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Malignancies among children and young people with HIV in Western and Eastern Europe and Thailand.

OBJECTIVES
Investigate trends over time and predictors of malignancies among children and young people with HIV.


DESIGN
Pooled data from 17 cohorts in 15 countries across Europe and Thailand.


METHODS
Individuals diagnosed with HIV and presenting to paediatric care <18 years of age were included. Time at risk began at birth for children with documented vertically-acquired HIV, and from first HIV-care visit for others. Children were followed until death, loss-to-follow-up, or last visit in paediatric or adult care (where data after transfer to adult care were available). Rates of reported malignancies were calculated overall and for AIDS-defining malignancies (ADM) and non-AIDS-defining malignancies (NADM) separately. Risk factors for any malignancy were explored using Poisson regression, and for mortality following a malignancy diagnosis using Cox regression.


RESULTS
Among 9,632 individuals included, 140 (1.5%) were ever diagnosed with a malignancy, of which 112 (80%) were ADM. Overall, the rate of any malignancy was 1.18 per 1,000 person-years; the rate of ADM decreased over time while the rate of NADM increased. Male sex, being from a European cohort, vertically-acquired HIV, and current severe immunosuppression, viral load >400 copies/mL, older age and, for those not on treatment, earlier calendar year, were risk factors for a malignancy diagnosis. 58 (41%) of individuals with a malignancy died, a median 2.4 months (IQR 0.6, 8.8) after malignancy diagnosis.


CONCLUSION
The rate of ADM has declined since widespread availability of combination ART, although of NADM there was a small increase. Mortality following a malignancy was high, warranting further investigation.