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

Sean F. Altekruse, Meredith S. Shiels, Sharada P. Modur, Stephanie R. Land, Kristina A. Crothers, Mari M. Kitahata, Jennifer E. Thorne, William C. Mathews, Diana M. Fernández-Santos, Angel M. Mayor, John M. Gill, Michael A. Horberg, John T. Brooks, Richard D. Moore, Michael J. Silverberg, Keri N. Althoff, Eric A. Engels

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)513-521
Number of pages9
Issue number4
StatePublished - Feb 20 2018


  • HIV
  • North America
  • attributable risk
  • cancer
  • smoking

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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