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

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

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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