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Cancer Incidence in a Nationwide HIV/AIDS Patient Cohort in Taiwan in 1998–2009

Chen, Marcelo MD, PhD*,†,‡; Jen, Ian PhD§; Chen, Yi-Hsien MSc; Lin, Ming-Wei MPH, PhD§; Bhatia, Kishor PhD; Sharp, Gerald B. DrPH#; Law, Matthew G. MSc, PhD**; Arthur Chen, Yi-Ming MD, ScD‖,††

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2014 - Volume 65 - Issue 4 - p 463–472
doi: 10.1097/QAI.0000000000000065
Epidemiology and Prevention

Background: The aims of this study were to investigate the cancer incidence and risk in HIV/AIDS patients relative to the general population in Taiwan.

Methods: Using Taiwan's National Health Insurance Research Database, 15,269 HIV/AIDS patients were identified between 1998 and 2009. Gender-specific incidence densities (IDs) of both AIDS-defining cancers (ADC) and non–AIDS-defining cancers (NADC) after HIV infection were calculated. Age-, sex-, and period-adjusted standardized incidence rates (SIRs) were obtained using 1.8 million people from the general population as controls.

Results: A total of 1117 male and 165 female HIV/AIDS patients were diagnosed with cancer. Non-Hodgkin lymphoma (n = 196; ID = 328.79/100,000 person-years) and cervical cancer (n = 50; ID = 712.08/100,000 person-years) were the most common ADCs, whereas liver cancer (n = 125; ID = 184.52/100,000 person-years) and colon cancer (n = 11; ID = 156.66/100,000 person-years) were the most common NADCs in males and females, respectively. Period-adjusted gender-specific ADC and NADC rates decreased from more than 1500 cases/100,000 person-years to less than 500 cases/100,000 person-years (P < 0.001 for trend). SIRs of ADCs and NADCs also decreased. However, relative to the general population, increased SIRs were still seen for most cancers, many of which had an infectious etiology. The highest SIRs in ADCs and NADCs were seen in Kaposi sarcoma [SIR = 298.0, 95% confidence interval (CI): 258.16 to 343.85] and anal cancer (SIR = 19.10, 95% CI: 12.80 to 27.50).

Conclusion: This study showed that although the cancer incidence rates have significantly decreased in the highly active antiretroviral therapy era, HIV/AIDS patients were still at increased risk of ADCs and most NADCs. Cancer screening, especially for infection-related NADCs, should therefore be promoted.

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*Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan;

Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan;

School of Medicine, Mackay Medical College, New Taipei City, Taiwan;

§Department and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan;

Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan;

AIDS Malignancy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD;

#Epidemiology Branch, Basic Science Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD;

**Kirby Institute, the University of New South Wales, Sydney, Australia; and

††Department of Microbiology and Institute of Medical Research, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Correspondence to: Yi-Ming Arthur Chen, MD, ScD, Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan (e-mail:

Supported in part by the Asia Pacific HIV Research Collaboration, an initiative of TREAT Asia, a program of amfAR, the Foundation for AIDS Research, with support from the US National Institute of Health's National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Cancer Institute, as part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA; U01AI069907), and from the Dutch Ministry of Foreign Affairs through a partnership with Stichting Aids Fonds. The Kirby Institute is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, the University of New South Wales.

The authors have no conflicts of interest to disclose.

M.C. and I.J. contributed equally to this work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or National Health Research Institutes. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned.

Received November 05, 2013

Accepted November 05, 2013

© 2014 by Lippincott Williams & Wilkins