www.hivandhepatitis.com

EACS 2011: Incidence of Non-AIDS Malignancies Stabilizes in D:A:D Study, but Prognosis Improves

Occurrence of non-AIDS-defining cancer has remained stable in recent years, according to an analysis of the large D:A:D observational cohort presented at the 13th European AIDS Conference (EACS 2011) last week in Belgrade. Prognosis for HIV positive people with such malignancies remains poor, but appears to have improved somewhat over time.

D:A:D investigators looked at trends over time in the incidence of non-AIDS-defining malignancies -- that is, all cancers except Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer -- and their survival outcomes. They prospectively collected information about the types and sites of all new non-AIDS cancers reported between January 2004 and January 2010.

Incidence rates were calculated for non-AIDS cancer overall and separately for lung cancer, anal cancer, and Hodgkin lymphoma.

Results

• During 176,776 person-years (PY) of follow-up, 880 cohort participants (2%) developed a new non-AIDS-defining malignancy, for an incidence rate of 4.8 per 1000 PY.
• The most common non-AIDS malignancies were lung cancer (140 cases), Hodgkin lymphoma (112 cases), and anal cancer (79 cases).
• Patients diagnosed with non-AIDS cancer had a median CD4 cell count of 392 cells/mm³, a median CD4 nadir (lowest-ever level) of 127 cells/mm³, and most (92%) used antiretroviral therapy,
• Incidence of first non-AIDS malignancies did not change greatly over the course of the observation period, after controlling for advancing patient age.
• A total of 333 participants (38%) with non-AIDS malignancies died during follow-up.
• Estimated mortality rates after cancer diagnosis were as follows:

o      1 year: 28%;

o      3 years: 42%;

o      5 years: 48%.

• The median overall survival duration was 5.5 years.
• 1-year mortality rates differed for selected types of non-AIDS cancer:

o      Lung cancer: 57%;

o      Hodgkin lymphoma: 22%.

o      Anal cancer: 16%.

• Besides cancer type, other factors significantly associated with poorer survival included male sex, history of smoking, and history of injection drug use.
• Older age, current smoking, and hepatitis C coinfection showed a trend toward association with poorer survival, but did not reach statistical significance.
• Having a higher CD4 cell count significantly predicted better survival.

Based on these findings, the D:A:D investigators concluded, "The incidence of [non-AIDS-defining malignancies] overall and for Hodgkin lymphoma and for lung and anal cancer has remained relatively stable from 2004-2010."

"The prognosis after a diagnosis of [non-AIDS-defining malignancies] is poor but has improved somewhat over time," they added. "Improvement in earlier diagnosis and better management of [non-AIDS-defining malignancies] is warranted."

Investigator affiliations: Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark; Research Department of Infection and Population Health, London, UK; Academic Medical Center, Amsterdam, Amsterdam, Netherlands; The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia; INSERM Université Bordeaux Segalen, Bordeaux, France; Hopital de l'Archet, Nice, France; University Hospital, Lausanne, Switzerland; Hospital San Paolo, University of Milan, Milan, Italy; CHU Saint-Pierre Hospital, Department of Infectious Diseases, Bruxelles, Belgium.

10/18/11

Reference

SW Worm, C Sabin, P Reiss et al (D:A:D Study Group). Non-AIDS Defining Malignancies (NADM) in the D:A:D Study: Time Trends and Predictors of Survival. 13th European AIDS Conference (EACS 2011). Belgrade, October 12-15, 2011. Abstract PS2/1.