title: Assessing the impact of HAART on the incidence of defining and non-defining AIDS cancers among patients with HIV/AIDS: a systematic review.
abstract: After highly active antiretroviral therapy (HAART) became widespread, several studies demonstrated changes in the incidence of defining and non-defining AIDS cancers among HIV/AIDS patients. We conducted a systematic review of observational studies evaluating the incidence of malignancies before and after the introduction of HAART in people with HIV/AIDS. Eligible studies were searched up to December 2012 in the following databases: Pubmed, Embase, Scielo, Cancerlit and Google Scholar. In this study, we determined the cancer risk ratio by comparing the pre- and post-HAART eras. Twenty-one relevant articles were found, involving more than 600,000 people with HIV/AIDS and 10,891 new cases of cancers. The risk for the development of an AIDS-defining cancer decreased after the introduction of HAART: Kaposi's sarcoma (RR=0.30, 95% CI: 0.28-0.33) and non-Hodgkin's lymphoma (RR=0.52, 95% CI: 0.48-0.56), in contrast to invasive cervical cancer (RR=1.46, 95% CI: 1.09-1.94). Among the non-AIDS-defining cancers, the overall risk increased after the introduction of HAART (RR=2.00, 95% CI: 1.79-2.23). The incidence of AIDS-defining cancers decreased and the incidence of non-AIDS-defining cancers increased after the early use of HAART, probably due to better control of viral replication, increased immunity and increased survival provided by new drugs.
authors.affiliation: Center for Health Sciences of the Federal University of Rio Grande do Norte, Natal, Brazil; Department of Gynecology and Obstetrics of the Potiguar University, Natal, Brazil. Electronic address: rncobucci@hotmail.com.
authors.forename: Ricardo Ney Oliveira
authors.initials: RN
authors.lastname: Cobucci
authors.affiliation: Center for Health Sciences of the Federal University of Rio Grande do Norte, Natal, Brazil.
authors.forename: Paulo Henrique
authors.initials: PH
authors.lastname: Lima
authors.affiliation: Department of Gynecology and Obstetrics of the Potiguar University, Natal, Brazil.
authors.forename: Pollyana Carvalho
authors.initials: PC
authors.lastname: de Souza
authors.affiliation: Department of Gynecology and Obstetrics of the Potiguar University, Natal, Brazil.
authors.forename: Vanessa Viana
authors.initials: VV
authors.lastname: Costa
authors.affiliation: Department of Gynecology and Obstetrics of the Federal University of Rio Grande do Norte, Natal, Brazil.
authors.forename: Maria da Conceição de Mesquita
authors.initials: Mda C
authors.lastname: Cornetta
authors.affiliation: Department of Biosciences of the Federal University of Rio Grande do Norte, Natal, Brazil.
authors.forename: José Veríssimo
authors.initials: JV
authors.lastname: Fernandes
authors.affiliation: Department of Gynecology and Obstetrics of the Federal University of Rio Grande do Norte, Natal, Brazil.
authors.forename: Ana Katherine
authors.initials: AK
authors.lastname: Gonçalves
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology*; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology*; D008297:Male; D064887:Observational Studies as Topic; D012514:Sarcoma, Kaposi / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*
keywords: Acquired immunodeficiency syndrome; Carcinoma; Highly active antiretroviral therapy; Incidence