@article{141a4c611ccb4f53aa165d3bf1c73df2,
title = "Cancer burden attributable to cigarette smoking among HIV-infected people in North America",
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.",
keywords = "HIV, North America, attributable risk, cancer, smoking",
author = "Altekruse, {Sean F.} and Shiels, {Meredith S.} and Modur, {Sharada P.} and Land, {Stephanie R.} and Crothers, {Kristina A.} and Kitahata, {Mari M.} and Thorne, {Jennifer E.} and Mathews, {William C.} and Fern{\'a}ndez-Santos, {Diana M.} and Mayor, {Angel M.} and Gill, {John M.} and Horberg, {Michael A.} and Brooks, {John T.} and Moore, {Richard D.} and Silverberg, {Michael J.} and Althoff, {Keri N.} and Engels, {Eric A.}",
note = "Funding Information: Contracts CDC-200-2006-18797 and CDC-200-2015-63931 from the Centers for Disease Control and Prevention, USA; contract 90047713 from the Agency for Healthcare Research and Quality, USA; contract 90051652 from the Health Resources and Services Administration, USA; grants CBR-86906, CBR-94036, HCP-97105, and TGF-96118 from the Canadian Institutes of Health Research, Canada; Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Funding Information: The current work was supported by National Institutes of Health grants U01AI069918, F31DA037788, G12MD-007583, K01AI093197, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01R-R000052, N01CP01004, N02CP055504, N02CP-91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI-110527, P30MH62246, R01AA016893, R01CA-165937, R01DA011602, R01DA012568, R01 AG0-53100, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI-034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI-037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI-069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY00-8067, U24AA020794,U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM-1AI035043, Z01CP010214, Z01CP010176, and NIH grant supplement to U01AI069918, with American Recovery and Reinvestment Act of 2009 funds. Additional support was provided by the National Cancer Institute, National Institute for Mental Health, and National Institute on Drug Abuse. M.S.S. and E.A.E. were supported by the Intramural Research Program, National Cancer Institute. S.F.A. and S.R.L. were supported by the Division of Cancer Control and Population Sciences, National Cancer Institute. Funding Information: Grant support was received from the National Institutes of Health, U.S. Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, Health Resources and Services Administration, USA; Canadian Institutes of Health Research, Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Publisher Copyright: Copyright {\textcopyright} 2018 Wolters Kluwer Health, Inc. All rights reserved.",
year = "2018",
month = feb,
day = "20",
doi = "10.1097/QAD.0000000000001721",
language = "English (US)",
volume = "32",
pages = "513--521",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "4",
}