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 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 Althoff, Eric A. Engels

Research output: Contribution to journalArticlepeer-review


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


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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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