Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era: 1997-2012

• Authors: Lesley S. Park, Stanford University; Janet P. Tate, Veterans Affairs Connecticut Healthcare System; Keith Sigel, Icahn School of Medicine at Mt. Sinai; David Rimland, Emory University; Kristina Crothers, University of Washington; Cynthia Gibert, Washington DC Veterans Affairs Medical Center; Maria C. Rodriguez-Barradas, Michael E. DeBakey Veterans Affairs Medical Center; Matthew Bidwell Goetz, iVeterans Affairs Greater Los Angeles Healthcare System; Roger J. Bedimo, Veterans Affairs North Texas Healthcare System; Sheldon T. Brown, Icahn School of Medicine at Mt. Sinai; Amy C. Justice, Veterans Affairs Connecticut Healthcare System; Robert Dubrow, Yale School of Medicine
• Journal Title: AIDS
• Volume: Volume 30, Number 11
• Publisher: Lippincott, Williams & Wilkins | 2016-07-17, Pages 1795-1806
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/QAD.0000000000001112
• Subjects: Health Sciences, General; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Virology; AIDS; cancer; HIV infections; neoplasms; veterans; HIV-INFECTED PATIENTS; AIDS-DEFINING CANCERS; FORCE RECOMMENDATION STATEMENT; HUMAN-PAPILLOMAVIRUS VACCINE; UNITED-STATES; NORTH-AMERICA; LUNG-CANCER; ANAL CANCER; HIV-1-INFECTED PATIENTS; CHANGING PATTERNS

Abstract

Objective: Utilizing the Veterans Aging Cohort Study, the largest HIV cohort in North America, we conducted one of the few comprehensive comparisons of cancer incidence time trends in HIV-infected (HIV+) versus uninfected persons during the antiretroviral therapy (ART) era. Design: Prospective cohort study. Methods: We followed 44 787 HIV+ and 96 852 demographically matched uninfected persons during 1997–2012. We calculated age-, sex-, and race/ethnicity-standardized incidence rates and incidence rate ratios (IRR, HIV+ versus uninfected) over four calendar periods with incidence rate and IRR period trend P values for cancer groupings and specific cancer types. Results: We observed 3714 incident cancer diagnoses in HIV+ and 5760 in uninfected persons. The HIV+ all-cancer crude incidence rate increased between 1997–2000 and 2009–2012 (P trend = 0.0019). However, after standardization, we observed highly significant HIV+ incidence rate declines for all cancer (25% decline; P trend <0.0001), AIDS-defining cancers (55% decline; P trend <0.0001), nonAIDS-defining cancers (NADC; 15% decline; P trend = 0.0003), and nonvirus-related NADC (20% decline; P trend <0.0001); significant IRR declines for all cancer (from 2.0 to 1.6; P trend <0.0001), AIDS-defining cancers (from 19 to 5.5; P trend <0.0001), and nonvirus-related NADC (from 1.4 to 1.2; P trend = 0.049); and borderline significant IRR declines for NADC (from 1.6 to 1.4; P trend = 0.078) and virus-related NADC (from 4.9 to 3.5; P trend = 0.071). Conclusion: Improved HIV care resulting in improved immune function most likely contributed to the HIV+ incidence rate and the IRR declines. Further promotion of early and sustained ART, improved ART regimens, reduction of traditional cancer risk factor (e.g. smoking) prevalence, and evidence-based screening could contribute to future cancer incidence declines among HIV+ persons.