title: Risk of non-AIDS-defining cancers among HIV-1-infected individuals in France between 1997 and 2009: results from a French cohort.
abstract: OBJECTIVE
  Improved survival among HIV-infected individuals after the advent of combination antiretroviral therapy (cART) had drawn attention on non-AIDS-defining cancers. We evaluated the incidence and risk trends of lung cancer, Hodgkin's lymphoma, liver and anal cancers, focusing on patients with CD4 cell recovery and age at diagnosis, by comparison with the general population.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Standardized incidence rates were calculated in the HIV-infected individuals followed in the FHDH and the general population in France in 1997-2000, 2001-2004, and 2005-2009. We estimated standardized incidence ratios for each period and for patients with CD4 cell count at least 500 cells/μl for at least 2 years on cART.
  
  
  RESULTS
  Among the 84,504 HIV-infected individuals, the risk of lung and anal cancers fell during the cART era, whereas that of Hodgkin's lymphoma and liver cancer remained stable. In 2005-2009, the standardized incidence ratios for lung cancer, Hodgkin's lymphoma, liver and anal cancers were, respectively, 2.8 [95% confidence interval (CI) 2.5-3.1], 26.5 (95% CI 23.2-30.1), 10.9 (95% CI 9.6-12.3) and 79.3 (95% CI 69.5-90.1). Among patients with CD4 cell recovery on cART, the risk was close to that of the general population for lung cancer, nine-fold higher for Hodgkin's lymphoma, and 2.4-fold higher for liver cancer. Age at diagnosis was significantly younger among HIV-infected individuals for lung cancer (-3.3 years), Hodgkin's lymphoma (-1 year) and liver cancer (-10.1 years).
  
  
  CONCLUSIONS
  HIV-infected patients were at a higher risk for the four cancers over 1997-2009. CD4 cell recovery appears to control the excess risk of lung cancer. For liver cancer and Hodgkin's lymphoma, our results suggest that CD4 should never drop below 500/μl 500 cells/μl to avoid the excess risk.
authors.affiliation: aINSERM, UMR_S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France bSorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France. *Members of the writing committee are listed in the acknowledgement section.
authors.forename: Mira
authors.initials: M
authors.lastname: Hleyhel
authors.forename: Mira
authors.initials: M
authors.lastname: Hleyhel
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Bouvier
authors.forename: Aurélien
authors.initials: A
authors.lastname: Belot
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.forename: Jérôme
authors.initials: J
authors.lastname: Pacanowski
authors.forename: Philippe
authors.initials: P
authors.lastname: Genet
authors.forename: Nathalie
authors.initials: N
authors.lastname: De Castro
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Berger
authors.forename: Caroline
authors.initials: C
authors.lastname: Dupont
authors.forename: Armelle
authors.initials: A
authors.lastname: Lavolé
authors.forename: Christian
authors.initials: C
authors.lastname: Pradier
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon
authors.forename: Anne
authors.initials: A
authors.lastname: Simon
authors.forename: Valérie
authors.initials: V
authors.lastname: Martinez
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Spano
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Sophie
authors.initials: S
authors.lastname: Grabar
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000276:immunology / Q000401:mortality*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000276:immunology / Q000401:mortality*; D006689:Hodgkin Disease / Q000276:immunology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000276:immunology / Q000401:mortality*; D008175:Lung Neoplasms / Q000276:immunology / Q000401:mortality*; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D019380:Anti-HIV Agents