Assessing the Impact of HAART on the Incidence of Defining and Non-Defining AIDS Cancers Among Patients With HIV/AIDS: A Systematic Review

J Infect Public Health. Jan-Feb 2015;8(1):1-10. doi: 10.1016/j.jiph.2014.08.003. Epub 2014 Oct 5.

Abstract

After highly active antiretroviral therapy (HAART) became widespread, several studies demonstrated changes in the incidence of defining and non-defining AIDS cancers among HIV/AIDS patients. We conducted a systematic review of observational studies evaluating the incidence of malignancies before and after the introduction of HAART in people with HIV/AIDS. Eligible studies were searched up to December 2012 in the following databases: Pubmed, Embase, Scielo, Cancerlit and Google Scholar. In this study, we determined the cancer risk ratio by comparing the pre- and post-HAART eras. Twenty-one relevant articles were found, involving more than 600,000 people with HIV/AIDS and 10,891 new cases of cancers. The risk for the development of an AIDS-defining cancer decreased after the introduction of HAART: Kaposi's sarcoma (RR=0.30, 95% CI: 0.28-0.33) and non-Hodgkin's lymphoma (RR=0.52, 95% CI: 0.48-0.56), in contrast to invasive cervical cancer (RR=1.46, 95% CI: 1.09-1.94). Among the non-AIDS-defining cancers, the overall risk increased after the introduction of HAART (RR=2.00, 95% CI: 1.79-2.23). The incidence of AIDS-defining cancers decreased and the incidence of non-AIDS-defining cancers increased after the early use of HAART, probably due to better control of viral replication, increased immunity and increased survival provided by new drugs.

Keywords: Acquired immunodeficiency syndrome; Carcinoma; Highly active antiretroviral therapy; Incidence.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology*
  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Antiretroviral Therapy, Highly Active*
  • Cohort Studies
  • Female
  • Humans
  • Lymphoma, AIDS-Related / epidemiology*
  • Lymphoma, Non-Hodgkin / epidemiology*
  • Male
  • Observational Studies as Topic
  • Sarcoma, Kaposi / epidemiology*
  • Uterine Cervical Neoplasms / epidemiology*

Supplementary concepts

  • AIDS-related Kaposi sarcoma