Survival Among HIV-Infected and HIV-Uninfected Individuals with Common Non-AIDS-Defining Cancers
Menée aux Etats-Unis, cette étude de cohorte compare, entre les patients infectés par le VIH et les autres, l'évolution de la survie à différents types de cancer non classant sida (119 cas de lymphome hodgkinien, 148 cas de cancer anal, 2 200 cas de cancer de la prostate, 699 cas de cancer colorectal, 587 cas de cancer du poumon), sur la période 1996-2011
Background: Non-AIDS-defining cancers increasingly contribute to mortality among human immunodeficiency virus (HIV)-infected individuals. However, few studies have compared cancer prognosis by HIV status with adjustment for risk factors. Methods: We conducted a cohort study of HIV-infected and HIV-uninfected adults in Kaiser Permanente California during 1996-2011, following subjects diagnosed with Hodgkin lymphoma (HL) or anal, prostate, colorectal, or lung cancers. We used Kaplan-Meier curves and Cox regression to assess cancer-related mortality within five years, comparing HIV-infected with HIV-uninfected subjects. Adjusted models included age, race/ethnicity, sex, cancer stage, cancer treatment, and smoking. Results: Among HIV-infected and HIV-uninfected subjects, there were 68 and 51 cases of HL, 120 and 28 of anal cancer, 150 and 2050 of prostate cancer, 53 and 646 of colorectal cancer, and 80 and 507 of lung cancer, respectively. Five-year cancer-related survival was reduced for HIV-infected compared with HIV-uninfected subjects, reaching statistical significance for lung cancer (10% vs. 19%, P=0.002) but not HL (83% vs. 89%, P=0.40) or anal (64% vs. 74%, P=0.38), prostate (86% vs. 92%, P=0.074), or colorectal cancers (49% vs. 58%, P=0.55). Adjusted results were similar, with lung cancer (hazard ratio [HR] 1.3, 95% confidence interval [CI]: 1.0-1.7) and prostate cancer (HR 2.1, 95% CI: 1.1-4.1) reaching significance. Conclusions: Cancer-related mortality was higher among HIV-infected compared with HIV-uninfected individuals for prostate and lung cancers, but not HL, anal cancer, or colorectal cancer. Impact: Our findings emphasize the need for a focus on prevention, early detection, and adequate treatment of cancer among HIV-infected individuals.