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Int J Cancer. 2018 Feb 1;142(3):524-533. doi: 10.1002/ijc.31081. Epub 2017 Oct 16.

Cancer survival in people with AIDS: A population-based study from São Paulo, Brazil.

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Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
Population-Based Cancer Registry of São Paulo, Department of Epidemiology, University of São Paulo, São Paulo, Brazil.
Municipal STD-AIDS Program, Secretaria Municipal de Saúde, São Paulo, Brazil.
A. C. Camargo Cancer Center, São Paulo, Brazil.
International Prevention Research Institute, Lyon, France.
Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy.
Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
Department of Statistics, University of Munich (LMU), Munich, Germany.


Cancer survival among people with AIDS (PWA) has been described in developed countries, but there is lack of data from developing countries. The aim of this study was to evaluate survival after cancer diagnosis in PWA and compare it with people without AIDS (non-PWA) in São Paulo, Brazil. A probabilistic record linkage was carried out between the databases of the Population-based Cancer Registry of São Paulo (PBCR-SP) and the AIDS registry of SP (SINAN) to identify PWA who developed cancer. For comparison, non-PWA were frequency matched from the PBCR-SP by cancer site/type, sex, age, and period. Hazard ratio (HR) stratified by matching variables was estimated using a Cox proportional hazards model. A total of 1,294 PWA (20 patients with two primary site tumors) were included in the site/type-specific analyses. AIDS-defining cancers (ADC) comprised 51.9% of cases assessed. The all-cancer 5-year overall survival in PWA was 49.4% versus 72.7% in non-PWA (HR = 2.64; 95%CI = 2.39-2.91). Survival was impaired in PWA for both ADC (HR = 2.93; 95%CI = 2.49-3.45) and non-ADC (HR = 2.51; 95%CI = 2.21-2.84), including bladder (HR = 8.11; 95% CI = 2.09-31.52), lung (HR = 2.93; 95%CI = 1.97-4.36) and anal cancer (HR = 2.53; 95%CI = 1.63-3.94). These disparities were seen mainly in the first year after cancer diagnosis. The overall survival was significantly lower in PWA in comparison with non-PWA in São Paulo, as seen in high-income countries. Efforts to enhance early diagnosis and ensure proper cancer treatment in PWA should be emphasized.


HIV/AIDS; cancer; epidemiology; medical record linkage; survival

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