title: Trends in cancer risk among people with AIDS in the United States 1980-2002.
abstract: 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.
authors.affiliation: 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
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.forename: James J
authors.initials: JJ
authors.lastname: Goedert
authors.forename: Phillip
authors.initials: P
authors.lastname: Virgo
authors.forename: Timothy S
authors.initials: TS
authors.lastname: McNeel
authors.forename: Steven M
authors.initials: SM
authors.lastname: Scoppa
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Biggar
mesh_terms: 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