Cancer incidence in the multicenter AIDS Cohort Study before and during the HAART era: 1984 to 2007.
BACKGROUND
The incidence of Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) among human immunodeficiency virus (HIV)-infected individuals declined after the introduction of highly active antiretroviral therapy (HAART) in the mid-1990s, but the cancer risk associated with HIV infection during the HAART era remains to be clarified.


METHODS
Cancer incidence among HIV-infected and HIV-uninfected participants in the Multicenter AIDS (acquired immunodeficiency syndrome) Cohort Study (MACS) between 1984 and 2007 was compared with the expected incidence using US population-based data from the Surveillance, Epidemiology, and End Results (SEER) program. Age- and race-adjusted cancer incidence rates were also compared HIV by status and over time within the MACS. Exact statistical methods were used for all analyses.


RESULTS
A total of 933 incident cancers were observed during 77,320 person-years of follow-up. Compared with SEER, MACS HIV-infected men had significantly (P<.05) elevated rates of KS (standardized incidence ratio [SIR], 139.10), NHL (SIR, 36.80), Hodgkin lymphoma (HL)(SIR, 7.30), and anal cancer (SIR, 25.71). Within MACS, HIV infection was found to be independently associated with each of these cancers across the entire follow-up period, and KS (incidence rate ratio [IRR], 54.93), NHL (IRR, 11.18), and anal cancer (IRR, 18.50) were each found to be significantly elevated among HIV-infected men during the HAART era. Among these men, the incidence of KS and NHL declined (IRR, 0.13 and 0.23, respectively), the incidence of anal cancer increased (IRR, 5.84), and the incidence of HL remained statistically unchanged (IRR, 0.75) from the pre-HAART to the HAART era.


CONCLUSIONS
Cancer risk remains elevated among HIV-infected men who have sex with men, highlighting the continuing need for appropriate cancer screening in this population.
Seaberg
Eric C
EC
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA. eseaberg@jhsph.edu
Wiley
Dorothy
D
Martínez-Maza
Otoniel
O
Chmiel
Joan S
JS
Kingsley
Lawrence
L
Tang
Yiwei
Y
Margolick
Joseph B
JB
Jacobson
Lisa P
LP
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D006689:Hodgkin Disease / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000453:epidemiology