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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 513-521 |
| Number of pages | 9 |
| Journal | AIDS |
| Volume | 32 |
| Issue number | 4 |
| DOIs | |
| State | Published - Feb 20 2018 |
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Keywords
- attributable risk
- cancer
- HIV
- North America
- smoking
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
- Infectious Diseases
Cite this
Cancer burden attributable to cigarette smoking among HIV-infected people in North America. / Altekruse, Sean F.; Shiels, Meredith S.; Modur, Sharada P; Land, Stephanie R.; Crothers, Kristina A.; Kitahata, Mari M.; Thorne, Jennifer; Mathews, William C.; Fernández-Santos, Diana M.; Mayor, Angel M.; Gill, John M.; Horberg, Michael A.; Brooks, John T.; Moore, Richard D; Silverberg, Michael J.; Althoff, Keri; Engels, Eric A.
In: AIDS, Vol. 32, No. 4, 20.02.2018, p. 513-521.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Cancer burden attributable to cigarette smoking among HIV-infected people in North America
AU - Altekruse, Sean F.
AU - Shiels, Meredith S.
AU - Modur, Sharada P
AU - Land, Stephanie R.
AU - Crothers, Kristina A.
AU - Kitahata, Mari M.
AU - Thorne, Jennifer
AU - Mathews, William C.
AU - Fernández-Santos, Diana M.
AU - Mayor, Angel M.
AU - Gill, John M.
AU - Horberg, Michael A.
AU - Brooks, John T.
AU - Moore, Richard D
AU - Silverberg, Michael J.
AU - Althoff, Keri
AU - Engels, Eric A.
PY - 2018/2/20
Y1 - 2018/2/20
N2 - 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.
AB - 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.
KW - attributable risk
KW - cancer
KW - HIV
KW - North America
KW - smoking
UR - http://www.scopus.com/inward/record.url?scp=85042438783&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85042438783&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000001721
DO - 10.1097/QAD.0000000000001721
M3 - Article
VL - 32
SP - 513
EP - 521
JO - AIDS
JF - AIDS
SN - 0269-9370
IS - 4
ER -