Background: Although the incidence of AIDS-defining malignancies has decreased in the highly active antiretroviral therapy (HAART) era, less is known about the incidence of non-AIDS defining malignancies among HIV-infected persons.  We determined the incidence of the most frequent malignancies among HIV-infected persons relative to the general population.

Methods: Incidence rates of three AIDS-defining malignancies and eleven non-AIDS defining malignancies were calculated using combined data from 1992 to 2002 from two longitudinal medical records abstraction projects, the HIV Outpatient Study (HOPS) and the Adult/Adolescent Spectrum of Disease (ASD) project.  All incidence rates were adjusted for age and several were also adjusted for race and gender using direct standardization.  Using incidence rate ratios, these rates were compared to data from the Surveillance and End Results (SEER) project. 

Results: A total of 59,101 persons were observed in the combined dataset, representing 181,201 person-years of follow-up.  The rates of the 3 AIDS-defining malignancies as well as of 7 non-AIDS defining malignancies were significantly higher in the HIV-infected population than in the SEER population.  Incidence rate ratios for these malignancies were as follows: Kaposi’s sarcoma (RRadj= 353.7 [95%CI: 338.6, 369.4]), non-Hodgkin’s lymphoma (RRadj= 28.7 [95%CI: 26.9, 30.5]), cervical cancer (RRadj= 17.0 [95%CI: 13.9 , 20.7]), anal cancer (RRadj = 18.3 [95%CI: 13.6, 24.2]), Hodgkin’s disease (RRadj= 17.5 [95%CI: 14.4, 21.1]), liver cancer (RRadj= 4.5 [95%CI: 3.2, 6.1]), testicular cancer (RRadj= 3.3 [95%CI: 2.3, 4.5]), melanoma (RRadj=2.1 [95%CI: 1.6, 2.6]), oropharyngeal cancer (RRadj=  2.0 [95%CI: 1.5 , 2.5]), and lung cancer (RRadj= 1.6 [95%CI: 1.4, 1.8]).  The incidence rates of breast and prostate cancer were significantly lower in the HIV-infected population; there were no differences in incidence rates of colorectal or renal cancer.

Conclusions: Relative to the SEER population, the incidence of many non-AIDS defining malignancies were significantly higher in HIV-infected persons from 1992-2002.  Health care providers should consider enhanced monitoring for these malignancies in their HIV-infected patients.