title: Risk of melanoma in people with HIV/AIDS in the pre- and post-HAART eras: a systematic review and meta-analysis of cohort studies.
abstract: OBJECTIVE
  Following the introduction of highly active antiretroviral therapy (HAART) the risk of AIDS-defining cancers decreased but incidence of many non-AIDS-defining cancers has reportedly increased in those with HIV/AIDS. Whether melanoma risk has also changed in HIV/AIDS patients post-HAART is unknown and therefore we evaluated this in comparison with the risk before HAART.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  We searched Medline, Embase and ISI science citation index databases to April 2013. All cohort studies of patients diagnosed with HIV/AIDS that permitted quantitative assessment of the association with melanoma were eligible. Detailed quality assessment of eligible studies was conducted, focussing particularly on adjustment for ethnicity, a priori considered essential for an unbiased assessment of melanoma risk. Data were pooled using a random effects model.
  
  
  RESULTS
  From 288 articles, we identified 21 that met the inclusion criteria, 13 presenting data for the post-HAART era and 8 for the pre-HAART era. Post-HAART the pooled relative risk (pRR) for the association between HIV/AIDS and melanoma was 1.26 (95% CI, 0.97-1.64) and 1.50 (95% CI 1.12-2.01) among studies that accounted for ethnicity, with evidence of significant heterogeneity (P = 0.004, I2 = 55.5). Pre-HAART pRRs were 1.26 (95% CI 1.11-1.43; P het = 0.82) and 1.28 (95% CI 1.10-1.49) among studies adjusted for ethnicity.
  
  
  CONCLUSIONS
  People with HIV/AIDS remain at a significantly increased risk of developing melanoma in the post-HAART era. White skinned people with HIV/AIDS should be screened regularly and counselled against excessive sun exposure.
authors.affiliation: Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Olsen
authors.affiliation: Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Lani L
authors.initials: LL
authors.lastname: Knight
authors.affiliation: Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Adèle C
authors.initials: AC
authors.lastname: Green
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology / Q000821:virology; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D044383:Black People; D005260:Female; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008545:Melanoma / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology / Q000821:virology; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D012878:Skin Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology / Q000821:virology; D044465:White People
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