Pattern of cancer risk in persons with AIDS in Italy in the HAART era

Abstract

A record-linkage study was carried out between the Italian AIDS Registry and 24 Italian cancer registries to compare cancer excess among persons with HIV/AIDS (PWHA) before and after the introduction of highly active antiretroviral therapy (HAART) in 1996. Standardised incidence ratios (SIR) were computed in 21951 AIDS cases aged 16-69 years reported between 1986 and 2005. Of 101 669 person-years available, 45 026 were after 1996. SIR for Kaposi sarcoma (KS) and non-Hodgkin lymphoma greatly decreased in 1997-2004 compared with 1986-1996, but high SIRs for KS persisted in the increasingly large fraction of PWHA who had an interval of <1 year between first HIV-positive test and AIDS diagnosis. A significant excess of liver cancer (SIR=6.4) emerged in 1997-2004, whereas the SIRs for cancer of the cervix (41.5), anus (44.0), lung (4.1), brain (3.2), skin (non-melanoma, 1.8), Hodgkin lymphoma (20.7), myeloma (3.9), and non-AIDS-defining cancers (2.2) were similarly elevated in the two periods. The excess of some potentially preventable cancers in PWHA suggests that HAART use must be accompanied by cancer-prevention strategies, notably antismoking and cervical cancer screening programmes. Improvements in the timely identification of HIV-positive individuals are also a priority in Italy to avoid the adverse consequences of delayed HAART use.

Figure 1

Standardised incidence ratio (SIR) and corresponding 95% confidence interval of selected cancers in persons with HIV/AIDS by time of cancer occurrence with respect to AIDS diagnosis. Italy, 1997–2004^a. Abbreviations: KS: Kaposi sarcoma, NHL: non-Hodgkin lymphoma, NADC: non-AIDS-defining cancers, HL: Hodgkin lymphoma. ^aCancers reported to cancer registries in people with AIDS, aged 16–69 years, from 5 years prior to 10 years after AIDS diagnosis (at/after AIDS for AIDS-defining cancers). ^bVertical bars represent 95% confidence intervals.