EFFECT OF ANTIRETROVIRAL THERAPY ON RECENT TRENDS IN CANCERS AMONG HIV-INFECTED PERSONS

Abstract

S3 Background: Antiretroviral therapy may slow the progression of HIV-related disease and effect the occurrence of cancers in HIV-infected persons. We examined recent incidence trends in 7 cancers (Kaposi's sarcoma [KS], invasive cervical cancer, immunoblastic lymphoma, primary brain lymphoma [PBL], Burkitt's lymphoma, other non-Hodgkin's lymphoma, Hodgkin's lymphoma) and the effect of antiretroviral therapy on these trends. Methods: We used data abstracted from medical records in 89 hospitals and clinics 1/94 - 12/96 in 9 U.S. cities that participate in the Adult/Adolescent Spectrum of HIV Disease (ASD) project. Incidence was calculated per 1000 person-years by half-year intervals and adjusted to AIDS surveillance data from the ASD metropolitan areas. The stratified (time dependent CD4+ T-lymphocyte count, race, sex, age, HIV-exposure mode, and geographic area) Cochran-Mantel-Haenszel statistic was used to test for overall trends and trends by prescribed use of any antiretroviral therapy. Results: 17,978 HIV-infected persons (22,489 person-years) were in the study population (79% men, 21% women). Overall, KS (1-6/94, 53.4; 7-12/96, 10.3; P<.001) and PBL (1-6/94, 8.5; 7-12/96, 0.9; P=.04) declined and no significant trend occurred in the other 5 cancers. During time on antiretroviral therapy, KS and PBL incidence declined (P<.001 for both), but the incidence did not decline significantly during time without therapy. From 1-6/94 to 7-12/96 combination (2 or more drugs) antiretroviral therapy at all CD4+ count levels increased from 20% to 46%. Conclusion: The incidences of KS and PBL are decreasing overall and specifically during time on antiretroviral therapy. The effects of recent changes in antiretroviral therapy in slowing the progression of HIV disease may account for these decreases.