Mortality for non-AIDS-defining cancers among people with AIDS.

Abstract

1590 Background: In the era of highly active antiretroviral therapies, the impact of non-AIDS-defining cancers on mortality of people with HIV/AIDS has been rarely quantified. To evaluate the risk of death for non-AIDS-defining cancers, among Italian people with AIDS (PWA). Methods: Population-based, retrospective, cohort study. 10,391 Italian citizens, aged 15 years or more, diagnosed with AIDS, in Italy, between 1999 and 2006, were included in the study. Record-linkage with mortality databases of the Italian Institute of Statistics was carried out to retrieve vital status and death certificates. Follow-up was calculated from date of AIDS diagnosis to date of death, or to December 31, 2006 for PWA who were still alive. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs), in comparison with the Italian population, were calculated for each non-AIDS-defining cancer, which was the underlying cause of death. Results: Among 3,209 deceased PWA, 7.4% died for non-AIDS-defining cancers, with a SMR of 6.6 (95% CI 5.8-7.5). Significantly elevated SMRs were found for several cancer types, notably for Hodgkin lymphoma (SMR = 174, 95% CI 115-251), and cancers of liver (SMR = 11.1, 95% CI 7.4-16.1), brain (SMR = 10.0, 95% CI 5.4-16.8), head and neck (SMR = 8.2, 95% CI 4.8-12.9), lung (SMR = 5.9, 95% CI 4.4-7.6), and myeloma and leukaemias (SMR = 5.9, 95% CI 2.8- 10.8). Overall mortality for non-AIDS-defining cancers was particularly high among injecting drug users (SMR = 15.5, 95% CI 12.5-18.9). Conclusions: The finding of elevated SMRs for non-AIDS-defining cancers should be interpreted as the joint result of the increased incidence and of the worse prognosis for these malignancies among PWA. They also reveal the importance of monitoring the cancer burden on mortality of PWA. No significant financial relationships to disclose.