Abstract
ObjectiveFollowing the introduction of highly active antiretroviral therapy (HAART) the risk of AIDS-defining cancers decreased but incidence of many non-AIDS-defining cancers has reportedly increased in those with HIV/AIDS. Whether melanoma risk has also changed in HIV/AIDS patients post-HAART is unknown and therefore we evaluated this in comparison with the risk before HAART.DesignSystematic review and meta-analysis.MethodsWe searched Medline, Embase and ISI science citation index databases to April 2013. All cohort studies of patients diagnosed with HIV/AIDS that permitted quantitative assessment of the association with melanoma were eligible. Detailed quality assessment of eligible studies was conducted, focussing particularly on adjustment for ethnicity, a priori considered essential for an unbiased assessment of melanoma risk. Data were pooled using a random effects model.ResultsFrom 288 articles, we identified 21 that met the inclusion criteria, 13 presenting data for the post-HAART era and 8 for the pre-HAART era. Post-HAART the pooled relative risk (pRR) for the association between HIV/AIDS and melanoma was 1.26 (95% CI, 0.97–1.64) and 1.50 (95% CI 1.12–2.01) among studies that accounted for ethnicity, with evidence of significant heterogeneity (P = 0.004, I2 = 55.5). Pre-HAART pRRs were 1.26 (95% CI 1.11–1.43; Phet = 0.82) and 1.28 (95% CI 1.10–1.49) among studies adjusted for ethnicity.ConclusionsPeople with HIV/AIDS remain at a significantly increased risk of developing melanoma in the post-HAART era. White skinned people with HIV/AIDS should be screened regularly and counselled against excessive sun exposure.
Highlights
Prior to the introduction of highly active antiretroviral therapy (HAART) in the latter part of the 1990s, a modestly increased incidence of cutaneous melanoma in people with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) was observed
We conducted a systematic review and meta-analysis to evaluate melanoma risk in HIV/AIDS patients compared with the general population in the pre-HAART and post-HAART eras
Six studies defined their cohort as patients with AIDS [22,23,27,28,31,36], though four of these six studies included time before onset of AIDS in calculations of person-years at risk
Summary
Prior to the introduction of highly active antiretroviral therapy (HAART) in the latter part of the 1990s, a modestly increased incidence of cutaneous melanoma in people with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) was observed. A meta-analysis of population-based data collected mostly prior to the introduction of HAART reported an overall Standardised Incidence Ratio (SIR) for melanoma of 1.24 (95% CI = 1.04-1.48) [1]. Whether the risk of melanoma in HIV/AIDS populations compared with the general population has increased since the introduction of HAART along with other non-AIDSdefining cancers is unknown . We conducted a systematic review and meta-analysis to evaluate melanoma risk in HIV/AIDS patients compared with the general population in the pre-HAART and post-HAART eras
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