title: Cancer incidence and mortality for all causes in HIV-infected patients over a quarter century: a multicentre cohort study.
abstract: BACKGROUND
  We aimed to assess cancer incidence and mortality for all-causes and factors related to risk of death in an Italian cohort of HIV infected unselected patients as compared to the general population.
  
  
  METHODS
  We conducted a retrospective (1986-2012) cohort study on 16 268 HIV infected patients enrolled in the MASTER cohort. The standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were computed using cancer incidence rates of Italian Cancer Registries and official national data for overall mortality. The risk factors for death from all causes were assessed using Poisson regression models.
  
  
  RESULTS
  1,195 cancer cases were diagnosed from 1986 to 2012: 700 AIDS-defining-cancers (ADCs) and 495 non-AIDS-defining-cancers (NADCs). ADC incidence was much higher than the Italian population (SIR = 30.8, 95% confidence interval 27.9-34.0) whereas NADC incidence was similar to the general population (SIR = 0.9, 95% CI 0.8-1.1). The SMR for all causes was 11.6 (11.1-12.0) in the period, and it decreased over time, mainly after 1996, up to 3.53 (2.5-4.8) in 2012. Male gender, year of enrolment before 1993, older age at enrolment, intravenous drug use, low CD4 cell count, AIDS event, cancer occurrence and the absence of antiretroviral therapy were all associated independently with risk of death.
  
  
  CONCLUSIONS
  In HIV infected patients, ADC but not NADC incidence rates were higher than the general population. Although overall mortality in HIV infected subjects decreased over time, it is about three-fold higher than the general population at present.
authors.affiliation: Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy. e.raffetti@unibs.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Raffetti
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy. lauralbini@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Albini
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy. daria.gotti@gmail.com.
authors.forename: Daria
authors.initials: D
authors.lastname: Gotti
authors.affiliation: Department of Infectious Diseases of Nuovo Polo Ospedaliero S.Anna di Cona, Ferrara, Italy. d.segala@yahoo.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Segala
authors.affiliation: Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy. franco31556@hotmail.com.
authors.forename: Franco
authors.initials: F
authors.lastname: Maggiolo
authors.affiliation: Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy. elisadifilippo@libero.it.
authors.forename: Elisa
authors.initials: E
authors.lastname: di Filippo
authors.affiliation: Department of Infectious Diseases of Polyclinic of Bari, University of Bari, Bari, Italy. a.saracino@medicina.unifg.it.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Saracino
authors.affiliation: Department of Infectious Diseases of Polyclinic of Bari, University of Bari, Bari, Italy. n.ladisa@hotmail.com.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Ladisa
authors.affiliation: Department of Infectious Diseases, San Gerardo de' Tintori" Hospital, Monza, Italy. giuseppe.lapadula@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lapadula
authors.affiliation: Clinic of Infectious Diseases of Istituti Ospitalieri of Cremona, Cremona, Italy. chifor76@yahoo.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fornabaio
authors.affiliation: Hospital Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy. filippo.castel@tin.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Castelnuovo
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy. s.casari@infettivibrescia.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Casari
authors.affiliation: Institute of Clinical Infectious Diseases of Polyclinic A. Gemelli, University of Sacred Heart, Rome, Italy. massifab@alice.it.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fabbiani
authors.affiliation: Department of Infectious Diseases of SM, Annunziata Hospital of Florence, Florence, Italy. piera.pierotti@asf.toscana.it.
authors.forename: Piera
authors.initials: P
authors.lastname: Pierotti
authors.affiliation: Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy. francesco.donato@unibs.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Donato
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy. eugeniaquiros@yahoo.it.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Quiros-Roldan
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents