Changing Prevalence of AIDS and Non-AIDS-Defining Cancers in an Incident Cohort of People Living with HIV over 28 Years

Author:

Cattelan Anna Maria1ORCID,Mazzitelli Maria1ORCID,Presa Nicolò1,Cozzolino Claudia2ORCID,Sasset Lolita1,Leoni Davide1,Bragato Beatrice1,Scaglione Vincenzo1,Baldo Vincenzo2ORCID,Parisi Saverio Giuseppe3

Affiliation:

1. Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy

2. Department of Cardiothoracic and Vascular Sciences and Public Health, Padua University, 35122 Padua, Italy

3. Department of Molecular Medicine, Padua University Hospital, 35128 Padua, Italy

Abstract

Background: The introduction and evolution of antiretrovirals has changed the panorama of comorbidities in people living with HIV (PLWH) by reducing the risk of AIDS-defining cancers (ADC). By contrast, due to ageing and persistent inflammation, the prevalence and incidence of non-AIDS-defining cancers have significantly increased. Therefore, we aimed at describing cancer epidemiology in our cohort over 28 years. Methods: We retrospectively included all PLWH in our clinic who ever developed cancers, considering features of ADC and NADC, from January 1996 to March 2023. Demographic, clinical characteristics, and survival were analyzed, comparing three observation periods (1996–2003, 2004–2013, and 2014–2023). Results: A total of 289 PLWH developed 308 cancers over the study period; 77.9% were male, the mean age was 49.6 years (SD 12.2), and 57.4% PLWH developed NADC and 41.5% ADC. Kaposi (21.8%) and non-Hodgkin lymphoma (20.1%) were the most frequent cancers. Age at the time of cancer diagnosis significantly increased over time (41.6 years in the first period vs. 54.4 years in the third period, p < 0.001). In the first period compared with the last, a simultaneous diagnosis of HIV infection and cancer occurred in a higher proportion of persons (42.7 vs. 15.3, p < 0.001). While viro-immunological control at cancer diagnosis significantly improved over time, the proportions of cancer progression/remission remained stable. Overall survival significantly increased, but this trend was not confirmed for ADC. Conclusions: The probability of survival for ADC did not decrease as significantly as the number of ADC diagnoses over time. By contrast, NADC dramatically increased, in line with epidemiological studies and other literature data. The changing patterns of malignancies from ADC to NADC underline the need for public health interventions and the fostering of screening programs aimed at the prevention and early detection of NADC in PLWH.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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