Malignancy‐related causes of death in human immunodeficiency virus–infected patients in the era of highly active antiretroviral therapy

• Published in: Cancer 2004-07, Vol.101 (2), p.317-324
• Main Authors: Bonnet, Fabrice, Lewden, Charlotte, May, Thierry, Heripret, Laurence, Jougla, Eric, Bevilacqua, Sibylle, Costagliola, Dominique, Salmon, Dominique, Chêne, Geneviève, Morlat, Philippe
• Format: Article
• Language: English
• Subjects: acquired immunodeficiency syndrome; Acquired Immunodeficiency Syndrome - complications; Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - mortality; Adult; Antiretroviral Therapy, Highly Active; Biological and medical sciences; death; Female; France - epidemiology; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - mortality; human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Lymphoma, AIDS-Related - mortality; Lymphoma, Non-Hodgkin - mortality; Male; malignancy; Medical sciences; Middle Aged; Neoplasms - mortality; Prospective Studies; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.20354

BACKGROUND Before the introduction of highly active antiretroviral therapy (HAART), malignancies accounted for less than 10% of all deaths among human immunodeficiency virus (HIV)‐infected patients. This figure may have increased, and the observed types of malignant disease may have been modified, as a result of decreased occurrence of opportunistic infections, the chronicity of HIV infection, the possible oncogenic role of HIV itself, and the aging of the HIV‐infected population. METHODS All French hospital wards involved in the management of HIV infection were asked to prospectively document the deaths of HIV‐infected patients in the year 2000. Underlying causes of death were defined using a standardized questionnaire. RESULTS Of a total of 964 deaths, 269 (28%) were attributable to malignancies. Acquired immunodeficiency virus (AIDS)‐related malignancies were the underlying cause of 149 deaths (15%); among these malignancies were non‐Hodgkin lymphoma (n = 105 [11%]), noncerebral lymphoma (n = 78 [median CD4 count, 86 × 106 per liter; interquartile range [IQR], 35–231 × 106 per liter), and primary cerebral lymphoma (n = 27 [median CD4 count, 20 × 106 per liter; IQR, 4–109 × 106 per liter). Kaposi sarcoma was associated with 40 deaths (4%), and cervical carcinoma was associated with 5 (0.5%). Non‐AIDS‐related malignancies were the underlying cause of 120 deaths (13%); these non‐AIDS‐related malignancies included 103 solid tumors (50 respiratory tumors, 19 hepatocarcinomas, 9 digestive tumors, and 6 anal tumors; median CD4 count, 218 × 106 per liter; IQR, 108–380 × 106 per liter) and 17 hemopathies (12 Hodgkin lymphomas, 4 myeloid leukemias, and 1 myeloma; median CD4 count, 113 × 106 per liter; IQR, 56–286 × 106 per liter). Compared with patients who died of other causes, patients who died of solid tumors were more likely to be male, to smoke, to be older, and to have higher CD4 counts. CONCLUSIONS Malignant disease has been a major cause of death among HIV‐infected patients in industrialized nations since the introduction of HAART. Whereas lethal hemopathies and Kaposi sarcoma are associated with advanced immunosuppression, lethal solid tumors can occur in patients with controlled HIV infection. Cancer 2004. © 2004 American Cancer Society. Malignancies accounted for 28% of all deaths in a national prospective study involving human immunodeficiency virus–infected patients during the highly active antiretroviral therapy era. Hemopathies often are associated