Overview of cancer incidence and mortality among people living with HIV/AIDS in British Columbia, Canada: Implications for HAART use and NADM development

Connie G. Chiu,Kate A. Salters,Sam M. Wiseman,Steve Kanters,Julio S.G. Montaner,Robert S. Hogg,Andy Coldman,Danielle Smith,David Milan,Wendy Zhang

doi:10.1186/s12885-017-3229-1

Abstract

BackgroundThe objective of this study is to evaluate the incidence of non-AIDS defining malignancies (NADMs) among people living with HIV/AIDS (PLWHA) in British Columbia, focusing on clinical correlates, highly active antiretroviral therapy (HAART) use, and survival, in order to elucidate mechanisms for NADM development.MethodsA retrospective population based analysis was carried out for individuals with HIV/AIDS that began their treatment between 1996 and 2008.ResultsThere were 145 (2.95%) NADMs and 123 (2.50%) AIDS defining malignancies (ADMs) identified in 4918 PLWHA in the study population. NADMs were represented by a range of cancer types including, most commonly, lung cancer, followed by anal, breast, head/neck, prostate, liver, rectal, and renal cancers. PLWHA had a SIR of 2.05 (CI:1.73, 2.41) for the development of NADMs compared to individuals without an HIV/AIDS diagnosis in the general population. Independent factors significantly associated with a NADM were: male gender, older age, lower CD4 cell counts, previous NADM, absence of HAART (non-HAART versus HAART) and treatment during the early-HAART era (before 2000 versus after 2000).ConclusionsNADMs represent an important source of morbidity for PLWHA. Use of HAART with its associated improvement in immune-restoration, and tailored targeted cancer screening interventions, may be beneficial and improve outcomes in this unique patient population.

Highlights

The objective of this study is to evaluate the incidence of non-AIDS defining malignancies (NADMs) among people living with HIV/AIDS (PLWHA) in British Columbia, focusing on clinical correlates, highly active antiretroviral therapy (HAART) use, and survival, in order to elucidate mechanisms for nonAIDS defining malignancy (NADM) development
Our current study found that individuals undergoing treatment in the late-HAART era (2000 and later) did not have a significantly decreased incidence of NADM when compared to individuals that began therapy during the early-HAART era
To further understand the mechanism by which HAART protects against NADM development, our present study found that a nadir CD4 level > 200 cells/ mm3 was protective against NADM development

Summary

Introduction

The objective of this study is to evaluate the incidence of non-AIDS defining malignancies (NADMs) among people living with HIV/AIDS (PLWHA) in British Columbia, focusing on clinical correlates, highly active antiretroviral therapy (HAART) use, and survival, in order to elucidate mechanisms for NADM development. Reports of remarkable improvements in patient survival and morbidity with the expanded use of the HAART regimen soon followed, ushering in a new era in which HIV/AIDS became viewed as a chronic manageable disease [3,4,5,6]. The longevity experienced by people living with HIV/AIDS (PLWHA) in the modern HAART era has resulted in increasing vulnerability to age-related diseases and new health challenges [7, 8]. While behavioural differences between HIV-positive and HIVnegative populations must be noted, studies controlling for smoking status found PLWHA to remain at increased

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