Changing patterns of cancer incidence in the early- and late-HAART periods: the Swiss HIV Cohort Study.
BACKGROUND
The advent of highly active antiretroviral therapy (HAART) in 1996 led to a decrease in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL), but not of other cancers, among people with HIV or AIDS (PWHA). It also led to marked increases in their life expectancy.


METHODS
We conducted a record-linkage study between the Swiss HIV Cohort Study and nine Swiss cantonal cancer registries. In total, 9429 PWHA provided 20,615, 17,690, and 15,410 person-years in the pre-, early-, and late-HAART periods, respectively. Standardised incidence ratios in PWHA vs the general population, as well as age-standardised, and age-specific incidence rates were computed for different periods.


RESULTS
Incidence of KS and NHL decreased by several fold between the pre- and early-HAART periods, and additionally declined from the early- to the late-HAART period. Incidence of cancers of the anus, liver, non-melanomatous skin, and Hodgkin's lymphoma increased in the early- compared with the pre-HAART period, but not during the late-HAART period. The incidence of all non-AIDS-defining cancers (NADCs) combined was similar in all periods, and approximately double that in the general population.


CONCLUSIONS
Increases in the incidence of selected NADCs after the introduction of HAART were largely accounted for by the ageing of PWHA.
Franceschi
S
S
International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France. franceschi@iarc.fr
Lise
M
M
Clifford
G M
GM
Rickenbach
M
M
Levi
F
F
Maspoli
M
M
Bouchardy
C
C
Dehler
S
S
Jundt
G
G
Ess
S
S
Bordoni
A
A
Konzelmann
I
I
Frick
H
H
Dal Maso
L
L
Elzi
L
L
Furrer
H
H
Calmy
A
A
Cavassini
M
M
Ledergerber
B
B
Keiser
O
O
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D002874:Chromosome Mapping; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012514:Sarcoma, Kaposi / Q000453:epidemiology; D012878:Skin Neoplasms / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology