Background:  HIV-infected people have elevated cancer risk. With longer survival, cancer risk, especially late after AIDS diagnosis, may rise, and a larger fraction of deaths may be due to cancer. We used population-based data to estimate cancer risk 3 to 5 years after AIDS diagnosis and evaluate the impact of HAART (available since 1996) on cumulative incidence of AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC). In addition, we estimated the fraction of deaths attributable to cancer.

Methods:  Records of persons with AIDS (PWA; N = 372,364) were linked to 15 US cancer registries. Standardized incidence ratios (SIR) measured cancer risk relative to the general population during the 3 to 5 years after AIDS onset. We used competing risk models to estimate 5-year cumulative incidence of ADC and NADC. Cox regression yielded relative risks for death following cancer, from which cancer-attributable mortality was derived. We compared 3 calendar periods (AIDS onset 1980 to 1989, 1990 to 1995, 1996 to 2006).

Results:  Risks of ADC (Kaposi sarcoma, non-Hodgkin lymphoma, cervical cancer) were significantly elevated during the 3 to 5 years after AIDS. Risk was also elevated for cancers of the oral cavity (SIR 1.9), anus (SIR 27), lung (SIR 3.0), and Hodgkin lymphoma (SIR 9.1). Five-year cumulative incidence of ADC declined across AIDS periods: from 8.7% (1980s) to 6.4% (1990 to 1995) to 2.1% (1996 to 2006). In contrast, cumulative incidence of NADC increased significantly from 0.9% during the period 1980 to 1989 to 1.1% during the period 1990 to 1995, and then remained constant (1.0%) from 1996 to 2006. Among specific NADC, cumulative incidence of anal, lung, liver cancers, and Hodgkin lymphoma increased over time. For people with an ADC or NADC, mortality attributable to their cancer also rose over time, reaching 88.3% and 87.1% of deaths, respectively, during the time period 1996 to 2006. Among all PWA, the fraction of deaths due to an NADC (ie, population attributable risk) increased over time, reaching 2.3% of all deaths in persons diagnosed with AIDS in 1996 to 2006.

Conclusions:  Among people who survived an AIDS diagnosis for several years, we noted elevated risks of ADC and several NADC. With overall declines in mortality, PWA are living longer, leading to strong increases in cumulative incidence of these NADC. Among PWA who develop cancer, almost all deaths are now attributed to their cancer. Further, a growing fraction of all deaths among PWA are attributed to NADC. Increased cancer prevention and screening among PWA is needed.