Deaths Attributable to Cancer in the US Human Immunodeficiency Virus Population During 2001–2015. (25th July 2020)

• Record Type: Journal Article
• Authors: Horner, Marie-Josèphe; Shiels, Meredith S; Pfeiffer, Ruth M; Engels, Eric A
• Is Part Of: Clinical infectious diseases. Volume 72:Number 9(2021)
• Page Start: e224
• Page End: e231
• Publication Date: 2020-07-25
• Subjects: human immunodeficiency virus -- AIDS -- cancer -- population-attributable fraction -- mortality; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa1016
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Antiretroviral therapy (ART) has reduced mortality among people living with human immunodeficiency virus (HIV), but cancer remains an important cause of death. We characterized cancer-attributable mortality in the HIV population during 2001–2015. Methods: We used data from population-based HIV and cancer registries in the United States (US). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) associating cancer diagnoses with overall mortality. Population-attributable fractions (PAFs) were calculated using these HRs and the proportion of deaths preceded by cancer. Cancer-specific PAFs and cancer-attributable mortality rates were calculated for demographic subgroups, AIDS-defining cancers (Kaposi sarcoma [KS], non-Hodgkin lymphoma [NHL], cervical cancer), and non–AIDS-defining cancers. Results: Cancer-attributable mortality was 386.9 per 100 000 person-years, with 9.2% and 5.0% of deaths attributed to non–AIDS-defining and AIDS-defining cancers, respectively. Leading cancer-attributable deaths were from NHL (3.5%), lung cancer (2.4%), KS (1.3%), liver cancer (1.1%), and anal cancer (0.6%). Overall, cancer-attributable mortality declined from 484.0 per 100 000 person-years during 2001–2005 to 313.6 per 100 000 person-years during 2011–2015, while the PAF increased from 12.6% to 17.1%; the PAF for non–AIDS-defining cancers increased from 7.2% to 11.8% during 2011–2015. Cancer-attributable mortality was highest among those aged ≥60 years (952.2 per 100 000 person-years), with 19.0% of deaths attributed to non–AIDS-defining cancers. Conclusions: Although cancer-attributable mortality has declined over time, it remains high and represents a growing fraction of deaths in the US HIV population. Mortality from non–AIDS-defining cancers may rise as the HIV population ages. ART access, early cancer detection, and improved cancer treatment are priorities for reducing cancer-attributable mortality. Abstract : Cancer accounts for a growing fraction of deaths in the US human immunodeficiency virus population. During 2011–2015, 1 in 6 deaths was attributed to cancer. Cancer mortality rates are much higher than in the general population for all age groups.