Pattern of cancer risk in persons with AIDS in Italy in the HAART era.
A record-linkage study was carried out between the Italian AIDS Registry and 24 Italian cancer registries to compare cancer excess among persons with HIV/AIDS (PWHA) before and after the introduction of highly active antiretroviral therapy (HAART) in 1996. Standardised incidence ratios (SIR) were computed in 21951 AIDS cases aged 16-69 years reported between 1986 and 2005. Of 101 669 person-years available, 45 026 were after 1996. SIR for Kaposi sarcoma (KS) and non-Hodgkin lymphoma greatly decreased in 1997-2004 compared with 1986-1996, but high SIRs for KS persisted in the increasingly large fraction of PWHA who had an interval of <1 year between first HIV-positive test and AIDS diagnosis. A significant excess of liver cancer (SIR=6.4) emerged in 1997-2004, whereas the SIRs for cancer of the cervix (41.5), anus (44.0), lung (4.1), brain (3.2), skin (non-melanoma, 1.8), Hodgkin lymphoma (20.7), myeloma (3.9), and non-AIDS-defining cancers (2.2) were similarly elevated in the two periods. The excess of some potentially preventable cancers in PWHA suggests that HAART use must be accompanied by cancer-prevention strategies, notably antismoking and cervical cancer screening programmes. Improvements in the timely identification of HIV-positive individuals are also a priority in Italy to avoid the adverse consequences of delayed HAART use.
Dal Maso
L
L
Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy. epidemiology@cro.it
Polesel
J
J
Serraino
D
D
Lise
M
M
Piselli
P
P
Falcini
F
F
Russo
A
A
Intrieri
T
T
Vercelli
M
M
Zambon
P
P
Tagliabue
G
G
Zanetti
R
R
Federico
M
M
Limina
R M
RM
Mangone
L
L
De Lisi
V
V
Stracci
F
F
Ferretti
S
S
Piffer
S
S
Budroni
M
M
Donato
A
A
Giacomin
A
A
Bellù
F
F
Fusco
M
M
Madeddu
A
A
Vitarelli
S
S
Tessandori
R
R
Tumino
R
R
Suligoi
B
B
Franceschi
S
S
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D012042:Registries; D012307:Risk Factors; D055815:Young Adult