Background: Before the use of HAART, malignancies accounted for 10-15% of causes of death among HIV infected persons and were very rarely non AIDS-related; this could have been modified since the widespread use of HAART and the frequent exposition of HIV-infected patients to most risk factors of cancer. The present study focuses on repartition and characteristics of malignancies-related causes of death in the HAART era in a national survey conducted in France.

Methods: Hospital wards involved in the management of HIV infection were asked to prospectively document all deaths occurring in 2000 among HIV-infected patients, using a standardized questionnaire. Chi-square and Kruskal-Wallis tests  were used to compare proportions between categories and continuous variables, respectively.

Results: Overall, malignancies-related causes of death accounted for 28% of the 964 deaths recorded (n = 269). Cancer-deceased patients were male in 83%, 43 years old in median [interquartile range: 38 to 51] and had a known duration of HIV infection of 8.0 years [3.7 to 11.8]. Medians of  last CD4 count and HIV-RNA were 110/mm³ [34-262] and 3.3 log copies/mL [2.2 to 5.0], respectively. AIDS cancer represented 16.5 % of total causes of deaths: non-Hodgkin's lymphoma (NHL) 11% (105 cases including 78 non-cerebral NHL; median CD4 count = 86/mm³ [35 to 231] and 27 cerebral primary NHL; CD4 = 20/mm³ [4 to 109]), Kaposi sarcoma 5% (40 cases) and cervical cancer 0.5% (5 cases). Non-AIDS malignancies represented 12.5% of  total causes of deaths (120 cases): solid cancers accounted for 103 cases (CD4 = 218/mm³ [108 to 380]) including 50 respiratory, 19 hepatocarcinoma, 9 digestive and 6 anal, and hemopathies for 17 cases (CD4 = 113/mm³ [56 to 286]) including 12 Hodgkin's lymphoma, 4 myeloid leukemias, and 1 myeloma. Patients dying from solid cancers were significantly more often males (86% vs 76%), smokers (71% vs 53%), older (median age: 46 vs 40 years), and had a higher CD4 count (median: 218/mm³ vs 82/mm³) than those dying from others causes.

Conclusions: In an industrialized country in the HAART era, more than a quarter of causes of deaths are malignancies-related and fairly distributed between AIDS and non-AIDS events. If most of letal hemopathies (including NHL) and Kaposi sarcoma are associated with advanced immunosuppression, letal solid cancers may occur in people with controlled immunological parameters. Management of HIV-infected patients should take into account this evolving mortality pattern .

Keywords: Cancer; Mortality