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Clin Infect Dis. 2017 Aug 15;65(4):636-643. doi: 10.1093/cid/cix392.

Cancer-Attributable Mortality Among People With Treated Human Immunodeficiency Virus Infection in North America.

Author information

1
National Cancer Institute, Bethesda.
2
Information Management Services, Inc., Rockville, Maryland.
3
University of Calgary, Alberta, Canada.
4
Yale School of Public Health, New Haven, Connecticut.
5
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
6
Kaiser Permanente Northern California, Oakland.
7
Centers for Disease Control and Prevention, Atlanta, Georgia.
8
University of Washington, Seattle.
9
University of Pennsylvania, Philadelphia.
10
Unversidad Central del Caribe, Bayamon, Puerto Rico.
11
Johns Hopkins School of Medicine, Baltimore, Maryland.
12
Stanford School of Medicine, California.
13
Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
14
Icahn School of Medicine at Mount Sinai, New York.
15
Vanderbilt School of Medicine, Nashville, Tennessee.

Abstract

Background:

Cancer remains an important cause of morbidity and mortality in people with human immunodeficiency virus (PWHIV) on effective antiretroviral therapy (ART). Estimates of cancer-attributable mortality can inform public health efforts.

Methods:

We evaluated 46956 PWHIV receiving ART in North American HIV cohorts (1995-2009). Using information on incident cancers and deaths, we calculated population-attributable fractions (PAFs), estimating the proportion of deaths due to cancer. Calculations were based on proportional hazards models adjusted for age, sex, race, HIV risk group, calendar year, cohort, CD4 count, and viral load.

Results:

There were 1997 incident cancers and 8956 deaths during 267145 person-years of follow-up, and 11.9% of decedents had a prior cancer. An estimated 9.8% of deaths were attributable to cancer (cancer-attributable mortality rate 327 per 100000 person-years). PAFs were 2.6% for AIDS-defining cancers (ADCs, including non-Hodgkin lymphoma, 2.0% of deaths) and 7.1% for non-AIDS-defining cancers (NADCs: lung cancer, 2.3%; liver cancer, 0.9%). PAFs for NADCs were higher in males and increased strongly with age, reaching 12.5% in PWHIV aged 55+ years. Mortality rates attributable to ADCs and NADCs were highest for PWHIV with CD4 counts <100 cells/mm3. PAFs for NADCs increased during 1995-2009, reaching 10.1% in 2006-2009.

Conclusions:

Approximately 10% of deaths in PWHIV prescribed ART during 1995-2009 were attributable to cancer, but this fraction increased over time. A large proportion of cancer-attributable deaths were associated with non-Hodgkin lymphoma, lung cancer, and liver cancer. Deaths due to NADCs will likely grow in importance as AIDS mortality declines and PWHIV age.

KEYWORDS:

AIDS; HIV; aging; cancer; mortality

PMID:
29017269
PMCID:
PMC5849088
DOI:
10.1093/cid/cix392
[Indexed for MEDLINE]
Free PMC Article

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