Amsterdam 2015
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| Abstract #2123 - Comorbidity - double jeopardy | ||||
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Session: 23.5: Comorbidity - double jeopardy (Parallel) on Wednesday @ 16.30-18.00 in 202 Chaired by Margalit Lorber, Simon Rackstraw Authors: Presenting Author: Dr Zohar Mor - Ministry of Health, Israel |
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| Additional Authors: | ||||
| Aim: Antiretroviral-therapy (ART), which has become available in Israel in 1996, improved the survival of people living with HIV/AIDS (PLWHA) and decreased HIV-related morbidities. However, along with the longer survival of PLWHA, they have had prolonged exposure to cancer risk factors, such as environmental or infectious agents, and also to aging and side effects of the ART. This study aims to assess cancer incidence of all adult-PLWHA in Israel by transmission routes before and after 1996. | ||||
| Method / Issue: This cohort-study was based on cross-matching the national HIV/AIDS and cancer registries of all HIV/AIDS to identify PLWHA who were also diagnosed with cancer from 1981 to 2010. All PLWHA were also cross-matched with the national civil census to define the date of death or leaving Israel. All PLWHA was followed-up from date of reporting until cancer diagnosis, death, leaving Israel or 2010, whichever occurred first. Cancer-incidence was adjusted for age, and compared with the national incidence. | ||||
| Results / Comments: Of all 5,154 PLWHA Israeli citizens who were followed-up for 36,296 person-years, 362 (7.0%) developed cancer (997.4 cases per 100,000 person-years). Higher hazard-ratios to develop cancer were demonstrated among older PLWHA, Jews, and intra-venous drug-users. Cancer-incidence among PLWHA was higher in the pre-ART period than after 1997 (1,232.0 and 846.7 cases per 100,000 person-years, respectively). The incidence of AIDS-defining cancers was higher than non-AIDS defining malignancies and higher in the pre-ART than the post-ART period (777.0 and 467.2 cases per 100,000 person-years, respectively), while incidence of non-AIDS defining cancers showed the opposite trend (376.5 and 455.0 cases per 100,000 person-years, respectively). The incidence of AIDS and non-AIDS defining cancers declined between the pre-ART and the post-ART period by 2.0 to 3.4 times. PLWHA had higher rate of malignancies than the general population. Cox proportional regression models adjusted for age and time of follow-up showed that PLWHA who acquired the infection by homosexual transmission were at the greater risk to develop cancers of all causes before 1996, while those who were infected by contaminated blood products were at highest risk after 1997. Of all homosexuals who developed malignancies, higher rate developed AIDS-defining cancers before ART were introduced than after marketing, while non-AIDS related cancers were more prevalent in the post than the pre-ART. | ||||
| Discussion: Both AIDS- and non-AIDS related cancers decreased after the introduction of ART and their diagnoses were strongly associated with age. Yet, cancers remain an important prognostic factor in PLWHA and initiation of age-related cancer screening and ART early in the course of HIV-infection can sustain high levels of immune function and reduce malignancies. Additionally, programs targeting smoking cessation and viruses' vaccination should be promoted in the population of PLWHA. | ||||
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