Survival after cancer in Italian persons with AIDS, 1986-2005: A population-based estimation.

BACKGROUND:
Cancer survival in persons with AIDS (PWA) after introduction of antiretroviral therapies remains poorly characterized. The aim is to provide population-based estimates of cancer survival, overall and for the most important cancer types in PWA, and a comparison with persons without AIDS (non-PWA) affected by the same cancers.
METHODS:
PWA with cancer at AIDS or thereafter were individually matched with non-PWA by type of cancer, sex, age, year of diagnosis, area of living and, for lymphomas, histological subtype. Five-year observed survival and hazard ratios (HRs) of death in PWA versus non-PWA with 95% confidence intervals (CI) were estimated.
RESULTS:
We included 2262 Italian PWA and 4602 non-PWA with cancer diagnosed during 1986-2005. Between 1986-1995 and 1996-2005, 5-year survival for all cancers in PWA improved from 12% to 41% and the corresponding HR versus non-PWA decreased from 5.1 (95% CI: 4.3-6.1) to 2.9 (95% CI: 2.6-3.3). In 1996-2005, HRs were 2.0 (95% CI: 1.4-2.9) for Kaposi sarcoma; 3.4 (2.9-4.1) for non-Hodgkin lymphoma; 2.4 (1.4-4.0) for cervical cancer. HRs were 2.5 (2.1-3.1) for all non-AIDS-defining cancers; 5.9 (3.1-11.2) for Hodgkin lymphoma; and 7.3 (2.8-19.2) for non-melanoma skin. A ≤3-fold survival difference was found for cancer of the stomach, liver, anus, lung, brain and the most aggressive lymphoma subtypes.
CONCLUSION(S):
The persisting, although narrowing, gap in cancer survival between PWA and non-PWA indicates the necessity of enhancing therapeutic approaches, so that PWA will be provided the same chances of survival observed in the general population, and improving cancer prevention and screening.