Cancer burden attributable to cigarette smoking among HIV-infected people in North America. (20th February 2018)

• Record Type: Journal Article
• Authors: Altekruse, Sean F.; Shiels, Meredith S.; Modur, Sharada P.; Land, Stephanie R.; Crothers, Kristina A.; Kitahata, Mari M.; Thorne, Jennifer E.; 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 N.; Engels, Eric A.
• Is Part Of: AIDS. Volume 32:Number 4(2018)
• Publication Date: 2018-02-20
• Subjects: attributable risk -- cancer -- HIV -- North America -- smoking; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000001721
• Languages: English
• ISSNs: 0269-9370

Abstract

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.