Abstract
ObjectivesWe studied survival and associated risk factors in an Italian nationwide cohort of HIV-infected individuals after an AIDS-defining cancer (ADC) or non-AIDS-defining cancer (NADC) diagnosis in the modern cART era.MethodsMulti-center, retrospective, observational study of HIV patients included in the MASTER Italian Cohort with a cancer diagnosis from January 1998 to September 2012. Malignancies were divided into ADC or NADC on the basis of the Centre for Disease Control-1993 classification. Recurrence of cancer and metastases were excluded. Survivals were estimated according to the Kaplan-Meier method and compared according to the log-rank test. Statistically significant variables at univariate analysis were entered in a multivariate Cox regression model.ResultsEight hundred and sixty-six cancer diagnoses were recorded among 13,388 subjects in the MASTER Database after 1998: 435 (51%) were ADCs and 431 (49%) were NADCs. Survival was more favorable after an ADC diagnosis than a NADC diagnosis (10-year survival: 62.7%±2.9% vs. 46%±4.2%; p = 0.017). Non-Hodgkin lymphoma had lower survival rates than patients with Kaposi sarcoma or cervical cancer (10-year survival: 48.2%±4.3% vs. 72.8%±4.0% vs. 78.5%±9.9%; p<0.001). Regarding NADCs, breast cancer showed better survival (10-year survival: 65.1%±14%) than lung cancer (1-year survival: 28%±8.7%), liver cancer (5-year survival: 31.9%±6.4%) or Hodgkin lymphoma (10-year survival: 24.8%±11.2%). Lower CD4+ count and intravenous drug use were significantly associated with decreased survival after ADCs or NADCs diagnosis. Exposure to cART was found to be associated with prolonged survival only in the case of ADCs.ConclusionscART has improved survival in patients with an ADC diagnosis, whereas the prognosis after a diagnosis of NADCs is poor. Low CD4+ counts and intravenous drug use are risk factors for survival following a diagnosis of ADCs and Hodgkin lymphoma in the NADC group.
Highlights
Several studies have shown that cancers are an increasingly important cause of illness and death in people with HIV [1,2,3]
Trends in relative incidence rates of AIDS-defining cancers (ADCs) and nonAIDS-defining cancers (NADCs) have been well characterized [4,5,6,7,8,9], but little is known about survival after a diagnosis of cancer in the setting of HIV infection- with the exception of non Hodgkin lymphoma (NHL), Kaposi sarcoma (KS), and anal cancer [10,11,12,13]
The aim of the present work is to investigate survival after diagnosis with either ADCs or NADCs in HIV-infected patients engaged in routine care at five sites across Italy from 1998 by September 2012 and to explore possible predictors of mortality after a diagnosis of cancer in this population
Summary
Several studies have shown that cancers are an increasingly important cause of illness and death in people with HIV [1,2,3]. A recent Italian study has analyzed the long term survival in HIV-infected patients after malignancies [18] but few studies have investigated possible factors associated with survival in the era of cART and data in the literature are often limited to specific cancers [10,11,12,13]. The aim of the present work is to investigate survival after diagnosis with either ADCs or NADCs in HIV-infected patients engaged in routine care at five sites across Italy from 1998 by September 2012 and to explore possible predictors of mortality after a diagnosis of cancer in this population. The proposed study will add further information in estimates of cancers (ADCs and NADCs), their characteristics, and prognosis in the setting of HIV and cART, to better understand the challenges that this booming population poses to oncologic and infectious health services in the near future
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