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Risk of AIDS-defining cancers in HIV-1-infected patients (1992-2009): results from FHDH-ANRS CO4

M Hleyhel, A Belot, A Bouvier, P Tattevin, J Pacanowski, P Genet, N De Castro, J Berger, C Dupont, A Lavolé, C Pradier, D Salmon, A Simon, V Martinez, D Costagliola, S Grabar

Abstract


Purpose of the study: To describe long-term incidence trends and median age at diagnosis for the three AIDS-defining cancers (ADC) in HIV-1- infected (HIV1+) patients compared to general population. To study the risk of ADC in HIV1+ patients with good immune status (CD4 ≥500/mm3 for at least 2 years).

Methods: Incident ADC (Kaposi's sarcoma [KS], non-Hodgkin's lymphomas [NHL] and cervix uteri cancer [CUC]) were retrieved in HIV1+ adults followed in the French hospital database on HIV (FHDH) cohort between 1992 and 2009. Cancer incidence rates (IR) in general population were calculated using data from the French cancer registries (Francim network). IR among the HIV1+ and the general population were standardized using the 5 years age and sex groups structure of the HIV1+ population (1997-2009) and standardized incidence ratios (SIR) were estimated in HIV1+ patients vs. general population in 4 calendar periods (1992-1996, 1997-2000, 2001-2004, and 2005-2009). Median age at diagnosis was estimated after adjusting for the difference in age structure between HIV1+ and general population.

Summary of results: 5,935 incident ADC were diagnosed among 100,536 HIV1+ patients followed between 1992 and 2009. All ADC IRs were significantly reduced between pre- and post-cART eras and continue to decline in the cART period (p<10-4). SIR are presented in the table.
Median age at diagnosis was significantly younger among HIV1+ patients than the general population for KS (40.4 vs. 42.5; p<10-4), NHL (41.4 vs. 52.5; p<10-4) and CUC (39.3 vs. 42.5; p<10-4). For HIV1+ patients under treatment who maintained controlled viral load (<500 copies/μL) and CD4 ≥500/mm3 for at least 2 years, the risk for KS, NHL and CUC were respectively SIR = 71.6 (28.7-147.5), 2.4 (0.9-4.8) and 1.6 (0.3-4.7) vs. general population.

Conclusions: The incidence rates of KS, NHL and CUC continued to decline through 2009 but the risk remained elevated as compared to general population in the most recent cART period. Despite the great reduction when compared to general population, the risk is still very high for KS in HIV1+ patients who maintained CD4 ≥500/mm3 for at least 2 years. The risk was not significant for CUC and NHL.

(Published: 11 November 2012)

Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection

Hleyhel M et al. Journal of the International AIDS Society 2012, 15(Suppl 4):18196

http://www.jiasociety.org/index.php/jias/article/view/18196 | http://dx.doi.org/10.7448/IAS.15.6.18196




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