Trends and predictors of non-AIDS-defining cancers in men and women with HIV infection: a single-Institution retrospective study before and after the introduction of HAART

Background: The incidence of non-AIDS defining cancers (NADCs) in HIV-positive patients has increased over recent years. Most studies of the risk and spectrum of NADCs are primarily based on male populations and only a few have provided specific information regarding females. Methods: We retrospectively analysed all incident NADCs occurring in a cohort of HIV-positive patients followed up between 1985 and 2011. Incidence rates before and after the introduction of highly active antiretroviral therapy (HAART) were examined using Poisson regression models. Standardised incidence ratios (SIRs) were used to compare the cancer risk of HIV-infected subjects with that of the age- and gender-matched general population as estimated by the Milan Cancer Registry. Results: 5,924 patients (4,382 males and 1,542 females) contributed 50,990 person-years (py) to the follow-up. Among them 144 had new NADC diagnosis. The overall incidence increased from 1.0 case/1,000 py in the pre-HAART period to 4.5 cases/1,000 py in the HAART period (p <0.01). In women, the risks were higher than expected in the case of cancer of the vulva (SIR 69.2), Hodgkin lymphoma (SIR 7.5), anal cancer (SIR 41.2), and lung cancer (SIR 4.8). In men, the risks were higher than expected in the case of anal cancer (SIR 91.5), Hodgkin lymphoma (SIR 13.0), tonsil cancer (SIR 10.9), lung cancer (SIR 2.1), and liver cancer (SIR 7.1). Conclusions: The spectrum and incidence of NADCs in our cohort increased over time. The incidence of NADCs, especially virus- and smoking-associated cancers, was significantly higher than expected in HIV-positive men and women.