Cancer-Attributable Mortality among People with Treated Human Immunodeficiency Virus Infection in North America

North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS

Research output: Contribution to journalArticle

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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/mm 3. 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.

Original languageEnglish (US)
Pages (from-to)636-643
Number of pages8
JournalClinical Infectious Diseases
Volume65
Issue number4
DOIs
StatePublished - Aug 15 2017

Fingerprint

Virus Diseases
North America
HIV
Mortality
Neoplasms
Liver Neoplasms
Lung Neoplasms
CD4 Lymphocyte Count
Non-Hodgkin's Lymphoma
Population
Acquired Immunodeficiency Syndrome
Viral Load
Proportional Hazards Models
Therapeutics
Public Health
N-acetoacetyl-N-deacetylcolchicine
Morbidity

Keywords

  • aging
  • AIDS
  • cancer
  • HIV
  • mortality

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS (2017). Cancer-Attributable Mortality among People with Treated Human Immunodeficiency Virus Infection in North America. Clinical Infectious Diseases, 65(4), 636-643. https://doi.org/10.1093/cid/cix392

Cancer-Attributable Mortality among People with Treated Human Immunodeficiency Virus Infection in North America. / North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS.

In: Clinical Infectious Diseases, Vol. 65, No. 4, 15.08.2017, p. 636-643.

Research output: Contribution to journalArticle

North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS 2017, 'Cancer-Attributable Mortality among People with Treated Human Immunodeficiency Virus Infection in North America', Clinical Infectious Diseases, vol. 65, no. 4, pp. 636-643. https://doi.org/10.1093/cid/cix392
North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS. Cancer-Attributable Mortality among People with Treated Human Immunodeficiency Virus Infection in North America. Clinical Infectious Diseases. 2017 Aug 15;65(4):636-643. https://doi.org/10.1093/cid/cix392
North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS. / Cancer-Attributable Mortality among People with Treated Human Immunodeficiency Virus Infection in North America. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 4. pp. 636-643.
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title = "Cancer-Attributable Mortality among People with Treated Human Immunodeficiency Virus Infection in North America",
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/mm 3. 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 = "aging, AIDS, cancer, HIV, mortality",
author = "{North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS} and Engels, {Eric A.} and Yanik, {Elizabeth L.} and Willian Wheeler and Gill, {M. John} and Shiels, {Meredith S.} and Robert Dubrow and Althoff, {Keri N.} and Silverberg, {Michael J.} and Brooks, {John T.} and Kitahata, {Mari M.} and Goedert, {James J.} and Surbhi Grover and Mayor, {Angel M.} and Moore, {Richard D.} and Park, {Lesley S.} and Anita Rachlis and Keith Sigel and Sterling, {Timothy R.} and Thorne, {Jennifer E.} and Pfeiffer, {Ruth M.} and Benson, {Constance A.} and Bosch, {Ronald J.} and Kirk, {Gregory D.} and Stephen Boswell and Mayer, {Kenneth H.} and Chris Grasso and Hogg, {Robert S.} and Harrigan, {P. Richard} and Montaner, {Julio S.G.} and Benita Yip and Julia Zhu and Kate Salters and Karyn Gabler and Kate Buchacz and Gebo, {Kelly A.} and Carey, {John T.} and Benigno Rodriguez and Horberg, {Michael A.} and Charles Rabkin and Jacobson, {Lisa P.} and Gypsyamber D'Souza and Klein, {Marina B.} and Rourke, {Sean B.} and Rachlis, {Anita R.} and Jason Globerman and Madison Kopansky-Giles and Hunter-Mellado, {Robert F.} and Deeks, {Steven G.} and Martin, {Jeffrey N.} and Kathryn Anastos",
year = "2017",
month = "8",
day = "15",
doi = "10.1093/cid/cix392",
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pages = "636--643",
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TY - JOUR

T1 - Cancer-Attributable Mortality among People with Treated Human Immunodeficiency Virus Infection in North America

AU - North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS

AU - Engels, Eric A.

AU - Yanik, Elizabeth L.

AU - Wheeler, Willian

AU - Gill, M. John

AU - Shiels, Meredith S.

AU - Dubrow, Robert

AU - Althoff, Keri N.

AU - Silverberg, Michael J.

AU - Brooks, John T.

AU - Kitahata, Mari M.

AU - Goedert, James J.

AU - Grover, Surbhi

AU - Mayor, Angel M.

AU - Moore, Richard D.

AU - Park, Lesley S.

AU - Rachlis, Anita

AU - Sigel, Keith

AU - Sterling, Timothy R.

AU - Thorne, Jennifer E.

AU - Pfeiffer, Ruth M.

AU - Benson, Constance A.

AU - Bosch, Ronald J.

AU - Kirk, Gregory D.

AU - Boswell, Stephen

AU - Mayer, Kenneth H.

AU - Grasso, Chris

AU - Hogg, Robert S.

AU - Harrigan, P. Richard

AU - Montaner, Julio S.G.

AU - Yip, Benita

AU - Zhu, Julia

AU - Salters, Kate

AU - Gabler, Karyn

AU - Buchacz, Kate

AU - Gebo, Kelly A.

AU - Carey, John T.

AU - Rodriguez, Benigno

AU - Horberg, Michael A.

AU - Rabkin, Charles

AU - Jacobson, Lisa P.

AU - D'Souza, Gypsyamber

AU - Klein, Marina B.

AU - Rourke, Sean B.

AU - Rachlis, Anita R.

AU - Globerman, Jason

AU - Kopansky-Giles, Madison

AU - Hunter-Mellado, Robert F.

AU - Deeks, Steven G.

AU - Martin, Jeffrey N.

AU - Anastos, Kathryn

PY - 2017/8/15

Y1 - 2017/8/15

N2 - 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/mm 3. 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.

AB - 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/mm 3. 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.

KW - aging

KW - AIDS

KW - cancer

KW - HIV

KW - mortality

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UR - http://www.scopus.com/inward/citedby.url?scp=85026875329&partnerID=8YFLogxK

U2 - 10.1093/cid/cix392

DO - 10.1093/cid/cix392

M3 - Article

C2 - 29017269

AN - SCOPUS:85026875329

VL - 65

SP - 636

EP - 643

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

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