Changing patterns of cancer incidence in the early- and late-HAART periods: the Swiss HIV Cohort Study

S Franceschi, M Lise, G M Clifford, M Rickenbach, F Levi, M Maspoli, C Bouchardy, S Dehler, G Jundt, S Ess, A Bordoni, I Konzelmann, H Frick, L Dal Maso, L Elzi, H Furrer, A Calmy, M Cavassini, B Ledergerber, O Keiser, Swiss HIV Cohort Study, M Battegay, E Bernasconi, J Böni, H C Bucher, P Bürgisser, A Calmy, M Cavassini, R Dubs, M Egger, L Elzi, M Fischer, M Flepp, A Fontana, P Francioli, H Furrer, C A Fux, M Gorgievski, H F Günthard, H H Hirsch, B Hirschel, I Hösli, C Kahlert, L Kaiser, U Karrer, C Kind, T Klimkait, B Ledergerber, G Martinetti, B Martinez de Tejada, N Müller, D Nadal, F Paccaud, G Pantaleo, A Rauch, S Regenass, M Rickenbach, C Rudin, P Schmid, D Schultze, F Schöni-Affolter, J Schüpbach, R Speck, P Taffé, A Telenti, A Trkola, P Vernazza, R Weber, S Yerly, S Franceschi, M Lise, G M Clifford, M Rickenbach, F Levi, M Maspoli, C Bouchardy, S Dehler, G Jundt, S Ess, A Bordoni, I Konzelmann, H Frick, L Dal Maso, L Elzi, H Furrer, A Calmy, M Cavassini, B Ledergerber, O Keiser, Swiss HIV Cohort Study, M Battegay, E Bernasconi, J Böni, H C Bucher, P Bürgisser, A Calmy, M Cavassini, R Dubs, M Egger, L Elzi, M Fischer, M Flepp, A Fontana, P Francioli, H Furrer, C A Fux, M Gorgievski, H F Günthard, H H Hirsch, B Hirschel, I Hösli, C Kahlert, L Kaiser, U Karrer, C Kind, T Klimkait, B Ledergerber, G Martinetti, B Martinez de Tejada, N Müller, D Nadal, F Paccaud, G Pantaleo, A Rauch, S Regenass, M Rickenbach, C Rudin, P Schmid, D Schultze, F Schöni-Affolter, J Schüpbach, R Speck, P Taffé, A Telenti, A Trkola, P Vernazza, R Weber, S Yerly

Abstract

Background: The advent of highly active antiretroviral therapy (HAART) in 1996 led to a decrease in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL), but not of other cancers, among people with HIV or AIDS (PWHA). It also led to marked increases in their life expectancy.

Methods: We conducted a record-linkage study between the Swiss HIV Cohort Study and nine Swiss cantonal cancer registries. In total, 9429 PWHA provided 20,615, 17,690, and 15,410 person-years in the pre-, early-, and late-HAART periods, respectively. Standardised incidence ratios in PWHA vs the general population, as well as age-standardised, and age-specific incidence rates were computed for different periods.

Results: Incidence of KS and NHL decreased by several fold between the pre- and early-HAART periods, and additionally declined from the early- to the late-HAART period. Incidence of cancers of the anus, liver, non-melanomatous skin, and Hodgkin's lymphoma increased in the early- compared with the pre-HAART period, but not during the late-HAART period. The incidence of all non-AIDS-defining cancers (NADCs) combined was similar in all periods, and approximately double that in the general population.

Conclusions: Increases in the incidence of selected NADCs after the introduction of HAART were largely accounted for by the ageing of PWHA.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Incidence rates (standardised by 5-year age group and, when appropriate, sex, based on the age and sex distribution of all people with HIV or AIDS (PWHA) included in this study) and corresponding 95% confidence intervals of all cancers among PWHA by sex or HIV-transmission category and period of cancer diagnosis. MSM, men having sex with men; HET, heterosexual; IDU, intravenous drug user.
Figure 2
Figure 2
Age-specific incidence rates of selected cancers among people with HIV or AIDS (PWHA) and the general population from the same Swiss Cantons (age-standardised as in Figure 1) by period of cancer diagnosis. PY, person-years.

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Source: PubMed

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