Risk of melanoma in people with HIV/AIDS in the pre- and post-HAART eras: a systematic review and meta-analysis of cohort studies

PLoS One. 2014 Apr 16;9(4):e95096. doi: 10.1371/journal.pone.0095096. eCollection 2014.

Abstract

Objective: Following the introduction of highly active antiretroviral therapy (HAART) the risk of AIDS-defining cancers decreased but incidence of many non-AIDS-defining cancers has reportedly increased in those with HIV/AIDS. Whether melanoma risk has also changed in HIV/AIDS patients post-HAART is unknown and therefore we evaluated this in comparison with the risk before HAART.

Design: Systematic review and meta-analysis.

Methods: We searched Medline, Embase and ISI science citation index databases to April 2013. All cohort studies of patients diagnosed with HIV/AIDS that permitted quantitative assessment of the association with melanoma were eligible. Detailed quality assessment of eligible studies was conducted, focussing particularly on adjustment for ethnicity, a priori considered essential for an unbiased assessment of melanoma risk. Data were pooled using a random effects model.

Results: From 288 articles, we identified 21 that met the inclusion criteria, 13 presenting data for the post-HAART era and 8 for the pre-HAART era. Post-HAART the pooled relative risk (pRR) for the association between HIV/AIDS and melanoma was 1.26 (95% CI, 0.97-1.64) and 1.50 (95% CI 1.12-2.01) among studies that accounted for ethnicity, with evidence of significant heterogeneity (P = 0.004, I2 = 55.5). Pre-HAART pRRs were 1.26 (95% CI 1.11-1.43; P het = 0.82) and 1.28 (95% CI 1.10-1.49) among studies adjusted for ethnicity.

Conclusions: People with HIV/AIDS remain at a significantly increased risk of developing melanoma in the post-HAART era. White skinned people with HIV/AIDS should be screened regularly and counselled against excessive sun exposure.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Acquired Immunodeficiency Syndrome / complications
  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Acquired Immunodeficiency Syndrome / ethnology
  • Acquired Immunodeficiency Syndrome / virology
  • Adolescent
  • Adult
  • African Continental Ancestry Group
  • Antiretroviral Therapy, Highly Active*
  • European Continental Ancestry Group
  • Female
  • HIV-1 / drug effects
  • HIV-1 / physiology
  • Humans
  • Male
  • Melanoma / complications
  • Melanoma / drug therapy*
  • Melanoma / ethnology
  • Melanoma / virology
  • Middle Aged
  • Proportional Hazards Models
  • Risk
  • Skin Neoplasms / complications
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / ethnology
  • Skin Neoplasms / virology

Grant support

LLK was funded by special purpose donations for melanoma research to the QIMR Berghofer Medical Research Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.