Cancer rates after year 2000 significantly decrease in children with perinatal HIV infection: a study by the Italian Register for HIV Infection in Children.
OBJECTIVE
To evaluate the impact of highly active antiretroviral therapy (HAART) on cancer incidence in HIV-infected children throughout a 20-year period.


METHODS
An observational population study was conducted on 1,190 perinatally HIV-infected children enrolled onto the Italian Register for HIV Infection in Children from 1985 to 2004 and never lost to follow-up (total observation time, 10,037.66 years). Cancer rates were calculated in the pre-HAART (1985 to 1995), early HAART (1996 to 1999), and late HAART (2000 to 2004) periods and compared using Poisson regression adjusted for age. The proportion of HAART-treated children increased from 4.1% in 1996 to 60.4% in 1999 and to 81.5% in 2004. In the same time frame, the proportion of children receiving HAART for at least 2 years increased from 3.1% to 77.0%.


RESULTS
Overall, 35 cancers occurred. Cancer rates were 4.49 (95% CI, 2.37 to 6.64), 4.09 (95% CI, 1.68 to 6.50), and 0.76 (95% CI, 0.00 to 1.80) per 1,000 children per year in 1985 to 1995, 1996 to 1999, and 2000 to 2004, respectively. Notably, there was no significant difference comparing the periods from 1985 to 1995 and 1996 to 1999 (P = .081). By contrast, cancer rates were significantly lower in the period from 2000 to 2004 than in 1996 to 1999 (P < .0001). Results were confirmed by separately analyzing data from children observed from birth (P = .418 for 1985 to 1995 v 1996 to 1999; P = .001 for 1996 to 1999 v 2000 to 2004).


CONCLUSIONS
Dramatically reduced cancer rates were observed only in the late HAART period in parallel to the increasing proportion of children receiving HAART therapy.
Chiappini
Elena
E
Department of Pediatrics, University of Florence, Florence, Italy.
Galli
Luisa
L
Tovo
Pier-Angelo
PA
Gabiano
Clara
C
Lisi
Catiuscia
C
Giaquinto
Carlo
C
Rampon
Osvalda
O
Gattinara
Guido Castelli
GC
De Marco
Giulio
G
Osimani
Patrizia
P
Manzionna
Mariano
M
Miniaci
Angela
A
Pintor
Carlo
C
Rosso
Raffaella
R
Esposito
Susanna
S
Viganò
Alessandra
A
Dodi
Icilio
I
Maccabruni
Anna
A
Fundarò
Carlo
C
de Martino
Maurizio
M
D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000821:virology*; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome