Spectrum of Cancer Risk Late After AIDS Onset in the United States

"Persons living with AIDS today remain at elevated cancer risk. Highly active antiretroviral therapy (HAART), widely available since 1996, prolongs life, but immune function is not fully restored," noted the study authors, who assessed long-term cancer risk among persons with AIDS relative to the general population and the impact of HAART on cancer incidence.

The records of 263,254 adults and adolescents with AIDS (1980-2004) living in 15 US regions were matched to cancer registries to capture incident cancers during years three through five and six through 10 following AIDS onset. Risks relative to the general population were assessed using standardized incidence ratios (SIRs). Rate ratios (RRs) were employed to compare cancer incidence before and after 1996 to assess the impact of HAART availability.

Risk was elevated for the two main AIDS-defining cancers: Kaposi sarcoma (SIRs, 5,321 and 1,347 in years three through five and six through 10, respectively) and non-Hodgkin lymphoma (SIRs, 32 and 15). Incidence of both cancers declined in the HAART era (1996-2006). Risk was elevated for all non-AIDS-defining cancers combined (SIRs, 1.7 and 1.6 in years three through five and six through 10, respectively), and for the following specific non-AIDS-defining cancers: Hodgkin lymphoma and cancers of the oral cavity and/or pharynx, tongue, anus, liver, larynx, lung and/or bronchus, and penis. Anal cancer incidence increased between 1990-1995 and 1996-2006 (RR, 2.9; 95 percent confidence interval [CI], 2.1-4.0), as did incidence of Hodgkin lymphoma (RR, 2.0; 95 percent CI, 1.3-2.9).

"Among people who survived for several years or more after an AIDS diagnosis, we observed high risks of AIDS-defining cancers and increasing incidence of anal cancer and Hodgkin lymphoma," the authors concluded.