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Author Notes:

Correspondence to Lesley S. Park, PhD, MPH, Stanford University School of Medicine, Center on Health Policy/Center on Primary Care and Outcomes Research, 117 Encina Commons, Stanford, CA 94305-6006, USA. Tel: +1 650 725 3655; fax: +1 650 723 1919; e-mail: lesley.park@stanford.edu

Author contributions: L.S.P., J.P.T., A.C.J., and R.D. designed the study.

L.S.P. and R.D. wrote the initial drafts of the manuscript.

L.S.P. performed the analyses with supervision from J.P.T., A.C.J., and R.D.

All authors contributed to the overall intellectual content of the manuscript, read and edited subsequent drafts, and approved the final version.

We are grateful to the Veterans Affairs Central Cancer Registry (VACCR) for linking the VACS with the VACCR database and providing us with a dataset containing the linked records.

This study would not have been possible without the VACCR's generous assistance.

There are no conflicts of interest.

Subjects:

Research Funding:

This research was supported by the US Veterans Health Administration and by grants from the National Institute on Alcohol Abuse and Alcoholism (U01-AA020790, U24-AA020794, U10-AA013566), National Institute of Mental Health (T32-MH020031, P30-MH062294), National Institute of Allergy and Infectious Diseases (U01-A1069918), National Cancer Institute (F31-CA180775, R01-CA165937, R01-CA173754), and National Institute of Diabetes and Digestive and Kidney Diseases (3T32-DK007217) of the National Institutes of Health.

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

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

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Journal Title:

AIDS

Volume:

Volume 30, Number 11

Publisher:

, Pages 1795-1806

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2017 Wolters Kluwer Health, Inc. All rights reserved.

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