Cancer in HIV-infected persons from the Caribbean, Central and South America.
BACKGROUND
HIV-infected individuals have heightened cancer risk. With the advent of highly active antiretroviral therapy (HAART), the frequency of some AIDS-defining cancers (ADC) has decreased although certain non-AIDS-defining cancers (NADC) are becoming more frequent. Cancers among HIV-infected individuals in Latin American and the Caribbean have not yet been carefully studied.


METHODS
Cancer cases among the Caribbean, Central and South American network for HIV Research (CCASAnet) cohort were identified reviewing clinical records and pre-existing databases.


RESULTS
There were 406 cancers reported: 331 ADC (224 Kaposi sarcomas and 98 non Hodgkin lymphomas). Most frequent NADC (n = 75) were Hodgkin lymphoma and skin cancers. Seventy-three percent of NADC and 45% of ADC were diagnosed >1 year after HIV diagnosis. Fifty-six percent of ADC occurred before HAART start. Median time from HAART start until cancer diagnosis was 2.5 years for NADC and 0.5 years for ADC (P = <0.001). Within 3372 HAART starters, 158 were diagnosed with 165 cancers (82.4% ADC); 85 cases were previous to or concomitant with HAART initiation. Incidence of cancer after HAART initiation in 8080 person-years of follow-up was 7.2 per 1000 person-years (95% confidence interval = 5.5 to 9.3) for ADC and 2.7 (95% confidence interval = 1.8 to 4.1) for NADC; incidence was higher in the first 2 months, particularly for ADC (47.6). A pre-HAART ADC was a predictor of mortality after adjusting for age, sex, and CD4 at HAART initiation.


CONCLUSIONS
ADC were the most frequent cancers in this region and were often diagnosed close to HIV diagnosis and HAART start. Incidence of cancer was highest around HAART initiation.
Huésped, Investigaciones Clínicas, Buenos Aires, Argentina. valeria.fink@huesped.org.ar
Valeria I
VI
Fink
Bryan E
BE
Shepherd
Carina
C
Cesar
Alejandro
A
Krolewiecki
Firas
F
Wehbe
Claudia P
CP
Cortés
Brenda
B
Crabtree-Ramírez
Denis
D
Padgett
Maryam
M
Shafaee
Mauro
M
Schechter
Eduardo
E
Gotuzzo
Melanie
M
Bacon
Catherine
C
McGowan
Pedro
P
Cahn
Daniel
D
Masys
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D017691:Caribbean Region / Q000453:epidemiology; D002489:Central America / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006689:Hodgkin Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016483:Lymphoma, AIDS-Related / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000150:complications* / Q000453:epidemiology*; D012514:Sarcoma, Kaposi / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D013020:South America / Q000453:epidemiology
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