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. 2023 Jul 15;15(14):3640.
doi: 10.3390/cancers15143640.

Trends in Cancer Incidence in Different Antiretroviral Treatment-Eras amongst People with HIV

Lauren Greenberg  1 , Lene Ryom  1   2 , Elzbieta Bakowska  3 , Ferdinand Wit  4 , Heiner C Bucher  5 , Dominique L Braun  5 , Andrew Phillips  6 , Caroline Sabin  6 , Antonella d'Arminio Monforte  7 , Robert Zangerle  8 , Colette Smith  9 , Stéphane De Wit  10 , Fabrice Bonnet  11 , Christian Pradier  12 , Cristina Mussini  13 , Camilla Muccini  14 , Jörg J Vehreschild  15 , Jennifer Hoy  16   17 , Veronica Svedhem  18 , Jose M Miró  19   20 , Jan-Christian Wasmuth  21 , Peter Reiss  22 , Josep M Llibre  23 , Nikoloz Chkhartishvili  24 , Christoph Stephan  25 , Camilla I Hatleberg  1 , Bastian Neesgaard  1 , Lars Peters  1 , Nadine Jaschinski  1 , Nikos Dedes  26 , Elena Kuzovatova  27 , Marc Van Der Valk  4   28 , Marianna Menozzi  13 , Clara Lehmann  15 , Kathy Petoumenos  16   17 , Harmony Garges  29 , Jim Rooney  30 , Lital Young  31 , Jens D Lundgren  1 , Loveleen Bansi-Matharu  6 , Amanda Mocroft  1   6 , On Behalf Of The Respond And D A D Study Groups
Affiliations

Trends in Cancer Incidence in Different Antiretroviral Treatment-Eras amongst People with HIV

Lauren Greenberg et al. Cancers (Basel). .

Abstract

Despite cancer being a leading comorbidity amongst individuals with HIV, there are limited data assessing cancer trends across different antiretroviral therapy (ART)-eras. We calculated age-standardised cancer incidence rates (IRs) from 2006-2021 in two international cohort collaborations (D:A:D and RESPOND). Poisson regression was used to assess temporal trends, adjusted for potential confounders. Amongst 64,937 individuals (31% ART-naïve at baseline) and 490,376 total person-years of follow-up (PYFU), there were 3763 incident cancers (IR 7.7/1000 PYFU [95% CI 7.4, 7.9]): 950 AIDS-defining cancers (ADCs), 2813 non-ADCs, 1677 infection-related cancers, 1372 smoking-related cancers, and 719 BMI-related cancers (groups were not mutually exclusive). Age-standardised IRs for overall cancer remained fairly constant over time (8.22/1000 PYFU [7.52, 8.97] in 2006-2007, 7.54 [6.59, 8.59] in 2020-2021). The incidence of ADCs (3.23 [2.79, 3.72], 0.99 [0.67, 1.42]) and infection-related cancers (4.83 [4.2, 5.41], 2.43 [1.90, 3.05]) decreased over time, whilst the incidence of non-ADCs (4.99 [4.44, 5.58], 6.55 [5.67, 7.53]), smoking-related cancers (2.38 [2.01, 2.79], 3.25 [2.63-3.96]), and BMI-related cancers (1.07 [0.83, 1.37], 1.88 [1.42, 2.44]) increased. Trends were similar after adjusting for demographics, comorbidities, HIV-related factors, and ART use. These results highlight the need for better prevention strategies to reduce the incidence of NADCs, smoking-, and BMI-related cancers.

Keywords: AIDS defining cancer; HIV; body mass index; incidence; infection; non-AIDS defining cancer; smoking; trends.

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Conflict of interest statement

J.M.M. has received consulting honoraria and/or research grants from AbbVie, Angelini, Contrafect, Cubist, Genentech, Gilead Sciences, Jansen, Medtronic, MSD, Novartis, Pfizer, and ViiV Healthcare, outside the submitted work. C.L. has received honoraria for speaking at educational events or consulting from BioNTech, Pfizer, Astra Zeneca, MSD, Novartis, Gilead, Janssen and ViiV. J.R. is an employee and stockholder of Gilead Sciences. A.M. has received honoraria, travel support and lecture fees from ViiV and Gilead, and honoraria from Eiland and Bonnin, all outside the submitted work.

Figures

Figure 1
Figure 1
Participant flow for the analysis. * More than one reason could reply. Note, 9619 participants recruited into both D:A:D and RESPOND were only included once in the analysis dataset, with their data from D:A:D and RESPOND merged.
Figure 2
Figure 2
Age-standardised incidence rates and 95% confidence intervals over time for (a) all cancers; (b) ADCs and NADCs; (c) infection-related, smoking-related, and BMI-related cancers. Abbreviations: ADC—AIDS-defining cancer; NADC—non-AIDS-defining cancer; IR—incidence rate.
Figure 3
Figure 3
Change in incidence over time, after adjusting for potential confounders for (a) all cancers; (b) ADCs and NADCs; (c) infection-related, smoking-related, and BMI-related cancers. Abbreviations: ADC—AIDS-defining cancer; NADC—non-AIDS-defining cancer; IRR—incidence rate ratio. IRR calculated from a Poisson regression model adjusted for age, gender, ethnicity, CD4 count, CD4 nadir, prior cancer, and ART-experienced and viral suppression status, all fixed at baseline, and smoking status, body mass index, hepatitis C, hepatitis B, hypertension, diabetes, AIDS event, cardiovascular disease, end-stage liver disease, and end-stage renal disease, all time updated.
Figure 4
Figure 4
Change in the age-adjusted incidence of all cancers, by time period compared to 2006–2007, stratified by ART-experienced at baseline. IRR calculated from a Poisson regression model, adjusted for age and including an interaction term between the time period and ART-experienced at baseline.
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