Survival in HIV-infected patients after a cancer diagnosis in the cART Era: results of an italian multicenter study.
OBJECTIVE
We studied survival and associated risk factors in an Italian nationwide cohort of HIV-infected individuals after an AIDS-defining cancer (ADC) or non-AIDS-defining cancer (NADC) diagnosis in the modern cART era.


METHODS
Multi-center, retrospective, observational study of HIV patients included in the MASTER Italian Cohort with a cancer diagnosis from January 1998 to September 2012. Malignancies were divided into ADC or NADC on the basis of the Centre for Disease Control-1993 classification. Recurrence of cancer and metastases were excluded. Survivals were estimated according to the Kaplan-Meier method and compared according to the log-rank test. Statistically significant variables at univariate analysis were entered in a multivariate Cox regression model.


RESULTS
Eight hundred and sixty-six cancer diagnoses were recorded among 13,388 subjects in the MASTER Database after 1998: 435 (51%) were ADCs and 431 (49%) were NADCs. Survival was more favorable after an ADC diagnosis than a NADC diagnosis (10-year survival: 62.7%±2.9% vs. 46%±4.2%; p = 0.017). Non-Hodgkin lymphoma had lower survival rates than patients with Kaposi sarcoma or cervical cancer (10-year survival: 48.2%±4.3% vs. 72.8%±4.0% vs. 78.5%±9.9%; p<0.001). Regarding NADCs, breast cancer showed better survival (10-year survival: 65.1%±14%) than lung cancer (1-year survival: 28%±8.7%), liver cancer (5-year survival: 31.9%±6.4%) or Hodgkin lymphoma (10-year survival: 24.8%±11.2%). Lower CD4+ count and intravenous drug use were significantly associated with decreased survival after ADCs or NADCs diagnosis. Exposure to cART was found to be associated with prolonged survival only in the case of ADCs.


CONCLUSIONS
cART has improved survival in patients with an ADC diagnosis, whereas the prognosis after a diagnosis of NADCs is poor. Low CD4+ counts and intravenous drug use are risk factors for survival following a diagnosis of ADCs and Hodgkin lymphoma in the NADC group.
University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
Daria
D
Gotti
Section of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
Elena
E
Raffetti
University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
Laura
L
Albini
Division of Infectious Diseases, University Hospital of Ferrara, Ferrara, Italy.
Laura
L
Sighinolfi
Division of Infectious Diseases and Unit of Antiviral Therapy, AO Papa Giovanni XXIII, Bergamo, Italy.
Franco
F
Maggiolo
Division of Infectious Diseases and Unit of Antiviral Therapy, AO Papa Giovanni XXIII, Bergamo, Italy.
Elisa
E
Di Filippo
Clinic of Infectious Diseases, University of Bari, Bari, Italy.
Nicoletta
N
Ladisa
Clinic of Infectious Diseases, University of Bari, Bari, Italy.
Gioacchino
G
Angarano
Clinic of Infectious Diseases, San Gerardo de' Tintori" Hospital, Monza, Italy.
Giuseppe
G
Lapadula
Clinic of Infectious Diseases, Hospital of Cremona, Cremona, Italy.
Angelo
A
Pan
Clinic of Infectious Diseases, "Santa Maria Annunziata" Hospital, Firenze, Italy.
Anna Degli
AD
Esposti
Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Roma, Italy.
Massimiliano
M
Fabbiani
University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
Emanuele
E
Focà
Hospital Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
Alfredo
A
Scalzini
Section of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
Francesco
F
Donato
University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
Eugenia
E
Quiros-Roldan
D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies