title: Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy.
abstract: BACKGROUND
  Before the introduction of highly active antiretroviral therapy (HAART), malignancies accounted for less than 10% of all deaths among human immunodeficiency virus (HIV)-infected patients. This figure may have increased, and the observed types of malignant disease may have been modified, as a result of decreased occurrence of opportunistic infections, the chronicity of HIV infection, the possible oncogenic role of HIV itself, and the aging of the HIV-infected population.
  
  
  METHODS
  All French hospital wards involved in the management of HIV infection were asked to prospectively document the deaths of HIV-infected patients in the year 2000. Underlying causes of death were defined using a standardized questionnaire.
  
  
  RESULTS
  Of a total of 964 deaths, 269 (28%) were attributable to malignancies. Acquired immunodeficiency virus (AIDS)-related malignancies were the underlying cause of 149 deaths (15%); among these malignancies were non-Hodgkin lymphoma (n = 105 [11%]), noncerebral lymphoma (n = 78 [median CD4 count, 86 x 10(6) per liter; interquartile range [IQR], 35-231 x 10(6) per liter), and primary cerebral lymphoma (n = 27 [median CD4 count, 20 x 10(6) per liter; IQR, 4-109 x 10(6) per liter). Kaposi sarcoma was associated with 40 deaths (4%), and cervical carcinoma was associated with 5 (0.5%). Non-AIDS-related malignancies were the underlying cause of 120 deaths (13%); these non-AIDS-related malignancies included 103 solid tumors (50 respiratory tumors, 19 hepatocarcinomas, 9 digestive tumors, and 6 anal tumors; median CD4 count, 218 x 10(6) per liter; IQR, 108-380 x 10(6) per liter) and 17 hemopathies (12 Hodgkin lymphomas, 4 myeloid leukemias, and 1 myeloma; median CD4 count, 113 x 10(6) per liter; IQR, 56-286 x 10(6) per liter). Compared with patients who died of other causes, patients who died of solid tumors were more likely to be male, to smoke, to be older, and to have higher CD4 counts.
  
  
  CONCLUSIONS
  Malignant disease has been a major cause of death among HIV-infected patients in industrialized nations since the introduction of HAART. Whereas lethal hemopathies and Kaposi sarcoma are associated with advanced immunosuppression, lethal solid tumors can occur in patients with controlled HIV infection.
authors.affiliation: Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.forename: Thierry
authors.initials: T
authors.lastname: May
authors.forename: Laurence
authors.initials: L
authors.lastname: Heripret
authors.forename: Eric
authors.initials: E
authors.lastname: Jougla
authors.forename: Sibylle
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Philippe
authors.initials: P
authors.lastname: Morlat
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000401:mortality; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D011446:Prospective Studies