Human immunodeficiency virus-related cancer in children: incidence and treatment outcome--report of the Italian Register.
OBJECTIVE
To outline the incidence, presenting features, treatment response, and outcome of human immunodeficiency virus (HIV)-associated malignancies in infancy and childhood, together with the estimated risk of HIV-associated cancer in children born to mothers infected with HIV.


METHODS
The Italian Register for HIV Infection in Children collected data by specific registration and follow-up forms. By March 1999, 5,060 children were recruited, including 4,889 with perinatal exposure to HIV-1. Overall, 1,331 infected children were enrolled onto the Register and classified according to current Centers for Disease Control criteria; of them, 1,163 were vertically infected (24% of those with perinatal exposure). Of these 1,163, 569 (49%) were considered to have been prospectively followed-up since they had been registered at birth or within the first 3 months of age.


RESULTS
Of the 1,331 children observed for a median time of 6.5 years, 35 developed 36 malignancies, four of which occurred in patients with blood-borne risk. For the 1,163 vertically infected children, the cumulative number of years of observation was 7,178 child-years and the cumulative incidence of HIV-associated tumors was 4.18 per 1,000 children/yr (95% confidence interval [CI], 2.92 to 5.98). When only the 569 vertically infected children prospectively followed up since birth were considered, the cumulative number of years of observation was 2,803 child-years. In this group, 10 tumors were observed, with a cumulative incidence of HIV-associated tumors of 3.57 per 1,000 children per year (95% CI, 1.92 to 6.63).


CONCLUSIONS
The risk of cancer was significantly higher but not restricted to symptomatic and/or immune-compromised children. Cancer-directed treatment should be given promptly to these patients, who have a fair chance to survive their tumor in view of potential highly aggressive antiretroviral therapy-associated improvement in survival and quality of life.
Caselli
D
D
Clinica Pediatrica, Direzione Scientifica, Instituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia, Italy. caselli@smatteo.pv.it
Klersy
C
C
de Martino
M
M
Gabiano
C
C
Galli
L
L
Tovo
P A
PA
Aricò
M
M
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007558:Italy / Q000453:epidemiology; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome