Non-AIDS-Defining Cancer Mortality: Emerging Patterns in the Late HAART Era.
Non-AIDS-defining cancers (non-ADCs) have become the leading non-AIDS-related cause of death among people with HIV/AIDS. We aimed to quantify the excess risk of cancer-related deaths among Italian people with AIDS (PWA), as compared with people without AIDS (non-PWA).



A nationwide, population-based, retrospective cohort study was carried out among 5285 Italian PWA, aged 15-74 years, diagnosed between 2006 and 2011. Date of death and multiple-cause-of-death data were retrieved up to December 2011. Excess mortality, as compared with non-PWA, was estimated using sex- and age-standardized mortality ratios (SMRs) and the corresponding 95% confidence intervals (CIs).



Among 1229 deceased PWA, 10.3% reported non-ADCs in the death certificate, including lung (3.1%), and liver (1.4%), cancers. A 7.3-fold (95% CI: 6.1 to 8.7) excess mortality was observed for all non-ADCs combined. Statistically significant SMRs emerged for specific non-ADCs, ie, anus (5 deaths, SMR = 227.6, 95% CI: 73.9 to 531.0), Hodgkin lymphoma (12 deaths, SMR = 122.0, 95% CI: 63.0 to 213.0), unspecified uterus (4 deaths, SMR = 52.5, 95% CI: 14.3 to 134.5), liver (17 deaths, SMR = 13.2, 95% CI: 7.7 to 21.1), skin melanoma (4 deaths, SMR = 10.9, 95% CI: 3.0 to 27.8), lung (38 deaths, SMR = 8.0, 95% CI: 5.7 to 11.0), head and neck (9 deaths, SMR = 7.8, 95% CI: 3.6 to 14.9), leukemia (5 deaths, SMR = 7.6, 95% CI: 2.4 to 17.7), and colon-rectum (10 deaths, SMR = 5.4, 95% CI: 2.6 to 10.0). SMRs for non-ADCs were particularly elevated among PWA infected through injecting drug use.



This population-based study documented extremely elevated risks of death for non-ADCs among PWA. These findings stress the need of preventive interventions for both virus-related and non-virus-related cancers among HIV-infected individuals.
*Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy; †Servizio Sanità, Salute ed Assistenza, Istituto Nazionale di Statistica, Rome, Italy; and ‡Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
Antonella
A
Zucchetto
Saverio
S
Virdone
Martina
M
Taborelli
Enrico
E
Grande
Laura
L
Camoni
Marilena
M
Pappagallo
Vincenza
V
Regine
Francesco
F
Grippo
Jerry
J
Polesel
Luigino
L
Dal Maso
Barbara
B
Suligoi
Luisa
L
Frova
Diego
D
Serraino
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D055815:Young Adult