The impact of highly active antiretroviral therapy on the incidence and outcomes of AIDS-defining cancers in Southern Alberta

Objectives To determine the impact of highly active antiretroviral therapy (HAART) on the incidence and outcomes of Kaposi's sarcoma (KS), non-Hodgkin's lymphoma (NHL) and invasive cervical cancer/dysplasia in a well-defined geographical HIV-infected population between 1984 and 2005. Methods A clinic database search, chart review and verification with public health records were undertaken for all AIDS-defining cancers diagnosed in Southern Alberta before and after the introduction of HAART. Results A total of 2137 patients with 9265 person-years of HIV follow-up care were reviewed. One hundred and forty-three cases of KS, 64 cases of NHL and 11 cases of invasive cervical cancer/dysplasia were identified. KS and NHL together accounted for 15% of clinical presentations with an AIDS-defining illness that led to the HIV diagnosis. Following the introduction of HAART, the reduced number of severely immunocompromised patients was associated with 92 and 84% reductions in new diagnoses of KS and NHL, respectively, which were seen mainly in clinic patients declining or failing HAART. Crude reductions of 94 and 65% in mortality from KS and NHL, respectively, were also seen. The prevalences of KS, NHL and invasive cervical cancer/dysplasia have recently stabilized at 3, 1 and 5% of the population, respectively. Conclusions The introduction of HAART has dramatically reduced the incidence of KS and NHL and improved survival from these cancers for most patients in HIV care. However, patients still present with KS and NHL leading to their HIV diagnosis.