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Cancer Rates After Year 2000 Significantly Decrease in Children With Perinatal HIV Infection: A Study by the Italian Register for HIV Infection in Children

Elena Chiappini, Luisa Galli, Pier-Angelo Tovo, Clara Gabiano, Catiuscia Lisi, Carlo Giaquinto, Osvalda Rampon, Guido Castelli Gattinara, Giulio De Marco, Patrizia Osimani, Mariano Manzionna, Angela Miniaci, Carlo Pintor, Raffaella Rosso, Susanna Esposito, Alessandra Viganò, Icilio Dodi, Anna Maccabruni, Carlo Fundarò, Maurizio de Martino

From the Departments of Pediatrics and Statistics, University of Florence, Florence; Department of Pediatrics, University of Turin, Turin; Department of Pediatrics, University of Padua, Padua; Bambino Gesù Children's Hospital; A. Gemelli Hospital, Rome; Department of Pediatrics, Federico II University, Naples; Salesi Children's Hospital, Ancona; Biomedic Department, University of Bari, Bari; Pediatric Clinic III, University of Bologna, Bologna; Pediatric Clinic, University of Cagliari, Cagliari; Infectious Disease Unit, University of Genoa and S. Martino University Hospital, Genoa; Institute of Pediatrics, University of Milan, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena; Pediatric Clinic, Sacco Hospital, University of Milan, Milan; Pediatric Infectious Disease Unit, Parma; and Infectious Disease Department, University of Pavia, Pavia, Italy

Address reprint requests to Maurizio de Martino, MD, Department of Pediatrics, University of Florence, Via Luca Giordano, 13, I-50132 Florence, Italy; e-mail: maurizio.demartino{at}unifi.it

Purpose To evaluate the impact of highly active antiretroviral therapy (HAART) on cancer incidence in HIV-infected children throughout a 20-year period.

Patients and Methods An observational population study was conducted on 1,190 perinatally HIV-infected children enrolled onto the Italian Register for HIV Infection in Children from 1985 to 2004 and never lost to follow-up (total observation time, 10,037.66 years). Cancer rates were calculated in the pre-HAART (1985 to 1995), early HAART (1996 to 1999), and late HAART (2000 to 2004) periods and compared using Poisson regression adjusted for age. The proportion of HAART-treated children increased from 4.1% in 1996 to 60.4% in 1999 and to 81.5% in 2004. In the same time frame, the proportion of children receiving HAART for at least 2 years increased from 3.1% to 77.0%.

Results Overall, 35 cancers occurred. Cancer rates were 4.49 (95% CI, 2.37 to 6.64), 4.09 (95% CI, 1.68 to 6.50), and 0.76 (95% CI, 0.00 to 1.80) per 1,000 children per year in 1985 to 1995, 1996 to 1999, and 2000 to 2004, respectively. Notably, there was no significant difference comparing the periods from 1985 to 1995 and 1996 to 1999 (P = .081). By contrast, cancer rates were significantly lower in the period from 2000 to 2004 than in 1996 to 1999 (P < .0001). Results were confirmed by separately analyzing data from children observed from birth (P = .418 for 1985 to 1995 v 1996 to 1999; P = .001 for 1996 to 1999 v 2000 to 2004).

Conclusion Dramatically reduced cancer rates were observed only in the late HAART period in parallel to the increasing proportion of children receiving HAART therapy.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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