Abstract

Background: People with AIDS (PWA) are at increased risk for certain types of cancer. The objective of the present study was to describe three aspects of the cancer epidemiology among PWA: time trends, risk and survival. Methods: To identify PWA who had cancer, a probabilistic record linkage between the databases “Information System on Disease Notification (SINAN)” (87,109 records) and the “Population-based Cancer Registry of São Paulo” (628,161 cancer cases) was conducted. The trend analyses were based on the annual percent change (APC) and corresponding 95% confidence intervals (95% CI). To assess the risk for cancer the standardized incidence ratio (SIR) and 95% CI were calculated. The survival analyses were conducted by means of Kaplan Meier methods and Cox models. Results: The database comprised 2,074 cancer cases, diagnosed in 2,000 PWA (seventy-four people had two primary site tumors). The majority were male (1,461; 73.0%), white (1,111; 55.6%) and aged 30-49 years old at cancer diagnosis (1,257; 62.9%). Most cancers (1,057; 51.0%) were non-AIDS defining (NADC). A statistically significant decline in the incidence of AIDS-defining cancers (ADC) was found in males and females (APCM = -14.1%/year; APCF = -15.6%/year). Conversely the incidence of NADC has increased since the mid 2000’s (APCM = 7.4%/year) among men. The risks for both ADC (SIRM = 27.74; SIRF = 8.71) and NADC (SIRM = 1.87; SIRF = 1.44) were significantly elevated. The overall five-year survival in PWA after cancer diagnosis was 49.4% (versus 72.7% in matched non-PWA). The hazard ratios were 2.93 and 2.51 for ADC and NADC, respectively. Conclusion: Cancer burden among PWA in São Paulo was similar to that described in high-income countries following the introduction of the highly active antiretroviral therapy. Despite the significant reductions in the incidence of ADC, PWA remain at higher risk of developing cancer.