Sobrevida após o diagnóstico de câncer em pacientes vivendo com HIV/AIDS: um estudo de coorte do Rio de Janeiro

Abstract

Introduction of highly active antiretroviral therapy in the mid-1990s dramatically improved survival among patients living with HIV/AIDS, but cancer remains an important cause of death. Few studies have evaluated the impact of AIDS-defining and non-AIDS-defining cancers on patients’ survival in Brazil. The objective of this study was to evaluate the survival of patients living with HIV/AIDS after a cancer diagnosis in the last 35 years in a cohort from Rio de Janeiro. We performed a retrospective analysis of data from patients followed up at an HIV/AIDS outpatient clinic, diagnosed with cancer between January 1985 and December 2020. Statistical analysis to assess the impact on survival exerted by different variables was performed using Kaplan-Meier curves and multivariate analysis by Cox model. We inlcuded total of 197 patients in this study, of which 98 (49.75%) died, with an overall mortality in the period of 49.74%, and 16 patients (8.12%) were lost to follow-up. Most patients were men (N = 179; 79.70%), the median age was 40 years, and the median survival time was 5.56 years. The most diagnosed cancers were Kaposi's sarcoma (N = 82; 41.62%), non-Hodgkin's lymphomas (N = 44; 22.34%) and Hodgkin's lymphomas (N = 10; 5.08%). The risk of death was higher for patients diagnosed with Kaposi's sarcoma (p = 0.01) and the Kaplan-Meier curves revealed a statistical difference for patients with a period between diagnosis of HIV and cancer of up to one year (p = 0.0029) and for those not receiving antiretroviral treatment before cancer diagnosis (p = 0.00055). The survival of our patients was mainly impacted by AIDS-defining cancers during the study period, especially Kaposi's sarcoma. The lack of data is a major problem in Brazil and would not allow a comparison at national level, but late diagnosis of HIV still seems to be reality for a large part of the Brazilian population and probably contributed to the results found in our study.