The types of cancers diagnosed among HIV-infected patients have shifted in the era of antiretroviral (ARV) therapy, a new study has found. The incidence rates of non-AIDS-defining malignancies (non-ADMs) have grown among HIV-infected patients compared with non-infected patients since ARVs became available, wrote Dr. Roger Bedimo of the University of Texas Southwestern Medical Center and colleagues.

"It's a genuine increase in the incidence of these cancers," said Bedimo. "The increase is more visible because these patients are living longer, but our findings suggest that the increased number of [non-ADMs] is not simply the result of their longer lives."

The study analyzed a cohort of veterans in care - matched by age, race and gender - and compared HIV-infected patients with HIV-uninfected patients from 1997 to 2004. The incidence rate ratio of HIV-infected to HIV-uninfected was 1.6 (1,260 vs. 841 per 100,00 person-years, 95 percent confidence interval (CI): 1.5 to 1.7). The 33,420 HIV-positive and 66,840 HIV-negative patients were followed for a median of 5.1 and 6.4 years, respectively. The incidence rate ratio for individual cancers was highest for anal cancer (14.9; CI: 10.1-22.1). Among those with HIV, median CD4 counts were lower for those with non-ADM (249 vs. 270; P=0.02), anal cancer (156 vs. 250; P<0.001), and Hodgkin lymphoma (217 vs. 269; P=0.03). Prostate cancer was associated with a higher CD4 count (311 vs. 266; P<0.001).

"In the highly active antiretroviral era, the incidence of non-ADMs is higher among HIV-infected than HIV-uninfected patients, adjusting for age, race and gender," concluded researchers. "Some non-ADMs do not seem to be associated with significantly lower CD4 counts."

The report, "Incidence of Non-AIDS-Defining Malignancies in HIV-Infected Versus Non-Infected Patients in the HAART Era: Impact of Immunosuppression," was published in the Journal of Acquired Immune Deficiency Syndromes (2009;52(2):203-208).