Z Gastroenterol 2009; 47 - P5_27
DOI: 10.1055/s-0029-1191989

The Spectrum of Malignancies in the Era of HAART

M Vogel 1, O Friedrich 1, T Höller 2, J Wasmuth 1, J Emmelkamp 1, C Schwarze-Zander 1, N Vidovic 3, J Oldenburg 3, JK Rockstroh 1, U Spengler 1
  • 1Abteilung für Innere Medizin, Universitätsklinik Bonn
  • 2Institut für Medizinische Biometrie, Informatik und Epidemiologie, Universität Bonn
  • 3Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinik Bonn

Aims: Since the introduction of HAART life expectancy of HIV-infected patients has enormously improved. In clinical practice the number of newly diagnosed malignancies in HIV-infected patients appears to rise, however, despite immune-reconstitution under HAART. Little is known on the epidemiology of malignancies in the era of HAART.

Methods: Single-center cohort study. 1438 patients who regularly visited our center during the time period 1996–2006 were analyzed, contributing a total of 11232 person years of follow-up. Data was retrieved by a standardized questionnaire. Standardized incidence rates were compared with the state cancer registry. Due to the low prevalence of Kaposi sarcoma in the HIV-negative reference population Kaposi sarcoma was excluded from statistical analysis.

Results: 104 malignancies were observed: 47 kaposi sarcomas, 22 non-Hodgkin lymphomas (NHL), 7 anal carcinomas, 6 Hodgkin lymphomas, 6 hepatocellular carcinomas (HCC), 4 cervix carcinomas, 3 bronchial carcinomas, and 9 other tumors. Comparison of the age adjusted standardized incidence rates with the normal German population is seen in the table. Other tumor entities were encountered less frequently in HIV-infected patients, presumably reflecting the effects of competing risks.

Conclusions: Whereas opportunistic infections and related mortality have decreased considerably after the introduction of HAART, HIV-related malignancies and importantly non HIV-related malignancies are remaining therapeutic challenges in the health-management of HIV-infected patients.

Malignancy

Incidence
HIV-positive cohort Bonn University
n=1438

Incidence
German population of Saarlandia
n=1 050 293

p-value

NHL
20–39 years
40–59 years
60–80 years

1.6%
1.9%
2.7%

0.00004%
0.00016%
0.00062%

<0.0001
<0.0001
<0.0021

Anal carcinoma
20–39 years
40–59 years
60–80 years

0.4%
0.6%
0%

0%
0.000003%
0.000013%

-
<0.0001
=1

Hodgkin lymphoma
20–39 years
40–59 years
60–80 years

0.9%
0.2%
0%

0.00004%
0.00003%
0.00004%

<0.0001
<0.0313
=1

HCC
20–39 years
40–59 years
60–80 years

0.4%
0.6%
1.3%

0.000001%
0.000059%
0.000297%

<0.0001
<0.0001
=0.0441

Cervix carcinoma
20–39 years
40–59 years
60–80 years

1.7%
1.2%
0%

0.00040%
0.00032%
0.00074%

<0.0001
=0.0524
=1

Bronchial carcinoma
20–39 years
40–59 years
60–80 years

0%
0.6%
0%

0.00020%
0.00091%
0.00461%

=1
=0.0255
=1

HIV - Malignancy