Malignancies in HIV-infected patients - incidence and predictors of survival in a Romanian health care facility

Objective. To estimate incidence and survival in HIV-infected patients with malignancies. Methods. Retrospective study on patients with malignancies from a single HIV center between January 2007 and December 2014. Malignancies were classified in ADMs (AIDS-defining malignancies) and nADMs (non AIDS-defining malignancies) (CDC 1993). Statistical analysis was performed using STATA 20. Results. From 12,298 person-years (PY), 91 (3.2%) were diagnosed with malignancies (incidence 7.39/1000 PY): 57 (62.6%) ADMs and 34 (37.3%) nADMs. Median age (IQR) at HIV and cancer diagnosis was 32 years (1-70) respectively 34 years (34-74). The most common ADMs were: non-Hodgkin's lymphoma NHL 31 (54.3%), Kaposi Sarcoma KS 17 (29.8%) and cervical cancer 9 (15.7 %). Among nADM, Hodgkin's lymphoma (HL) was the most frequent: 10 cases (29.4%). Patients with ADM had significantly lower nadir and median CD4 cell count/mm(3) at cancer diagnosis compared to NADM (47 vs. 91 and 123 vs. 306 (p<0.01) and higher median HIV viral loads log10 (5.3 vs. 3.4). Kaplan-Meier survival estimates showed that patients with NHL had significantly worse survival than those with HL or KS (p= 0.03). All-cause annual death rate was 12.8% and significantly decreased to 11.1% and 7.6% for patients on cART and a combination of cART and chemotherapy respectively (p< 0.01). Conclusion. Incidence of malignancies slightly increased over the years. ADM were more frequent than nADM. The mortality rate was high, but chemotherapy and cART improved survival rates in both groups.