Cancer, immunodeficiency and antiretroviral treatment: results from the Australian HIV Observational Database (AHOD)

Objectives: The objective of the study was to conduct a within-cohort assessment of risk factors for incident AIDS-defining cancers (ADCs) and non-ADCs (NADCs) within the Australian HIV Observational Database (AHOD). Methods: A total of 2181 AHOD registrants were linked to the National AIDS Registry/National HIV Database (NAR/NHD) and the Australian Cancer Registry to identify those with a notified cancer diagnosis. Included in the current analyses were cancers diagnosed after HIV infection. Risk factors for cancers were also assessed using logistic regression methods. Results: One hundred and thirty-nine cancer cases were diagnosed after HIV infection among 129 patients. More than half the diagnoses (n=68; 60 ) were ADCs, of which 69 were Kaposi s sarcoma and 31 non-Hodgkin s lymphoma. Among the NADCs, the most common cancers were melanoma (n=10), lung cancer (n=6), Hodgkin s lymphoma (n=5) and anal cancer (n=5). Over a total of 21021 person-years (PY) of follow-up since HIV diagnosis, the overall crude cancer incidence rate for any cancer was 5.09/1000 PY. The overall rate of cancers decreased from 15.9/1000 PY [95 confidence interval (CI) 9.25-25.40/1000 PY] for CD4 counts 350 cells/?L. Lower CD4 cell count and prior AIDS diagnoses were significant predictors for both ADCs and NADCs. Conclusions: ADCs remain the predominant cancers in this population, although NADC rates have increased in the more recent time period. Immune deficiency is a risk factor for both ADCs and NADCs