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Observational Study
. 2018 Feb 20;32(4):513-521.
doi: 10.1097/QAD.0000000000001721.

Cancer burden attributable to cigarette smoking among HIV-infected people in North America

Sean F Altekruse  1 , Meredith S Shiels  2 , Sharada P Modur  3 , Stephanie R Land  1 , Kristina A Crothers  4 , Mari M Kitahata  4 , Jennifer E Thorne  5 , William C Mathews  6 , Diana M Fernández-Santos  7 , Angel M Mayor  7 , John M Gill  8 , Michael A Horberg  9 , John T Brooks  10 , Richard D Moore  5 , Michael J Silverberg  11 , Keri N Althoff  3 , Eric A Engels  2
Affiliations
Observational Study

Cancer burden attributable to cigarette smoking among HIV-infected people in North America

Sean F Altekruse et al. AIDS. .

Abstract

Objective: With combination-antiretroviral therapy, HIV-infected individuals live longer with an elevated burden of cancer. Given the high prevalence of smoking among HIV-infected populations, we examined the risk of incident cancers attributable to ever smoking cigarettes.

Design: Observational cohort of HIV-infected participants with 270 136 person-years of follow-up in the North American AIDS Cohort Collaboration on Research and Design consortium. Among 52 441 participants, 2306 were diagnosed with cancer during 2000-2015.

Main outcome measures: Estimated hazard ratios and population-attributable fractions (PAF) associated with ever cigarette smoking for all cancers combined, smoking-related cancers, and cancers that were not attributed to smoking.

Results: People with cancer were more frequently ever smokers (79%) compared with people without cancer (73%). Adjusting for demographic and clinical factors, cigarette smoking was associated with increased risk of cancer overall [hazard ratios = 1.33 (95% confidence interval: 1.18-1.49)]; smoking-related cancers [hazard ratios = 2.31 (1.80-2.98)]; lung cancer [hazard ratios = 17.80 (5.60-56.63)]; but not nonsmoking-related cancers [hazard ratios = 1.12 (0.98-1.28)]. Adjusted PAFs associated with ever cigarette smoking were as follows: all cancers combined, PAF = 19% (95% confidence interval: 13-25%); smoking-related cancers, PAF = 50% (39-59%); lung cancer, PAF = 94% (82-98%); and nonsmoking-related cancers, PAF = 9% (1-16%).

Conclusion: Among HIV-infected persons, approximately one-fifth of all incident cancer, including half of smoking-related cancer, and 94% of lung cancer diagnoses could potentially be prevented by eliminating cigarette smoking. Cigarette smoking could contribute to some cancers that were classified as nonsmoking-related cancers in this report. Enhanced smoking cessation efforts targeted to HIV-infected individuals are needed.

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Conflict of interest statement

Conflicts of Interest and Source of Funding:

Dr. Thorne has received consultant fees from Gilead. Dr. Silverberg has received research grants in the past from Pfizer and Merck. Dr. Altoff has served on medical and scientific advisory boards for Gilead Sciences, Inc., and TrioHealth. Dr. Moore has received honoraria as a consultant to Medscape. Dr. Gill has received honoraria from attendance as an Ad Hoc member of the Canadian HIV Advisory Board of Merck, ViiVHealth, and Gilead. For the remaining authors, no conflicts of interest or sources of funding were declared.

References

    1. Shiels MS, Pfeiffer RM, Gail MH, et al. Cancer burden in the HIV-infected population in the United States. J Natl Cancer Inst. 2011;103:753–762. - PMC - PubMed
    1. Hammer SM, Squires KE, Hughes MD, Grimes JM, Demeter LM, Currier JS, et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. N Engl J Med. 1997;337:725–733. - PubMed
    1. Detels R, Muñoz A, McFarlane G, Kingsley LA, Margolick JB, Giorgi J, et al. Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. JAMA. 1998;280:1497–1503. - PubMed
    1. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525–1533. - PMC - PubMed
    1. Ehren K, Hertenstein C, Kümmerle T, Vehreschild JJ, Fischer J, Gillor D, et al. Causes of death in HIV-infected patients from the Cologne-Bonn cohort. Infection. 2014;42:135–140. - PubMed

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