Trends in cancer risk among people with AIDS in the United States 1980-2002.
BACKGROUND
People with AIDS have heightened cancer risk from immunosuppression. HAART has been available since 1996 and has reduced AIDS-related mortality, but there are few large-scale studies on cancer trends.


METHODS
AIDS and cancer registries in 11 US regions (1980-2002) were used to identify cancers in 375 933 people with AIDS. Cancer risk relative to the general population was measured using the standardized incidence ratio (SIR), focusing on the 2 years after AIDS onset for those with AIDS in 1990-1995 and 1996-2002 (HAART era). Time trends were assessed with Poisson regression.


RESULTS
Between 1990-1995 and 1996-2002, risk declined for the two major AIDS-defining cancers: Kaposi sarcoma [(KS) n = 5131; SIR, 22 100 and 3640, respectively; P < 0.0001] and non-Hodgkin lymphoma [(NHL) n = 3412; SIR, 53.2 and 22.6, respectively; P < 0.0001]. Declines began in the 1980s, but risk fell sharply in 1996 and was stable thereafter. Risk of cervical cancer did not change (n = 64; SIR, 4.2 and 5.3, respectively; P = 0.33). Among non-AIDS malignancies, lung cancer was most common, but risk declined between 1990-1995 and 1996-2002 (n = 344; SIR, 3.3 and 2.6, respectively; P = 0.02). Risk of Hodgkin lymphoma increased substantially over the 1990-2002 period (n = 149; SIR, 8.1 and 13.6, respectively; P = 0.003).


CONCLUSIONS
Dramatic declines in KS and NHL were temporally related to improving therapies, especially introduction of HAART, but those with AIDS remain at marked risk. Among non-AIDS-related cancers, a recent increase in Hodgkin lymphoma was observed.
Engels
Eric A
EA
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland 20852, USA. engelse@exchange.nih.gov
Pfeiffer
Ruth M
RM
Goedert
James J
JJ
Virgo
Phillip
P
McNeel
Timothy S
TS
Scoppa
Steven M
SM
Biggar
Robert J
RJ
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D005260:Female; D006689:Hodgkin Disease / Q000150:complications / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000150:complications / Q000453:epidemiology / Q000276:immunology; D008175:Lung Neoplasms / Q000150:complications / Q000453:epidemiology / Q000276:immunology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000453:epidemiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000150:complications / Q000453:epidemiology / Q000276:immunology; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000453:epidemiology / Q000276:immunology