Risk of non-AIDS-defining cancers among HIV-1-infected individuals in France between 1997 and 2009: Results from a French cohort

摘要

Objectives: Improved survival among HIV-infected individuals after the advent of combination antiretroviral therapy (cART) had drawn attention on non-AIDS-defining cancers. We evaluated the incidence and risk trends of lung cancer, Hodgkin's lymphoma, liver and anal cancers, focusing on patients with CD4+ cell recovery and age at diagnosis, by comparison with the general population. Design: Cohort study. Methods: Standardized incidence rates were calculated in the HIV-infected individuals followed in the FHDH and the general population in France in 1997-2000, 2001- 2004, and 2005-2009. We estimated standardized incidence ratios for each period and for patients with CD4+ cell count at least 500 cells/糽 for at least 2 years on cART. Results: Among the 84 504 HIV-infected individuals, the risk of lung and anal cancers fell during the cART era, whereas that of Hodgkin's lymphoma and liver cancer remained stable. In 2005-2009, the standardized incidence ratios for lung cancer, Hodgkin's lymphoma, liver and anal cancers were, respectively, 2.8 [95% confidence interval (CI) 2.5-3.1], 26.5 (95% CI 23.2-30.1), 10.9 (95% CI 9.6-12.3) and 79.3 (95% CI 69.5-90.1). Among patients with CD4+ cell recovery on cART, the risk was close to that of the general population for lung cancer, nine-fold higher for Hodgkin's lymphoma, and 2.4-fold higher for liver cancer. Age at diagnosis was significantly younger among HIV-infected individuals for lung cancer (-3.3 years), Hodgkin's lymphoma (-1 year) and liver cancer (-10.1 years). Conclusion: HIV-infected patients were at a higher risk for the four cancers over 1997- 2009. CD4+ cell recovery appears to control the excess risk of lung cancer. For liver cancer and Hodgkin's lymphoma, our results suggest that CD4+ should never drop below 500/糽 500 cells/糽 to avoid the excess risk.