Background This study describes trends in malignancies as it relates to the availability of highly active antiretroviral therapy (HAART) in a Hispanic HIV/AIDS infected cohort.
Methods The database of 4,232 HIV infected adults followed in the Retrovirus Research Center at Bayamon, Puerto Rico was matched with the Puerto Rico Central Cancer Registry (PRCCR) database. AIDS and non-AIDS related malignancies standardised incidence rate (SIR) and 95% CI in three time periods, defined as: 1992–1995 (pre-HAART), 1996–2002 (early-HAART), and 2003–2009 (late-HAART) were established. SIR evaluates a measure of risk related to the general population, and is defined as the ratio of observed to expected number of cancers. Expected counts were estimated by applying gender, age, and calendar years PRCCR’s specific cancer incidence rates to our cohort.
Results Of the 296 malignancies found; 29.3% were women, 39.3% were injecting drug users and 42.9% were AIDS related cancers. The SIR for all malignancies in the pre-HAART period (10.15) decreased to 5.35 in the early-HAART, and to 2.04 in the late-HAART period. AIDS related malignancies SIRs decreased after HAART from 91.99 to 16.48; however, Kaposi’s sarcoma (KS) and invasive cervical carcinoma (ICC) SIRs remained significantly higher in the late-HAART period (50.52 and 9.17). Non-AIDS related malignancies’ SIRs of the oral cavity/pharynx, liver, anus, vaginal, testis, Hodgkin’s lymphomas (HL) and non-HL (NHL) were significantly higher (SIRs > 3.30) in the late-HAART period.
Conclusion Availability of HAART in this Hispanic HIV/AIDS cohort has significantly decreased the malignancies risk. However, the higher incidence of KS, ICC and non-AIDS related malignancies in the late-HAART is suggestive of the role of additional oncogenic factors including sexual transmitted and injecting drug use infections. Aggressive intervention in the form of vaccines, risky practise reduction, early screening intervention and education needs to be incremented in this vulnerable population. Granted by 8G12MD007583, 8U54MD007587 and NPCR-CDC