818 Incidence of Non-AIDS Defining Cancers before and during the HAART Era in an HIV-infected Patients Cohort M. Herida1, M. Mary-Krause1, R. Kaphan2, J. Cadranel3, I. Poizot-Martin4, C. Rabaud5, N. Plaisance6, H. Tissot-Dupont7, F. Boué8, JM Lang6, D Costagliola*1, The Clinical Epidemiology Group from the French Hospital Database on HIV 1INSERM EMI 0214, Paris, France; 2Hosp Archet 1, Nice, France; 3Hosp Tenon, Paris, France; 4Hosp St Marguerite, Marseille, France; 5Hosp de Brabois, Vandoeuvre Nancy, France; 6Ctr d'Information et de Soins de l'Immunodéficience Humaine d'Alsace, France; 7Hosp de la Conception, Marseille, France; and 8Hosp Antoine Béclère, Clamart, France
Background: To determine the incidence of non-AIDS defining cancers (NADC) in HIV-infected patients (pts) before and during the use of HAART, relative to that observed in the French general population of the same age and sex (FGP).
Methods: Sex- and age-adjusted NADC standardized incidence ratio (SIR), with FGP as reference, were estimated from a prospective hospital cohort study, the French Hospital Database on HIV in 1992-1995 (pre-HAART period = P1) and 1996-1999 (HAART period = P2).
Results: NADC were diagnosed in 260 pts during P1 and in 391 pts during P2 among the 77,025 subjects included in the database between 1 January 1992, and 31 December 1999. The estimated incidence of all cancers was higher in HIV-infected men than in FGP during both periods: P1 SIR = 2.33 (95% CI: 2.04-2.66) and P2 SIR = 1.89 (95% CI: 1.69-2.66), with the risk of colon-rectum-anus cancer higher in homosexual. No excess of cancers was observed among HIV-infected women in either period. The incidence of all cancers did not change from P1 to P2 in either sex: SIR=0.96 (95% CI: 0.86-1.26) for men and 1.00 (95% CI: 0.76-1.29) for women. In contrast, the incidence of Hodgkin’s disease was higher than in FGP in both sexes and both periods (men: SIR = 22.75 [95% CI: 17.27-29.42] for P1 and SIR = 31.70 [95% CI: 25.82-38.52] for P2; women: SIR = 9.70 [95% CI: 3.13-22.63] for P1 and SIR = 14.38 [95% CI: 6.88-26.45] for P2), and the incidence of lung cancer was higher in both sexes during P2 (SIR = 2.12 [95% CI: 1.62-2.65] for men and SIR = 6.58 [95% CI: 3.40-11.56] for women).
Conclusions: Relative to the French general population, the overall incidence of non AIDS-related malignancies was increased in HIV-infected men but not in women, and did not differ between the pre- and post-HAART eras. Hodgkin’s disease was the only NADC with a significantly increased incidence relative to the general population, regardless of sex, the study period (pre- or post-HAART), or the transmission group (among men). Lung cancer was more frequent in both sexes during P2, and colon-rectum-anus cancers were more frequent in homosexual men; findings which are probably linked more to lifestyle factors and exposure to carcinogens than to HIV infection. This suggests that HIV-infected people with known risk factors for cancer, such as smoking, should receive special attention and advice on preventive measures.
