title: Incidence and outcomes of malignancy in the HAART era in an urban cohort of HIV-infected individuals.
abstract: OBJECTIVE
  To investigate trends, patient characteristics, and survival associated with AIDS-defining cancer (ADC) and non-AIDS defining cancer (NADC) in the HAART era.
  
  
  METHODS
  Retrospective analysis of all incident malignancies occurring in 1996-2005 among 2566 patients in an urban HIV clinic.
  
  
  METHODS
  Clinical profiles of NADC were compared with ADC and the general cohort. Incidence was examined by Poisson analysis. Standardized incidence ratios (SIR) compared cancer risk with that in the general population. Survival was analyzed by Kaplan-Meier and Cox proportional hazards models.
  
  
  RESULTS
  Between 1996 and 2005, 138 ADC and 115 NADC were diagnosed. ADC rates decreased from 12.5 to 3.5 cases/1000 person-years (P < 0.001 for trend) while NADC rates increased from 3.9 to 7.1 cases/1000 person-years (P = 0.13 for trend). Incidence of the most common NADC was higher than expected, including cancers of the lung [n = 29; SIR, 5.5; 95% confidence interval (CI), 3.7-8.0], liver (n = 13, SIR, 16.5; 95% CI, 8.8-28.2), anus (n = 10; SIR, 39.0; 95% CI, 18.7-71.7), head and neck (n = 14; SIR, 5.1; 95% CI, 2.8-8.6), and Hodgkin's lymphoma (n = 8; SIR, 9.8; 95% CI, 4.2-19.2). Survival after cancer diagnosis did not differ between ADC and NADC. Advanced age was associated with NADC (P < 0.01 for trend) and increased mortality in ADC (age > or = 50 years adjusted hazard ratio, 2.21; 95% CI, 1.00-4.89).
  
  
  CONCLUSIONS
  Rates of ADC decreased while NADC increased within this cohort. Several NADC occurred at rates significantly higher than expected. Screening and suspicion for NADC should increase in care for HIV-infected patients.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287,USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Long
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015142:Baltimore / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D014504:Urban Health