Abstract
BackgroundWith successful antiretroviral therapy, non-communicable diseases, including malignancies, are increasingly contributing to morbidity and mortality among HIV-infected persons. The epidemiology of AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) in HIV-infected populations in Brazil has not been well described. It is not known if cancer trends in HIV-infected populations in Brazil are similar to those of other countries where antiretroviral therapy is also widely available.MethodsWe performed a retrospective analysis of clinical cohorts at Instituto Nacional de Infectologia Evandro Chagas (INI) in Rio de Janeiro and Vanderbilt Comprehensive Care Clinic (VCCC) in Nashville from 1998 to 2010. We used Poisson regression and standardized incidence ratios (SIRs) to examine incidence trends. Clinical and demographic predictors of ADCs and NADCs were examined using Cox proportional hazards models.ResultsThis study included 2,925 patients at INI and 3,927 patients at VCCC. There were 57 ADCs at INI (65% Kaposi sarcoma), 47 at VCCC (40% Kaposi sarcoma), 45 NADCs at INI, and 82 at VCCC. From 1998 to 2004, incidence of ADCs remained statistically unchanged at both sites. From 2005 to 2010, ADC incidence decreased in both cohorts (INI incidence rate ratio per year = 0.74, p < 0.01; VCCC = 0.75, p < 0.01). Overall Kaposi sarcoma incidence was greater at INI than VCCC (3.0 vs. 1.2 cases per 1,000 person-years, p < 0.01). Incidence of NADCs remained constant throughout the study period (overall INI incidence 3.6 per 1,000 person-years and VCCC incidence 5.3 per 1,000 person-years). Compared to general populations, overall risk of NADCs was increased at both sites (INI SIR = 1.4 [95% CI 1.1-1.9] and VCCC SIR = 1.3 [1.0-1.7]). After non-melanoma skin cancers, the most frequent NADCs were anal cancer at INI (n = 7) and lung cancer at VCCC (n = 11). In multivariate models, risk of ADC was associated with male sex and immunosuppression. Risk of NADC was associated with increased age.ConclusionsIn both cohorts, ADCs have decreased over time, though incidence of KS was higher at INI than VCCC. Rates of NADCs remained constant over time at both sites.Electronic supplementary materialThe online version of this article (doi:10.1186/1750-9378-10-4) contains supplementary material, which is available to authorized users.
Highlights
With successful antiretroviral therapy, non-communicable diseases, including malignancies, are increasingly contributing to morbidity and mortality among Human immunodeficiency virus (HIV)-infected persons
The epidemiology of Acquired immunodeficiency syndrome (AIDS)-defining cancer (ADC) and Non-AIDS-defining cancer (NADC) in HIV-infected populations has not been described in Brazil. It is unknown whether cancer trends in HIVinfected populations in Brazil are similar to those in high-income countries like the U.S This study aimed to compare the epidemiology and predictors of malignancy in clinical cohorts of HIV patients from Rio de Janeiro (Instituto Nacional de Infectologia Evandro Chagas [INI]), Brazil, and Tennessee (Vanderbilt Comprehensive Care Clinic [VCCC]), USA, as an example referent HIV-infected population with a diverse patient profile
Among the HIV disease markers that we examined, time-varying CD4+ lymphocyte count remained statistically associated with risk of ADC in multivariable models for both sites
Summary
Non-communicable diseases, including malignancies, are increasingly contributing to morbidity and mortality among HIV-infected persons. The epidemiology of AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) in HIV-infected populations in Brazil has not been well described. It is not known if cancer trends in HIV-infected populations in Brazil are similar to those of other countries where antiretroviral therapy is widely available. In the era of highly active antiretroviral therapy (ART), cancer is an important cause of morbidity and mortality of individuals living with HIV. Despite increasing availability of ART, ADCs continue to account for substantial morbidity and mortality [9,10]. There is a recognized global need for improved screening, diagnosis, and treatment programs for cancer in HIV-infected populations [12,13,14]
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