American Journal of Epidemiology Advance Access originally published online on March 6, 2007
American Journal of Epidemiology 2007 165(10):1143-1153; doi:10.1093/aje/kwm017
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ORIGINAL CONTRIBUTIONS |
The Impact of Highly Active Antiretroviral Therapy on Non-AIDS-Defining Cancers among Adults with AIDS
1 Department of Medicine, University of California, San Francisco, CA
2 AIDS Office, San Francisco Department of Public Health, San Francisco, CA
3 California Cancer Registry, Public Health Institute, Sacramento, CA
4 Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
Correspondence to Nancy A. Hessol, University of California San Francisco, Department of Medicine, 405 Irving Street, 2nd Floor, San Francisco, CA 94122 (e-mail: Nancy.Hessol{at}ucsf.edu).
Received for publication May 2, 2006. Accepted for publication November 8, 2006.
Highly active antiretroviral therapy (HAART) has dramatically reduced the incidence of acquired immunodeficiency syndrome (AIDS) and increased AIDS survival time, but little is known about its impact on cancer. Data from adults in the San Francisco, California, AIDS surveillance registry were computer matched with the California Cancer Registry. Age-, sex-, and race-adjusted standardized incidence ratios (SIRs) were computed, and proportional hazards models evaluated the effect of HAART use on cancer incidence and cancer survival time. Among 14,210 adults with AIDS diagnosed in 1990–2000, 482 non-AIDS-defining cancers were diagnosed. Compared with rates for the general population, significantly increased cancer incidence rates were observed for anal (SIR = 13.4), Hodgkin's lymphoma (SIR = 11.5), liver (SIR = 3.6), oral cavity and pharynx (SIR = 2.6), respiratory (SIR = 2.6), leukemia (SIR = 2.4), skin melanoma (SIR = 2.4), and prostate (SIR = 1.7) cancers. Risk of liver cancer was lower with HAART use (relative hazard (RH) = 0.32). Risk of anal cancer increased after 1995 (RH = 2.9). Respiratory cancer (RH = 0.40) and Hodgkin's lymphoma (RH = 0.17) showed increased cancer survival time with HAART use, while anal cancer survival may have been slightly decreased (RH = 1.4). The impact of HAART on non-AIDS-defining cancer incidence rates and survival is not uniform, and the mechanism(s) responsible for these differences should be investigated further.
acquired immunodeficiency syndrome; antiretroviral therapy, highly active; HIV infections; incidence; neoplasms; survival
Abbreviations: AIDS, acquired immunodeficiency syndrome; HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus; RH, relative hazard; SEER, Surveillance, Epidemiology, and End Results; SIR, standardized incidence ratio
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