AIDS-defining neoplasm prevalence in a cohort of HIV-infected patients, before and after highly active antiretroviral therapy.

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 conducted in 171 HIV-infected adults who were followed in Puerto Rico from May 1992 through December 2005. Neoplasm prevalence 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 chi2, 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 neoplasms 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.