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Open Access Highly Accessed Research article

Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study

Signe W Worm1, Mark Bower2, Peter Reiss3, Fabrice Bonnet4, Matthew Law5, Gerd Fätkenheuer6, Antonella d’Arminio Monforte7, Donald I Abrams8, Andrew Grulich5, Eric Fontas9, Ole Kirk1, Hansjakob Furrer10, Stephane De Wit11, Andrew Phillips12, Jens D Lundgren1, Caroline A Sabin12* and for the D:A:D Study Group

Author Affiliations

1 Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark

2 Chelsea and Westminster Hospital, London, UK

3 Academic Medical Center, Amsterdam, The Netherlands

4 ISPED, Universite Victor Segalen, Bordeaux, France

5 Kirby Institute, University of New South Wales, Sydney, Australia

6 University Hospital of Cologne, Cologne, Germany

7 Hospital San Paolo, University of Milan, Milan, Italy

8 Hematology-Oncology, San Francisco General Hospital/University of California, San Francisco, USA

9 CHU Nice Hopital de l’Archet, Nice, France

10 Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland

11 Department of Infectious Diseases, CHU Saint-Pierre Hospital, Bruxelles, Belgium

12 Research Department of Infection and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK

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BMC Infectious Diseases 2013, 13:471  doi:10.1186/1471-2334-13-471

Published: 9 October 2013

Abstract

Background

Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004–2010, and described subsequent mortality and predictors of these.

Methods

Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient’s last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient’s death, 1st February 2010 or 6 months after the patient’s last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.

Results

Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin’s lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004–2010 in this large observational cohort.

Conclusions

The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC.

Keywords:
HIV; Non-AIDS defining cancers; Incidence; Trends; Prognosis