期刊
CLINICAL INFECTIOUS DISEASES
卷 65, 期 4, 页码 636-643出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/cix392
关键词
HIV; AIDS; cancer; mortality; aging
资金
- National Cancer Institute
- NIH [R01CA165937, U01AI069918, F31DA037788, G12MD007583, K01AI093197, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410]
- Centers for Disease Control and Prevention [CDC-200-2006-18797, CDC-200-2015-63931]
- Agency for Healthcare Research and Quality, USA [90047713]
- Health Resources and Services Administration [90051652]
- Canadian Institutes of Health Research, Canada [CBR-86906, CBR-94036, HCP-97105, TGF-96118]
- Ontario Ministry of Health and Long Term Care
- Government of Alberta, Canada
- National Institute for Mental Health
- National Institute on Drug Abuse
- NIH grants [U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, Z01CP010176, P30AI094189]
- National Institute of Health [U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U01AI038855, U01AI038858]
- National Institute of Health grants [U10EY008052, P30AI110527, P30MH62246, R01AA016893, R01DA011602, R01DA012568, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984]
Background. Cancer remains an important cause of morbidity and mortality in people with human immunodeficiency virus (PWHIV) on effective antiretroviral therapy (ART). Estimates of cancer-attributable mortality can inform public health efforts. Methods. We evaluated 46 956 PWHIV receiving ART in North American HIV cohorts (1995-2009). Using information on incident cancers and deaths, we calculated population-attributable fractions (PAFs), estimating the proportion of deaths due to cancer. Calculations were based on proportional hazards models adjusted for age, sex, race, HIV risk group, calendar year, cohort, CD4 count, and viral load. Results. There were 1997 incident cancers and 8956 deaths during 267 145 person-years of follow-up, and 11.9% of decedents had a prior cancer. An estimated 9.8% of deaths were attributable to cancer (cancer-attributable mortality rate 327 per 100 000 person-years). PAFs were 2.6% for AIDS-defining cancers (ADCs, including non-Hodgkin lymphoma, 2.0% of deaths) and 7.1% for non-AIDS-defining cancers (NADCs: lung cancer, 2.3%; liver cancer, 0.9%). PAFs for NADCs were higher in males and increased strongly with age, reaching 12.5% in PWHIV aged 55+ years. Mortality rates attributable to ADCs and NADCs were highest for PWHIV with CD4 counts <100 cells/mm(3). PAFs for NADCs increased during 1995-2009, reaching 10.1% in 2006-2009. Conclusions. Approximately 10% of deaths in PWHIV prescribed ART during 1995-2009 were attributable to cancer, but this fraction increased over time. A large proportion of cancer-attributable deaths were associated with non-Hodgkin lymphoma, lung cancer, and liver cancer. Deaths due to NADCs will likely grow in importance as AIDS mortality declines and PWHIV age.
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