Cancer incidence and all-cause mortality in HIV-positive patients in Northeastern Algeria before and during the era of highly active antiretroviral therapy
Karima Chaabna1, Robert Newton2, Philippe Vanhems3, Maamar Laouar4, David Forman5, Zahira Boudiaf4, Isabelle Soerjomataram5
1 Section of Cancer Information, International Agency for Research on Cancer, Lyon; Section of Cancer Information, University of Lyon, University of Lyon, France
2 Section of Cancer Information, International Agency for Research on Cancer, Lyon, France; MRC/UVRI Research Unit on AIDS, Entebbe, Uganda; Department of Health Sciences, University of York, York, United Kingdom
3 Section of Cancer Information, University of Lyon, University of Lyon 1; Department of Hygiene, Epidemiology and Prevention, Edouard Herriot Hospital, Civil Hospital of Lyon; Laboratory of Epidemiology and Public Health, CNRS, UMR 5558, Lyon, France
4 Infectious Disease Service, Durban Hospital, University Teaching Hospital, 23000 Annaba, Algeria
5 Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
Section of Cancer Information, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon
Source of Support: None, Conflict of Interest: None
Aims: To assess cancer incidence and all-cause mortality trends in HIV-positive patients in Algeria before and during the highly active antiretroviral therapy (HAART) era.
Settings and Design: Cross-sectional study.
Subjects and Methods: We used hospital-based data of patients with HIV/AIDS between January 1988 and December 2010.
Statistical Analysis Used: Cancer incidence, standardized mortality ratios (SMRs), risk of death, and proportion of HIV-positive patients treated before and during the HAART era were calculated. The joinpoint model was used to assess the magnitude of changes in SMRs.
Results: In 1988–2010, 156 patients were diagnosed as HIV-positive. During pre-HAART era, Kaposi sarcoma (KS) incidence was 5%. After the introduction of HAART, KS incidence decreased to 2%. No other AIDS-related cancer was diagnosed during the study. One-third died (52/156), of which 83.6% died in the same year as or in the year after HIV diagnosis; median age at death (interquartile range) was 34.5 (11.8) years. Yearly risk of death declined from 100% in 1998 to 8% in 2010; percentage of patients treated with HAART increased from 13% in 1998 to >80% after 2002. Overall SMR decreased from 200.2 (95% confidence interval [95% CI], 123.2–325.2) before the HAART era to 91.4 (95% CI, 66.0–126.6) thereafter. From 2003, yearly SMRs decreased significantly by 66.1% (P < 0.05) until 2006 but not thereafter.
Conclusions: Since 1998, the proportion of HIV-positive patients treated with HAART increased, reaching 84% in 2010, all-cause mortality decreased, and cancer remained rare. However, almost all patients who died during the study seemed to be diagnosed at a late stage of the disease, emphasizing the need for earlier diagnosis of HIV in Algeria.