Journal of Std & AIDS, 14(1):
Lancet Infectious Diseases
Epstein-Barr virus - recent advances
Lancet Infectious Diseases, 3(3):
Journal of Clinical OncologyIncidence of non-AIDS-defining cancers before and during the highly active antiretroviral therapy era in a cohort of human immunodeficiency virus-infected patientsJournal of Clinical Oncology
British Journal of CancerThe risk of cancer in HIV-infected people in southeast England: a cohort studyBritish Journal of Cancer
Bulletin Du Cancer
Epidemiology of HIV-associated malignancies
Bulletin Du Cancer, 90(5):
Lung cancer in patients with HIV infection: is it AIDS-related?
Hiv Medicine, 5(2):
The changing face of the HIV epidemic in western Europe: what are the implications for public health policies?
Journal of Clinical OncologyWhich one is better: AIDS related or HIV associated?Journal of Clinical Oncology
Annals of Internal Medicine
Incidence of types of cancer among HIV-Infected persons compared with the general population in the United States, 1992-2003
Annals of Internal Medicine, 148():
Cochrane Database of Systematic ReviewsInterventions for previously untreated patients with AIDS-associated Non-Hodgkin's LymphomaCochrane Database of Systematic Reviews
Head and Neck-Journal for the Sciences and Specialties of the Head and NeckPrimary Squamous Cell Carcinoma of Stensen's Duct in A Patient With Hiv: the Role of Magnetic Resonance Imaging and Fine-Needle AspirationHead and Neck-Journal for the Sciences and Specialties of the Head and Neck
Internal MedicineGerm Cell Tumor Concomitant with Acquired Immune Deficiency SyndromeInternal Medicine
Transfusion and Apheresis ScienceHuman immunodeficiency and Hodgkin lymphomaTransfusion and Apheresis Science
British Journal of CancerPattern of cancer risk in persons with AIDS in Italy in the HAART eraBritish Journal of Cancer
Epidemiology of non-Hodgkin lymphomas and other haemolymphopoietic neoplasms in people with AIDS
Lancet Oncology, 4(2):
CancerPopulation-based patterns of human immunodeficiency virus-related Hodgkin lymphoma in the greater San Francisco Bay Area, 1988-1998Cancer
AIDSLung cancer in persons with AIDS in Italy, 1985-1998AIDS
Clinical Infectious Diseases
Trends in AIDS-defining and non-AIDS-defining malignancies among HIV-infected patients: 1989-2002
Clinical Infectious Diseases, 39(9):
Frontiers in Bioscience
Acquired immunodeficiency syndrome associated lymphoma
Frontiers in Bioscience, 10():
International Journal of CancerCancer risk in people infected with human immunodeficiency virus in the United StatesInternational Journal of Cancer
Seminars in HematologyTreatment of gammaherpesvirus-related neoplastic disorders in the immunosuppressed hostSeminars in Hematology
International Journal of CancerSpectrum of cancers among HIV-infected persons in Africa: The Uganda AIDS-cancer registry match studyInternational Journal of Cancer
Journal of the American Academy of DermatologyCutaneous malignancy and human immunodeficiency virus diseaseJournal of the American Academy of Dermatology
British Journal of CancerRisk of breast, ovary, and uterine corpus cancers among 85 268 women with AIDSBritish Journal of Cancer
BloodHodgkin lymphoma and immunodeficiency in persons with HIV/AIDSBlood
Acta HaematologicaEffect of L-Asparaginase Combined with Vincristine and Prednisolone on Acute Myeloblastic Leukemia (M0) Associated with Non-Hodgkin LymphomaActa Haematologica
Decline in the AIDS and death rates in the EuroSIDA study: an observational study
Journal of Laryngology and Otology
Head and neck cancer in patients with human immunodeficiency virus-1 infection: incidence, outcome and association with Epstein-Barr virus
Journal of Laryngology and Otology, 118(3):
Leukemia & Lymphoma
Plasma cell tumors in HIV-positive patients: Report of a case and review of the literature
Leukemia & Lymphoma, 46(7):
Serum prostate-specific antigen levels in older men with or at risk of HIV infection
Hiv Medicine, 7(7):
International Journal of CancerCancer and viral infections in immunocompromised individualsInternational Journal of Cancer
HIV infection and cancer in the era of highly active antiretroviral therapy (Review)
Oncology Reports, 17(5):
Hiv MedicineBritish HIV Association guidelines for HIV-associated malignancies 2008Hiv Medicine
Clinical Colorectal CancerHuman Immunodeficiency Virus-Associated Adenocarcinoma of the Colon: Clinicopathologic Findings and OutcomeClinical Colorectal Cancer
Plos OneThe Challenge of AIDS-Related Malignancies in Sub-Saharan AfricaPlos One
Infections in Medicine
AIDS-related non-Hodgkin lymphorna: Evolving clinical issues in the HAART era
Infections in Medicine, 24():
Uhod-Uluslararasi Hematoloji-Onkoloji DergisiSeroprevalence of HTLV I-II, HIV and HCV Antibodies in Lymphoma, Head and Neck Cancer PatientsUhod-Uluslararasi Hematoloji-Onkoloji Dergisi
Journal of Medical VirologyTesticular Cancer and Viral Infections: A Systematic Literature Review and Meta-AnalysisJournal of Medical Virology
Current Opinion in Infectious DiseasesNon-AIDS-defining cancersCurrent Opinion in Infectious Diseases
Current Opinion in OncologyAIDS-defining and non-AIDS-defining malignancies: cancer occurrence in the antiretroviral therapy eraCurrent Opinion in Oncology
Current Opinion in OncologyEvolving epidemiology of malignancies in HIVCurrent Opinion in Oncology
JAIDS Journal of Acquired Immune Deficiency SyndromesInterleukine-2 Therapy Does Not Increase the Risk of Hodgkin or Non-Hodgkin Lymphoma in HIV-Infected Patients: Results From FHDH ANRS CO4JAIDS Journal of Acquired Immune Deficiency Syndromes
JAIDS Journal of Acquired Immune Deficiency SyndromesImmune Deficiency and Risk for Malignancy Among Persons with AIDSJAIDS Journal of Acquired Immune Deficiency Syndromes
JAIDS Journal of Acquired Immune Deficiency SyndromesIncidence and Epidemiology of Anal Cancer in the Multicenter AIDS Cohort StudyJAIDS Journal of Acquired Immune Deficiency Syndromes
JAIDS Journal of Acquired Immune Deficiency SyndromesPopulation-Based Surveillance of HIV-Associated Cancers: Utility of Cancer Registry DataJAIDS Journal of Acquired Immune Deficiency Syndromes
JAIDS Journal of Acquired Immune Deficiency SyndromesIncidence of AIDS-Defining Cancers After AIDS Diagnosis Among People with AIDS in Italy, 1986–1998JAIDS Journal of Acquired Immune Deficiency Syndromes
JAIDS Journal of Acquired Immune Deficiency SyndromesA Meta-Analysis of the Incidence of Non-AIDS Cancers in HIV-Infected IndividualsJAIDS Journal of Acquired Immune Deficiency Syndromes
Journal of Clinical GastroenterologyEffect of HIV Infection on the Prevalence of Colorectal Adenomas During Screening ColonoscopyJournal of Clinical Gastroenterology
cancers; epidemiology; homosexual men; risk factors
© 2002 Lippincott Williams & Wilkins, Inc.
Highlight selected keywords in the article text.