title: Cancer incidence and all-cause mortality in HIV-positive patients in Northeastern Algeria before and during the era of highly active antiretroviral therapy.
abstract: OBJECTIVE
  To assess cancer incidence and all-cause mortality trends in HIV-positive patients in Algeria before and during the highly active antiretroviral therapy (HAART) era.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  We used hospital-based data of patients with HIV/AIDS between January 1988 and December 2010.
  
  
  METHODS
  Cancer incidence, standardized mortality ratios (SMRs), risk of death, and proportion of HIV-positive patients treated before and during the HAART era were calculated. The joinpoint model was used to assess the magnitude of changes in SMRs.
  
  
  RESULTS
  In 1988-2010, 156 patients were diagnosed as HIV-positive. During pre-HAART era, Kaposi sarcoma (KS) incidence was 5%. After the introduction of HAART, KS incidence decreased to 2%. No other AIDS-related cancer was diagnosed during the study. One-third died (52/156), of which 83.6% died in the same year as or in the year after HIV diagnosis; median age at death (interquartile range) was 34.5 (11.8) years. Yearly risk of death declined from 100% in 1998 to 8% in 2010; percentage of patients treated with HAART increased from 13% in 1998 to >80% after 2002. Overall SMR decreased from 200.2 (95% confidence interval [95% CI], 123.2-325.2) before the HAART era to 91.4 (95% CI, 66.0-126.6) thereafter. From 2003, yearly SMRs decreased significantly by 66.1% (P < 0.05) until 2006 but not thereafter.
  
  
  CONCLUSIONS
  Since 1998, the proportion of HIV-positive patients treated with HAART increased, reaching 84% in 2010, all-cause mortality decreased, and cancer remained rare. However, almost all patients who died during the study seemed to be diagnosed at a late stage of the disease, emphasizing the need for earlier diagnosis of HIV in Algeria.
authors.affiliation: Section of Cancer Information, International Agency for Research on Cancer, Lyon; Section of Cancer Information, University of Lyon, University of Lyon, France.
authors.forename: Karima
authors.initials: K
authors.lastname: Chaabna
authors.affiliation: Section of Cancer Information, International Agency for Research on Cancer, Lyon, France; MRC/UVRI Research Unit on AIDS, Entebbe, Uganda; Department of Health Sciences, University of York, York, United Kingdom, .
authors.forename: Robert
authors.initials: R
authors.lastname: Newton
authors.affiliation: Section of Cancer Information, University of Lyon, University of Lyon 1; Department of Hygiene, Epidemiology and Prevention, Edouard Herriot Hospital, Civil Hospital of Lyon; Laboratory of Epidemiology and Public Health, CNRS, UMR 5558, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
authors.affiliation: Infectious Disease Service, Durban Hospital, University Teaching Hospital, 23000 Annaba, Algeria.
authors.forename: Maamar
authors.initials: M
authors.lastname: Laouar
authors.affiliation: Section of Cancer Information, International Agency for Research on Cancer, Lyon, France.
authors.forename: David
authors.initials: D
authors.lastname: Forman
authors.affiliation: Infectious Disease Service, Durban Hospital, University Teaching Hospital, 23000 Annaba, Algeria.
authors.forename: Zahira
authors.initials: Z
authors.lastname: Boudiaf
authors.affiliation: Section of Cancer Information, International Agency for Research on Cancer, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Soerjomataram
mesh_terms: D000293:Adolescent; D000328:Adult; D000462:Algeria / Q000453:epidemiology; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*