Characteristics of non‐AIDS‐defining malignancies in the HAART era: a clinico‐epidemiological study

Nicolas Dauby,Stéphane De Wit,Valentina Coca Necsoi,Nathan Clumeck,Marc Delforge

doi:10.1186/1758-2652-14-16

Abstract

BackgroundNon-AIDS-defining malignancies (NADM) are becoming a major cause of mortality in the era of highly active antiretroviral therapy. We wished to investigate the incidence, risks factors and outcome of NADM in an urban cohort.MethodsWe carried out an observational cohort of HIV patients with 12,746 patient-years of follow up between January 2002 and March 2009. Socio-demographics and clinical characteristics of patients diagnosed with NADM were retrospectively compared with the rest of the cohort. Causes of death and risk factors associated with NADM were assessed using logistic regression. Survival analyses were performed with Kaplan-Meier estimates. Cancer incidences were compared with those of the general population of the Brussels-Capital Region using the standardized incidence ratio (SIR).ResultsForty-five NADM were diagnosed. At inclusion in the study, patients with NADM were older than patients without NADM (47 years vs. 38 years, p < 0.001), had a longer history of HIV infection (59 months vs. 39 months, p = 0.0174), a lower nadir CD4 count (110 cells/mm3 vs. 224 cells/mm3, p < 0.0001) and a higher rate of previous AIDS events (33% vs. 20%, p = 0.0455) and of hepatitis C virus co-infection (22.2% vs. 10%, p = 0.0149). In multivariate analysis, age over 45 at baseline (OR 3.25; 95% CI 1.70-6.22) and a nadir CD4 count of less than 200 cells/mm3 (OR 3.10; 95% CI 1.40-6.87) were associated with NADM. NADM were independently associated with higher mortality in the cohort (OR 14.79; 95% CI 6.95-31.49). Women with cancer, the majority of whom were of sub-Saharan African origin, had poorer survival compared with men. The SIR for both sexes were higher than expected for Hodgkin's lymphoma (17.78; 95% CI 6.49-38.71), liver cancers (8.73; 95% CI 2.35-22.34), anal cancers (22.67; 95% CI 8.28-49.34) and bladder cancers (3.79; 95% CI 1.02-9.70). The SIR for breast cancer was lower in women (SIR 0.29; 95% CI 0.06-0.85).ConclusionsAge over 45 and a nadir CD4 count of less than 200 cells/mm3 were predictive of NADM in our cohort. Mortality was high, especially in sub-Saharan African women. Cancers with increased incidences were Hodgkin's lymphoma and anal, bladder and liver cancers in both sexes; women had a lower incidence of breast cancer.

Highlights

Non-AIDS-defining malignancies (NADM) are becoming a major cause of mortality in the era of highly active antiretroviral therapy
We report our experience with NADM in a singlecentre cohort of HIV-infected patients during the late highly active antiretroviral therapy (HAART) era
Two cases of NADM were excluded from the analysis: one breast cancer because the diagnosis of HIV was made after the diagnosis of cancer; and one thyroid cancer because the diagnosis of cancer was made abroad and available data were insufficient

Summary

Introduction

Non-AIDS-defining malignancies (NADM) are becoming a major cause of mortality in the era of highly active antiretroviral therapy. HIV infection is associated with an increased incidence of certain types of cancer, i.e., Kaposi sarcoma, nonHodgkin’s lymphoma and cervical cancer, all linked with profound immunosuppression [1]. These cancers have been classified as AIDS-defining malignancies (ADM) by the Centers for Disease Control and Prevention since 1993. The introduction of highly active antiretroviral therapy (HAART) led to a change in the causes of hospitalization and death of HIV-infected patients, with a significant decrease in AIDS-related causes, like ADM, but with a rise in cardiovascular diseases and non-AIDSdefining malignancies (NADM); these became major causes of mortality in the HAART era [2,3,4]. More data are pointing to the role of prolonged immunosuppression, independently of other risk factors

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