Cancer survival in people with AIDS: A population‐based study from São Paulo, Brazil

• Published in: International journal of cancer 2018-02, Vol.142 (3), p.524-533
• Main Authors: Tanaka, Luana F., Latorre, Maria do Rosário D. O., Gutierrez, Eliana B., Curado, Maria P., Dal Maso, Luigino, Herbinger, Karl‐Heinz, Froeschl, Guenter, Heumann, Christian
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - mortality; Acquired Immunodeficiency Syndrome - pathology; Adult; AIDS; Brazil - epidemiology; Cancer; Developed countries; Developing Countries; Diagnosis; epidemiology; Female; HIV/AIDS; Humans; LDCs; Lungs; Male; Medical diagnosis; medical record linkage; Medical research; Middle Aged; Neoplasms - mortality; Neoplasms - virology; Population; Population studies; Population-based studies; Proportional Hazards Models; Registries; Statistical models; Survival; Tumors; Urinary bladder
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.31081

Cancer survival among people with AIDS (PWA) has been described in developed countries, but there is lack of data from developing countries. The aim of this study was to evaluate survival after cancer diagnosis in PWA and compare it with people without AIDS (non‐PWA) in São Paulo, Brazil. A probabilistic record linkage was carried out between the databases of the Population‐based Cancer Registry of São Paulo (PBCR‐SP) and the AIDS registry of SP (SINAN) to identify PWA who developed cancer. For comparison, non‐PWA were frequency matched from the PBCR‐SP by cancer site/type, sex, age, and period. Hazard ratio (HR) stratified by matching variables was estimated using a Cox proportional hazards model. A total of 1,294 PWA (20 patients with two primary site tumors) were included in the site/type‐specific analyses. AIDS‐defining cancers (ADC) comprised 51.9% of cases assessed. The all‐cancer 5‐year overall survival in PWA was 49.4% versus 72.7% in non‐PWA (HR = 2.64; 95%CI = 2.39–2.91). Survival was impaired in PWA for both ADC (HR = 2.93; 95%CI = 2.49–3.45) and non‐ADC (HR = 2.51; 95%CI = 2.21–2.84), including bladder (HR = 8.11; 95% CI = 2.09–31.52), lung (HR = 2.93; 95%CI = 1.97–4.36) and anal cancer (HR = 2.53; 95%CI = 1.63–3.94). These disparities were seen mainly in the first year after cancer diagnosis. The overall survival was significantly lower in PWA in comparison with non‐PWA in São Paulo, as seen in high‐income countries. Efforts to enhance early diagnosis and ensure proper cancer treatment in PWA should be emphasized. What's new? While increasing trends in cancer‐related mortality in people with AIDS have been widely reported, survival after cancer diagnosis remains less explored. This is the first population‐based study in Brazil and one of the few conducted in developing countries assessing cancer survival in people with AIDS. The large sample size allowed stratification by cancer type/site and analysis of 22 non‐AIDS‐defining cancers. The results revealed an impaired 5‐year overall survival after cancer diagnosis in people with AIDS in comparison to the general population, suggesting that national guidelines for the prevention, early diagnosis and management of cancer among HIV‐infected people may be beneficial.