Cancer incidence in people with AIDS in Italy.
People with HIV/AIDS (PWHA) have increased risk of some cancers. The introduction of highly active antiretroviral therapies (HAART) has improved their life expectancy, exposing them to the combined consequences of aging and of a prolonged exposure to cancer risk factors. The aim of this study was to estimate incidence rates (IR) in PWHA in Italy, before and after the introduction of HAART, after adjusting for sex and age through direct standardization. An anonymous record linkage between Italian AIDS Registry (21,951 cases) and Cancer Registries (17.3 million, 30% of Italian population) was performed. In PWHA, crude IR, sex- and age-standardized IR and age-specific IR were estimated. The standardized IR for Kaposi sarcoma and non-Hodgkin lymphoma greatly declined in the HAART period. Although the crude IR for all non-AIDS-defining cancers increased in the HAART period, standardized IR did not significantly differ in the 2 periods (352 and 379/100,000, respectively). Increases were seen only for cancer of the liver (IR ratio = 4.6, 95% CI: 1.3-17.0) and lung (IR ratio = 1.8, 95% CI: 1.0-3.2). Age-specific IRs for liver and lung cancers, however, largely overlapped in the 2 periods pointing to the strong influence of the shift in the age distribution of PWHA on the observed upward trends. In conclusion, standardized IRs for non-AIDS-defining cancers have not risen in the HAART period, even if crude IRs of these cancers increased. This scenario calls, however, for the intensification of cancer-prevention strategies, notably smoking cessation and screening programs, in middle-aged HIV-patients.
Polesel
Jerry
J
Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Pordenone, Italy. polesel@cro.it
Franceschi
Silvia
S
Suligoi
Barbara
B
Crocetti
Emanuele
E
Falcini
Fabio
F
Guzzinati
Stefano
S
Vercelli
Marina
M
Zanetti
Roberto
R
Tagliabue
Giovanna
G
Russo
Antonio
A
Luminari
Stefano
S
Stracci
Fabrizio
F
De Lisi
Vincenzo
V
Ferretti
Stefano
S
Mangone
Lucia
L
Budroni
Mario
M
Limina
Rosa Maria
RM
Piffer
Silvano
S
Serraino
Diego
D
Bellù
Francesco
F
Giacomin
Adriano
A
Donato
Andrea
A
Madeddu
Anselmo
A
Vitarelli
Susanna
S
Fusco
Mario
M
Tessandori
Roberto
R
Tumino
Rosario
R
Piselli
Pierluca
P
Dal Maso
Luigino
L
Lise
Mauro
M
Zucchetto
Antonella
A
De Paoli
Angela
A
Intrieri
Teresa
T
Vattiato
Rosa
R
Zambon
Paola
P
Puppo
Antonella
A
Patriarca
Silvia
S
Tittarelli
Andrea
A
Autelitano
Mariangela
M
Cirilli
Claudia
C
La Rosa
Francesco
F
Sgargi
Paolo
P
Di Felice
Enza
E
Cesaraccio
Rosaria
R
Donato
Francesco
F
Franchini
Silva
S
Zanier
Loris
L
Vittadello
Fabio
F
Vercellino
Pier Carlo
PC
Senatore
Gennaro
G
Contrino
Maria Lia
ML
Antonini
Silvia
S
Palombino
Raffaele
R
Maspero
Sergio
S
La Rosa
Maria Guglielmina
MG
Camoni
Laura
L
Regine
Vincenza
V
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*