title: HIV and cancer: a comparative retrospective study of Brazilian and U.S. clinical cohorts.
abstract: BACKGROUND
  With successful antiretroviral therapy, non-communicable diseases, including malignancies, are increasingly contributing to morbidity and mortality among HIV-infected persons. The epidemiology of AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) in HIV-infected populations in Brazil has not been well described. It is not known if cancer trends in HIV-infected populations in Brazil are similar to those of other countries where antiretroviral therapy is also widely available.
  
  
  METHODS
  We performed a retrospective analysis of clinical cohorts at Instituto Nacional de Infectologia Evandro Chagas (INI) in Rio de Janeiro and Vanderbilt Comprehensive Care Clinic (VCCC) in Nashville from 1998 to 2010. We used Poisson regression and standardized incidence ratios (SIRs) to examine incidence trends. Clinical and demographic predictors of ADCs and NADCs were examined using Cox proportional hazards models.
  
  
  RESULTS
  This study included 2,925 patients at INI and 3,927 patients at VCCC. There were 57 ADCs at INI (65% Kaposi sarcoma), 47 at VCCC (40% Kaposi sarcoma), 45 NADCs at INI, and 82 at VCCC. From 1998 to 2004, incidence of ADCs remained statistically unchanged at both sites. From 2005 to 2010, ADC incidence decreased in both cohorts (INI incidence rate ratio per year = 0.74, p < 0.01; VCCC = 0.75, p < 0.01). Overall Kaposi sarcoma incidence was greater at INI than VCCC (3.0 vs. 1.2 cases per 1,000 person-years, p < 0.01). Incidence of NADCs remained constant throughout the study period (overall INI incidence 3.6 per 1,000 person-years and VCCC incidence 5.3 per 1,000 person-years). Compared to general populations, overall risk of NADCs was increased at both sites (INI SIR = 1.4 [95% CI 1.1-1.9] and VCCC SIR = 1.3 [1.0-1.7]). After non-melanoma skin cancers, the most frequent NADCs were anal cancer at INI (n = 7) and lung cancer at VCCC (n = 11). In multivariate models, risk of ADC was associated with male sex and immunosuppression. Risk of NADC was associated with increased age.
  
  
  CONCLUSIONS
  In both cohorts, ADCs have decreased over time, though incidence of KS was higher at INI than VCCC. Rates of NADCs remained constant over time at both sites.
authors: Department of Medicine, Division of Infectious Diseases, MCN A2200, Vanderbilt University School of Medicine, 1611 21st Avenue South, Nashville, TN 37232 USA.
authors: Jessica L
authors: JL
authors: Castilho
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, HIV/AIDS Clinical Research Center, Avenida Brasil 4365, Rio de Janeiro, RJ CEP: 21040-360 Brazil.
authors: Paula M
authors: PM
authors: Luz
authors: Vanderbilt University School of Medicine Department of Biostatistics, 2525 West End, Suite 11000, Nashville, TN 37203 USA.
authors: Bryan E
authors: BE
authors: Shepherd
authors: Department of Medicine, Division of Infectious Diseases, MCN A2200, Vanderbilt University School of Medicine, 1611 21st Avenue South, Nashville, TN 37232 USA.
authors: Megan
authors: M
authors: Turner
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, HIV/AIDS Clinical Research Center, Avenida Brasil 4365, Rio de Janeiro, RJ CEP: 21040-360 Brazil.
authors: Sayonara R
authors: SR
authors: Ribeiro
authors: Department of Medicine, Division of Infectious Diseases, MCN A2200, Vanderbilt University School of Medicine, 1611 21st Avenue South, Nashville, TN 37232 USA.
authors: Sally S
authors: SS
authors: Bebawy
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, HIV/AIDS Clinical Research Center, Avenida Brasil 4365, Rio de Janeiro, RJ CEP: 21040-360 Brazil.
authors: Juliana S
authors: JS
authors: Netto
authors: Department of Medicine, Division of Infectious Diseases, MCN A2200, Vanderbilt University School of Medicine, 1611 21st Avenue South, Nashville, TN 37232 USA.
authors: Catherine C
authors: CC
authors: McGowan
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, HIV/AIDS Clinical Research Center, Avenida Brasil 4365, Rio de Janeiro, RJ CEP: 21040-360 Brazil.
authors: Valdiléa G
authors: VG
authors: Veloso
authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, MSC 9776, Bethesda, MD 20892 USA.
authors: Eric A
authors: EA
authors: Engels
authors: Department of Medicine, Division of Infectious Diseases, MCN A2200, Vanderbilt University School of Medicine, 1611 21st Avenue South, Nashville, TN 37232 USA.
authors: Timothy R
authors: TR
authors: Sterling
authors: Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, HIV/AIDS Clinical Research Center, Avenida Brasil 4365, Rio de Janeiro, RJ CEP: 21040-360 Brazil.
authors: Beatriz
authors: B
authors: Grinsztejn
keywords: Age; Anal cancer; Brazil; Cancer; HIV; Kaposi sarcoma; Lung cancer; Malignancy; Non-Hodgkin lymphoma; Sex