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Multicenter Study
. 2014 Apr 23;9(4):e94768.
doi: 10.1371/journal.pone.0094768. eCollection 2014.

Survival in HIV-infected patients after a cancer diagnosis in the cART Era: results of an italian multicenter study

Daria Gotti  1 , Elena Raffetti  2 , Laura Albini  1 , Laura Sighinolfi  3 , Franco Maggiolo  4 , Elisa Di Filippo  4 , Nicoletta Ladisa  5 , Gioacchino Angarano  5 , Giuseppe Lapadula  6 , Angelo Pan  7 , Anna Degli Esposti  8 , Massimiliano Fabbiani  9 , Emanuele Focà  1 , Alfredo Scalzini  10 , Francesco Donato  2 , Eugenia Quiros-Roldan  1 ; Master Cohort Group
Affiliations
Multicenter Study

Survival in HIV-infected patients after a cancer diagnosis in the cART Era: results of an italian multicenter study

Daria Gotti et al. PLoS One. .

Abstract

Objectives: We studied survival and associated risk factors in an Italian nationwide cohort of HIV-infected individuals after an AIDS-defining cancer (ADC) or non-AIDS-defining cancer (NADC) diagnosis in the modern cART era.

Methods: Multi-center, retrospective, observational study of HIV patients included in the MASTER Italian Cohort with a cancer diagnosis from January 1998 to September 2012. Malignancies were divided into ADC or NADC on the basis of the Centre for Disease Control-1993 classification. Recurrence of cancer and metastases were excluded. Survivals were estimated according to the Kaplan-Meier method and compared according to the log-rank test. Statistically significant variables at univariate analysis were entered in a multivariate Cox regression model.

Results: Eight hundred and sixty-six cancer diagnoses were recorded among 13,388 subjects in the MASTER Database after 1998: 435 (51%) were ADCs and 431 (49%) were NADCs. Survival was more favorable after an ADC diagnosis than a NADC diagnosis (10-year survival: 62.7%±2.9% vs. 46%±4.2%; p = 0.017). Non-Hodgkin lymphoma had lower survival rates than patients with Kaposi sarcoma or cervical cancer (10-year survival: 48.2%±4.3% vs. 72.8%±4.0% vs. 78.5%±9.9%; p<0.001). Regarding NADCs, breast cancer showed better survival (10-year survival: 65.1%±14%) than lung cancer (1-year survival: 28%±8.7%), liver cancer (5-year survival: 31.9%±6.4%) or Hodgkin lymphoma (10-year survival: 24.8%±11.2%). Lower CD4+ count and intravenous drug use were significantly associated with decreased survival after ADCs or NADCs diagnosis. Exposure to cART was found to be associated with prolonged survival only in the case of ADCs.

Conclusions: cART has improved survival in patients with an ADC diagnosis, whereas the prognosis after a diagnosis of NADCs is poor. Low CD4+ counts and intravenous drug use are risk factors for survival following a diagnosis of ADCs and Hodgkin lymphoma in the NADC group.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Survival probabilities according to cancer classification.
ADC, AIDS-defining cancer. NADC, non-AIDS-defining cancer.
Figure 2
Figure 2. Survival curves according to specific cancer types.
Panel (A) Survival probabilities according to AIDS-defining cancer (ADC) diagnosis. Overall, the median survival time from diagnosis of all ADC was 3.4 years; more specifically, the median survival time of NHL was 2.1 years, Kaposi sarcoma 4.7 years, and cervical cancer 5.1 years. Panel (B) Survival probabilities according to non-AIDS-defining cancer (NADC) diagnosis. The overall median survival time of NADC was 1.6 years; more specifically, the median survival time of liver cancer was 441 days, lung cancer 113 days, breast cancer 1624 days, and Hodgkin lymphoma 795 days.
See this image and copyright information in PMC

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