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. 2014 Mar 27;28(6):881-90.
doi: 10.1097/QAD.0000000000000163.

Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States

Hilary A Robbins  1 , Meredith S Shiels, Ruth M Pfeiffer, Eric A Engels
Affiliations

Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States

Hilary A Robbins et al. AIDS. .

Abstract

Objective: HIV-infected people have elevated risk for some cancers. Changing incidence of these cancers over time may reflect changes in three factors: HIV population demographic structure (e.g. age distribution), general population (background) cancer rates, and HIV-associated relative risks. We assessed the contributions of these factors to time trends for 10 cancers during 1996-2010.

Design: Population-based registry linkage study.

Methods: We applied Poisson models to data from the U.S. HIV/AIDS Cancer Match Study to estimate annual percentage changes (APCs) in incidence rates of AIDS-defining cancers [ADCs: Kaposi sarcoma, non-Hodgkin lymphoma (NHL), and cervical cancer] and seven non-AIDS-defining cancers (NADCs). We evaluated HIV-infected cancer trends with and without adjustment for demographics, trends in background rates, and trends in standardized incidence ratios (SIRs, to capture relative risk).

Results: Cancer rates among HIV-infected people rose over time for anal (APC 3.8%), liver (8.5%), and prostate (9.8%) cancers, but declined for Kaposi sarcoma (1996-2000: -29.3%; 2000-2010: -7.8%), NHL (1996-2003: -15.7%; 2003-2010: -5.5%), cervical cancer (-11.1%), Hodgkin lymphoma (-4.0%), and lung cancer (-2.8%). Breast and colorectal cancer incidence did not change over time. Based on comparison to adjusted models, changing demographics contributed to trends for Kaposi sarcoma and breast, colorectal, liver, lung, and prostate cancers (all P < 0.01). Trends in background rates were notable for liver (APC 5.6%) and lung (-3.2%) cancers. SIRs declined for ADCs, Hodgkin lymphoma (APC -3.2%), and lung cancer (-4.4%).

Conclusion: Demographic shifts influenced several cancer trends among HIV-infected individuals. Falling relative risks largely explained ADC declines, while background incidence contributed to some NADC trends.

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Conflict of interest statement

All authors declare no conflict of interest.

Figures

Figure 1
Figure 1. Incidence rates of AIDS-defining cancers in the U.S. HIV/AIDS Cancer Match Study, 1996–2010
Solid and dashed lines depict crude and standardized incidence in the HIV population, respectively, and lines with triangle markers depict standardized incidence in the general population. Vertical dashed lines are displayed for years in which a Joinpoint was identified. In panel A, we do not show standardized incidence in the general population, because the majority of Kaposi sarcoma cases are in HIV-infected people (16). Rates are displayed on a logarithmic scale; note differing y-axis scales for individual panels. Panels are annotated with the relevant data substantiating the epidemiologic contributions to cancer trends listed in Table 3. Abbreviations in annotations: APC, annual percent change; adj., adjusted; SIR, standardized incidence ratio; Gen.Pop., general population; comparison p, p-value for comparison between crude and adjusted HIV-infected trends.
Figure 2
Figure 2. Incidence rates of non-AIDS-defining cancers in the U.S. HIV/AIDS Cancer Match Study, 1996–2010
Solid and dashed lines depict crude and standardized incidence in the HIV population, respectively, and lines with triangle markers depict standardized incidence in the general population. Rates are displayed on a logarithmic scale; note differing y-axis scales for individual panels. Panels are annotated with the relevant data substantiating the epidemiologic contributions to cancer trends listed in Table 3. Abbreviations in annotations: APC, annual percent change; adj., adjusted; SIR, standardized incidence ratio; Gen.Pop., general population; comparison p, p-value for comparison between crude and adjusted HIV-infected trends.
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Comment in

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