AIDS-DEFINING NEOPLASM PREVALENCE IN A COHORT OF HIV-INFECTED PATIENTS,
BEFORE AND AFTER HIGHLY ACTIVE ANTIRETROVIRAL THERAPY
Angel M. Mayor, MD; Marı ´a A. Go ´mez, PhD; Eddy Rı ´os-Olivares,
PhD; Robert F. Hunter-Mellado, MD
Introduction: Malignant disorders have been
linked to the HIV epidemic from its onset.
Implementation of highly active antiretroviral
therapy (HAART) has resulted in a dramatic
reduction in the HIV/AIDS morbidity and
mortality. The present study evaluates the
neoplasm prevalence before and after the
implementation of HAART.
Methods: A cross-sectional study was con-
ducted in 171 HIV-infected adults who were
followed in Puerto Rico from May 1992
through December 2005. Neoplasm preva-
lence was measured, and the difference in
AIDS- and non-AIDS-defining neoplasms was
analyzed before and after the HAART era.
Between-group differences were explored by
using x2, Fisher exact test, analysis of variance,
and student t test.
Results: Malignant neoplasms were detected
in 171 patients (4.8%). Of these, 51.5% were
AIDS-defining neoplasms, and 68% were
established before HAART. AIDS-defining neo-
plasms accounted for 62.4% of those detected
before the availability of HAART and 25.9% of
those detected after HAART. Except for
cervical carcinoma, the prevalence of AIDS-
defining neoplasms decreased after HAART.
Non-AIDS lymphomas and prostate neoplasms
were more frequent after HAART.
Discussion: Our study found a significant
reduction of Kaposi sarcoma and AIDS-related
lymphoma in the HAART era of the AIDS
epidemic. A higher prevalence of non-AIDS-
defining lymphomas, prostate carcinoma, and
cervical carcinoma was seen in the HAART era.
These findings suggest that factors other than
severe immunosuppression are involved in the
neoplasms’ pathogenesis. Preventive strategies
that include screening tests, vaccination, and
lifestyle modification should be routinely
applied in HIV-infected patients. (Ethn Dis.
HIV Neoplasm Differences after
Malignant disorders have been asso-
ciated with clinical AIDS since the onset
of the HIV epidemic. Kaposi sarcoma
and high-grade non-Hodgkin lympho-
ma (NHL) were included in the first list
of AIDS-defining conditions in 1987.1
Six years later, invasive cervical cancer
was included as an additional AIDS
neoplasms are considered an additional
manifestation of the disrupted immune
system. The introduction of highly
active antiretroviral therapy (HAART)
in 1996 increased the life expectancy
among persons infected with HIV in
large part because of an improvement in
the immune status of patients and a
lowering of the HIV viral load. In
Puerto Rico, HAART was routinely
given to patients as of 1998, with the
same combinations of protease inhibi-
tors, nucleoside reverse transcriptase
inhibitors, and nonnucleoside reverse
transcriptase inhibitors reported to be
highly effective in HIV/AIDS patients.
These combinations of drugs partially
restore defects in cell-mediated immu-
nity, suppress the HIV viral load, and
improve the patient’s immunologic and
clinical status.3,4As a consequence,
AIDS-defining illnesses, including Ka-
posi sarcoma and high-grade NHL,
declined considerably after the intro-
duction of these drugs.4–7The patho-
genesis of invasive cervical carcinoma
appears to be more related to papilloma
virus infection, and HAART will not
decrease its incidence.8Eltom et al
found a significant decline in the
AIDS-related NHL in the general US
population between 1996 and 1998,
which was mainly attributed to de-
creased immunologic suppression of
HIV/AIDS patients after the implemen-
tation of HAART.9On the other hand,
with the improvement in survival, other
co-morbid conditions have played a
greater role in the morbidity and
mortality of HIV-positive patients.
Non-AIDS-defining neoplasms are co-
morbid conditions that increase the
morbidity, change the therapeutic in-
dex, and worsen the mortality profile of
patients with HIV infection.5,10–14
The prevalence of cancer in men in
Puerto Rico for the year 2000 was 300
per 100,000; the highest prevalence was
seen in prostate cancer (100 per
100,000), followed by colorectal cancer
(40 per 100,000). The cancer preva-
lence in women was 250 per 100,000,
principally related to breast cancer (85
per 10,000) and followed by colorectal
cancer (30 per 100.000). The principal
causes of cancer deaths were prostate
cancer (30 per 100,000) and lung
cancer (20 per 100,000) in men and
breast cancer (18 per 100,000) and
colorectal cancer (11 per 100,000) in
women.15In this article, we measure
and evaluate the prevalence of malig-
nant disorders, including AIDS-related
and non-AIDS-related neoplasms in a
cohort of HIV-infected persons before
and after HAART came into widespread
use in Puerto Rico.
The sample was composed of 171
patients, selected from 3576 adult HIV-
From the Retrovirus Research Center,
MAG, RFH); Department of Microbiology
(ER), Universidad Central del Caribe, School
of Medicine, Bayamo ´n, Puerto Rico.
Address correspondence and reprint
requests to: Angel M. Mayor, MD, MS;
Retrovirus Research Center; Universidad
Central del Caribe; School of Medicine;
Call Box 60-327; Bayamo ´n, Puerto Rico
00960-6032; 787-787-8722; 787-787-8733
Ethnicity & Disease, Volume 18, Spring 2008
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HIV/AIDS NEOPLASM BEFORE AND AFTER HAART - Mayor et al
Ethnicity & Disease, Volume 18, Spring 2008