Although the decline in cancer mortality rates with the advent of combination antiretroviral therapy (cART) in HIV-infected individuals can be mostly explained by a decrease in cancers incidence, we looked here if improved survival after cancer diagnosis could also contribute to this decline. Survival trends were analyzed for most frequent cancers in the HIV-infected population followed in the French Hospital Database on HIV: 979 and 2760 cases of visceral and non-visceral Kaposi's sarcoma (KS), 2339 and 461 cases of non-Hodgkin lymphoma (NHL) and Hodgkin's lymphoma (HL), 446 lung, 312 liver and 257 anal cancers. Five-year Kaplan-Meier survival rates were estimated for four periods: 1992-1996, 1997-2000, 2001-2004 and 2005-2009. Cox proportional hazard models were used to compare survival across the periods, after adjustment for confounding factors. For 2001-2004, survival was compared to the general population after standardization on age and sex. Between the pre-cART (1992-1996) and early-cART (1997-2000) periods, survival improved after KS, NHL, HL and anal cancer and remained stable after lung and liver cancers. During the cART era, 5-year survival improved after visceral and non-visceral KS, NHL, HL and liver cancer, being 83%, 92%, 65%, 87% and 19% in 2005-2009 respectively, and remained stable after lung and anal cancers, being 16% and 65% respectively. Compared with the general population, survival in HIV-infected individuals in 2001-2004 was poorer for hematological malignancies and similar for solid tumors. For hematological malignancies, survival continues to improve after 2004, suggesting that the gap between the HIV-infected and general populations will close in the future.
Auteur : Hleyhel M, Belot A, Bouvier AM, Tattevin P, Pacanowski J, Genet P, de Castro N, Berger JL, Dupont C, Lavole A, Pradier C, Salmon D, Simon A, Martinez V, Spano JP, Costagliola D, Grabar S
International journal of cancer, 2015, vol. 137, n°. 10, p. 2443-53