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People with AIDS have heightened cancer risk from immunosuppression. HAART has been available since 1996 and has reduced AIDS-related mortality, but there are few large-scale studies on cancer trends.AIDS and cancer registries in 11 US regions (1980–2002) were used to identify cancers in 375 933 people with AIDS. Cancer risk relative to the general population was measured using the standardized incidence ratio (SIR), focusing on the 2 years after AIDS onset for those with AIDS in 1990–1995 and 1996–2002 (HAART era). Time trends were assessed with Poisson regression.Between 1990–1995 and 1996–2002, risk declined for the two major AIDS-defining cancers: Kaposi sarcoma [(KS) n = 5131; SIR, 22 100 and 3640, respectively; P < 0.0001] and non-Hodgkin lymphoma [(NHL) n = 3412; SIR, 53.2 and 22.6, respectively; P < 0.0001]. Declines began in the 1980s, but risk fell sharply in 1996 and was stable thereafter. Risk of cervical cancer did not change (n = 64; SIR, 4.2 and 5.3, respectively; P = 0.33). Among non-AIDS malignancies, lung cancer was most common, but risk declined between 1990–1995 and 1996–2002 (n = 344; SIR, 3.3 and 2.6, respectively; P = 0.02). Risk of Hodgkin lymphoma increased substantially over the 1990–2002 period (n = 149; SIR, 8.1 and 13.6, respectively; P = 0.003).Dramatic declines in KS and NHL were temporally related to improving therapies, especially introduction of HAART, but those with AIDS remain at marked risk. Among non-AIDS-related cancers, a recent increase in Hodgkin lymphoma was observed.