HIV/AIDS • CID 2009:48 (1 March) • 633
H I V / A I D SM A J O R A R T I C L E
Changes in Cancer Mortality among HIV-Infected
Patients: The Mortalite ´ 2005 Survey
Fabrice Bonnet,1,2,3Christine Burty,4Charlotte Lewden,1,3Dominique Costagliola,5, 6Thierry May,4Vincent Bouteloup,1,3
Eric Rosenthal,9Eric Jougla,10Patrice Cacoub,7Dominique Salmon,8Genevie `ve Che ˆne,1,2,3and Philippe Morlat1,2,3; for
the Agence Nationale de Recherches sur le Sida et les He ´patites Virales EN19 Mortalite ´ Study Group and the
Mortavic Study Group
1Institut National de la Sante ´ et de la Recherche Me ´dicale (Inserm), U593,
2, Institut de Sante ´ Publique, d’Epide ´miologie et de De ´veloppement, Bordeaux,
2Centre Hospitalier Universitaire,
4Centre Hospitalier Universitaire Brabois, Vandouvre-le `s-Nancy,
7Centre Hospitalier Universitaire Pitie ´-Salpe ˆtrie `re, and
9Centre Hospitalier Universitaire L’Archet, Nice, and
3Universite ´ Victor Segalen Bordeaux
6Universite ´ Pierre-et-Marie-Curie,
8Centre Hospitalier Universitaire Cochin-
10Inserm, Ce ´piDc, Le Ve ´sinet, France
(See the editorial commentary by d’Arminio Monforte on pages 640–1)
The goal of the current study was to describe the distribution and characteristics of malignancy-
related deaths among human immunodeficiency virus (HIV)–infected patients with use of data obtained from a
national survey conducted in France in 2005 and to compare with results obtained from a similar survey conducted
The underlying cause of death was documented using a standardized questionnaire fulfilled in French
hospital wards and networks that were involved in the treatment of HIV-infected patients.
Among the 1042 deaths reported in 2005 (964 were reported in 2000), 344 were cancer related (34%),
which represented a significant increase from 2000 (29% of deaths were cancer related) (
cancer-related deaths were AIDS related and 210 were not AIDS related. Among the cancer-related causes of death,
the proportion of hepatitis-related cancers (6% in 2000 vs. 11% in 2005) and non–AIDS/hepatitis-related cancers
(38% in 2000 vs 50% in 2005) significantly increased from 2000 to 2005 (
compared with the proportion of cancer that was AIDS related and adjusting for age and sex. Among cases
involving AIDS, the proportion of non-Hodgkin lymphoma–associated deaths did not change statistically signif-
icantly between 2000 and 2005 (11% and 10% of deaths, respectively).
In this study, an increasing proportion of lethal non–AIDS-related cancers was demonstrated
from 2000 to 2005; meanwhile, the proportion of lethal AIDS-related cancers remained stable among HIV-infected
patients. Thus, cancer prophylaxis, early diagnosis, and improved management should be included in the routine
long-term follow-up of HIV-infected patients.
); 134 of theP p .02
and , respectively),P p .03P p .01
HIV-infected patients are at an increased risk of non-
Hodgkin lymphoma (NHL), Kaposi sarcoma, and cer-
vical cancer, all of which were considered to be AIDS-
related events in the 1993 revised classification system
for HIV infection . This increased risk seems to be
partly related to oncogenic virus coinfections (i.e., Ep-
stein-Barr virus, human herpes virus 8, human papil-
Received 3 July 2008; accepted 3 October 2008; electronically published 28
Reprints or correspondence: Dr. Fabrice Bonnet, Service de Me ´decine Interne
et MaladiesInfectieuses, Ho ˆpitalSaint-Andre ´,1rueJeanBurguet,33075Bordeaux,
Clinical Infectious Diseases2009;48:633–9
? 2009 by the Infectious Diseases Society of America. All rights reserved.
lomavirus, and hepatitis B virus [HBV] infection) and
to cellular immunodepression, as demonstrated by the
use of immunosuppressive drugs, particularly during
transplantation [2, 3]. The widespread use of combi-
nation antiretroviral therapies (cART) in industrialized
countries since the middle of the 1990s has been as-
sociated with a dramatic decrease in the incidence of
both mortality and AIDS-related events. However, the
incidences of NHL and cervical cancer decreased in a
lower proportion than did other opportunistic infec-
tions [4, 5]. Prolonged life expectancy was associated
with a diversification of morbidity and causes of death
to include cardiovascular events,hepaticcomplications,
bacterial infections and non–AIDS-related cancers [6–
12]. In a national survey conducted in France in 2000,
we demonstrated that 12% of deaths were attributable
by guest on December 21, 2015
HIV/AIDS • CID 2009:48 (1 March) • 639
anne, C. Chartier, C. Berlin,E.Andres,D.Christmann,Y.Hans-
mann, P. Fraisse (Strasbourg); O. Bletry, D. Zucman, C. Ma-
jerholc, M. Stern, L. Couderc (Suresnes); J. Petitou (Tarbes);
F. Truchetet, J. Pouaha (Thionville); P. Romand (Thonon Les
Bains); A. Lafeuillade, V. Lambry (Toulon); P. Bernard (Toulon
Naval); D. Adoue, M. Duffaut, B. Marchou, D. Garipuy, L.
Cuzin, B. Marchou, D. Garipuy, L. Cuzin, M. Uzan, J. Vinel,
S. Metivier, A. Didier, R. Rouquet (Toulouse); Y. Mouton, Y.
Yazdanpanah, F. Marysse, B. Guery, K. Faure (Tourcoing); J.
Besnier, P. Le Bret, P. Nau, H. Sigogneau (Tours); J. Bressieux,
E. Libbrecht, L. Rezzouk (Troyes); A. Collignon (Tulle);B.Pon-
ceau (Valence); X. Kyndt,A.Vermersch-Langlin(Valenciennes);
T. May, C. Burty, P. Lederlin (Vandoeuvre Les Nancy); Y. Poin-
signon (Vannes); C. Creusat (Verdun); C. Richard (Vernon);
C. Merle (Vesoul); A. Essayan (Vierzon); D. Vittecoq, C. Bolliot
(Villejuif); Quignard (Villenauxe-La-Grande); O. Patey, S. Del-
lion (Villeneuve St Georges); I. Chossat (Villeneuve/Lot).
based Group number 5.
Potential conflicts of interest.
ANRS, through a grant from the Scientific Sector-
All authors: no conflicts.
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