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. 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

Eric A Engels  1 , Elizabeth L Yanik  1 , Willian Wheeler  2 , M John Gill  3 , Meredith S Shiels  1 , Robert Dubrow  4 , Keri N Althoff  5 , Michael J Silverberg  6 , John T Brooks  7 , Mari M Kitahata  8 , James J Goedert  1 , Surbhi Grover  9 , Angel M Mayor  10 , Richard D Moore  11 , Lesley S Park  12 , Anita Rachlis  13 , Keith Sigel  14 , Timothy R Sterling  15 , Jennifer E Thorne  11 , Ruth M Pfeiffer  1 ; North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS; North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS
Collaborators, Affiliations

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

Eric A Engels et al. Clin Infect Dis. .

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.

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Figures

Figure 1.
Figure 1.
Cancer-attributable and noncancer mortality rates. The panels display estimates of mortality attributable to AIDS-defining cancer, non-AIDS–defining cancer, and the remaining noncancer mortality among human immunodeficiency virus–infected people in North America. The 3 rates are stacked to total the overall mortality rate. Results are shown stratified according to sex (panel A), age (panel B), most recent CD4 count (panel C), and calendar period (panel D). The vertical scale varies across the panels. Abbreviations: ADC, AIDS-defining cancer; NADC, non-AIDS–defining cancer.
See this image and copyright information in PMC

References

    1. Bhaskaran K, Hamouda O, Sannes M et al. ; CASCADE Collaboration Changes in the risk of death after HIV seroconversion compared with mortality in the general population. JAMA 2008; 300:51–9. - PubMed
    1. Smith CJ, Ryom L, Weber R et al. ; D:A:D Study Group Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet 2014; 384:241–8. - PubMed
    1. Samji H, Cescon A, Hogg RS et al. ; North American AIDS Cohort Collaboration on Research and Design of IeDEA Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One 2013; 8:e81355. - PMC - PubMed
    1. Hunt PW, Martin JN, Sinclair E et al. T cell activation is associated with lower CD4+ T cell gains in human immunodeficiency virus-infected patients with sustained viral suppression during antiretroviral therapy. J Infect Dis 2003; 187:1534–43. - PubMed
    1. French MA, King MS, Tschampa JM, da Silva BA, Landay AL. Serum immune activation markers are persistently increased in patients with HIV infection after 6 years of antiretroviral therapy despite suppression of viral replication and reconstitution of CD4+ T cells. J Infect Dis 2009; 200:1212–5. - PubMed

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