title: High cancer-related mortality in an urban, predominantly African-American, HIV-infected population.
abstract: OBJECTIVE
  To determine mortality associated with a new cancer diagnosis in an urban, predominantly African-American, HIV-infected population.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All HIV-infected patients diagnosed with cancer between 1 January 2000 and 30 June 2010 were reviewed. Mortality was examined using Kaplan-Meier estimates and Cox proportional hazards models.
  
  
  RESULTS
  There were 470 cases of cancer among 447 patients. Patients were predominantly African-American (85%) and male (79%). Non-AIDS-defining cancers (NADCs, 69%) were more common than AIDS-defining cancers (ADCs, 31%). Cumulative cancer incidence increased significantly over the study period. The majority (55.9%) was taking antiretroviral therapy (ART) at cancer diagnosis or started afterward (26.9%); 17.2% never received ART. Stage 3 or 4 cancer was diagnosed in 67%. There were 226 deaths during 1096 person years of follow-up, yielding an overall mortality rate of 206 per 1000 person years. The cumulative mortality rate at 30 days, 1 year, and 2 years was 6.5, 32.2, and 41.4%, respectively. Mortality was similar between patients on ART whether they started before or after the cancer diagnosis but was higher in patients who never received ART. In patients with a known cause of death, 68% were related to progression of the underlying cancer.
  
  
  CONCLUSIONS
  In a large cohort of urban, predominantly African-American patients with HIV and cancer, many patients presented with late-stage cancer. There was substantial 30-day and 2-year mortality, although ART had a significant mortality benefit. Deaths were most often caused by progression of cancer and not from another HIV-related or AIDS-related event.
authors.affiliation: Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. driedel@ihv.umaryland.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Riedel
authors.forename: Evelyn Ivy W
authors.initials: EI
authors.lastname: Mwangi
authors.forename: Lori E
authors.initials: LE
authors.lastname: Fantry
authors.forename: Carla
authors.initials: C
authors.lastname: Alexander
authors.forename: Mian B
authors.initials: MB
authors.lastname: Hossain
authors.forename: C David
authors.initials: CD
authors.lastname: Pauza
authors.forename: Robert R
authors.initials: RR
authors.lastname: Redfield
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Gilliam
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015142:Baltimore / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000401:mortality*; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced / Q000401:mortality* / Q000821:virology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000401:mortality; D014505:Urban Population; D019562:Viral Load; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D019380:Anti-HIV Agents