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The effect of highly active antiretroviral therapy (HAART) on the incidence of non-AIDS-defining cancers in adults with AIDS is variable, with little effect seen in many instances, according to a report in the May 15th American Journal of Epidemiology.
"We found that HAART use does not appear to substantially reduce the risk of non-AIDS cancers, and the impact of HAART on specific non-AIDS-defining cancer incidence rates and survival time is not uniform," Dr. Nancy A. Hessol from University of California San Francisco, San Francisco, California told Reuters Health. "The underlying etiology for each cancer type contributes to this observed variation, along with changes in HIV and cancer treatments."
Dr. Hessol and associates used the San Francisco, California AIDS surveillance registry and the California Cancer Registry to examine the impact of HAART on the incidence and survival time of non-AIDS-defining cancers among more than 14,000 adults with AIDS diagnosed between 1990 and 2000.
After adjusting for differences in survival, AIDS patients had higher than expected rates in the general population of all non-AIDS cancers and higher than expected rates of cancers of the oral cavity and pharynx, anus, liver, respiratory tract, and prostate, as well as melanoma, Hodgkin's disease, and leukemia.
Overall, the risk of developing non-AIDS-related cancers was somewhat higher during the HAART era (a 43% increased risk) but slightly lower for those who actually used HAART (21% reduced risk), the authors report.
"Risk of liver cancer was lower with HAART use (relative hazard = 0.32)," the team found, while the risk of anal cancer increased after 1995 (RH =2.9).
The use of HAART for at least 6 months was associated with longer survival times with respiratory cancer and Hodgkin's lymphoma, the results indicate, but anal cancer survival time may have decreased slightly.
"People with HIV infection and AIDS are living longer, due largely to effective antiretroviral medications, so clinicians should be vigilant and encourage both cancer prevention -- such as smoking cessation -- and screening for early detection of both AIDS-defining and non-AIDS defining malignancies," Dr. Hessol said.
"Speaking as an epidemiologist and not a clinician, I would focus on better cancer screening and prevention," Dr. Hessol advised. "For example, given the high rate of anal cancers in HIV-infected men who have sex with men, anal Pap testing should be encouraged for early detection and treatment of pre-cancerous and cancerous lesions."
