Cancer-Attributable Mortality Among People With Treated Human Immunodeficiency Virus Infection in North America

Engels, Eric A.; Yanik, Elizabeth L.; Wheeler, Willian; Shiels, Meredith S.; Goedert, James J.; Grover, Surbhi; Park, Lesley S.; Sigel, Keith; Pfeiffer, Ruth M.; Benson, Constance A.; Bosch, Ronald J.; Kirk, Gregory D.; Boswell, Stephen L.; Mayer, Kenneth H.; Grasso, Chris; Hogg, Robert S.; Harrigan, P. Richard; Montaner, Julio S. G.; Yip, Benita; Zhu, Julia; Salters, Kate; Gabler, Karyn; Buchacz, Kate; Gebo, Kelly A.; Carey, John T.; Rodríguez, Benigno; Horberg, Michael A.; Silverberg, Michael J.; Thorne, Jennifer E.; Rabkin, Charles S.; Jacobson, Lisa P.; D’Souza, Gypsyamber; Klein, Marina B.; Rourke, Sean B.; Rachlis, Anita; Globerman, Jason; Kopansky-Giles, Madison; Hunter-Mellado, Robert F.; Mayor, Angel M.; Gill, M John; Deeks, Steven G.; Martin, Jeffrey N.; Patel, Pragna; Brooks, John T.; Mugavero, Michael J.; Willig, James H.; Eron, Joseph J.; Napravnik, Sonia; Sterling, Timothy R.; Haas, David W.; Rebeiro, Peter F.; Turner, Megan; Bebawy, Sally; Rogers, Ben; Justice, Amy C.; Dubrow, Robert; Fiellin, David A.; Anastos, Kathryn; Saag, Michael S.; McKaig, Rosemary G.; Moore, Richard D.; Freeman, Aimee; Lent, Carol; Kitahata, Mari M.; Rompaey, Stephen E. Van; Crane, Heidi M.; Drozd, Daniel R.; Morton, Liz; McReynolds, Justin; Lober, William B.; Gange, Stephen J.; Althoff, Keri N.; Abraham, Alison G.; Lau, Bryan; Zhang, Jinbing; Jing, Jerry; Modur, Sharada P.; Wong, Chung F.; Hogan, Brenna; Desir, Fidel; Liu, Bin; You, Bin

doi:10.1093/cid/cix392

Cited by 76 publications

(44 citation statements)

References 34 publications

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“…Another study, performed by the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) on more than 46,000 subjects receiving antiretrovirals from 1995 to 2009, estimated that 9.8% of deaths were due to cancer. The fraction of deaths due to NADCs was 7.1%, while only 2.6% were attributable to AIDS-defining cancers [9]. More recent studies showed higher proportional mortality ratios, associating more than 10% of all deaths with NADCs [10].…”

Section: Introductionmentioning

confidence: 96%

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

Franzetti

Ricci

Bonfanti

2019

CHR

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: The advent of highly active antiretroviral therapy (HAART) has significantly reduced the incidence of AIDS events, including AIDS-defining malignancies. Nevertheless, several cohort studies conducted in the post-HAART period have reported an increasing risk of non-AIDS-defining cancers (NADC). : Overall, the potential mechanisms leading to an increased risk of developing NADCs probably involve multiple known and unknown factors. In addition to ageing, chronic inflammation and ongoing immune system dysregulation, other contributing factors are co-infection with potentially oncogenic viruses (HBV, HCV, HPV, EBV) and high-risk behaviours such as tobacco smoking. : As a consequence of these risk factors, high standardized incidence ratios have been consistently reported, mainly in cohort studies regarding smoking-related cancers (lung cancer, but also pharyngeal and kidney cancer), due to the far more common cigarette smoking habit in the HIV-population. Also in the setting of infection-related malignancies, the high frequency of liver cancer, as a consequence of HBV and HCV co-infection is well known. Similarly, HPV infection accounts for the higher risk of anal cancer. On the same line, Hodgkin lymphoma is more frequent in the HIV population, due to the dysregulation and proliferation of EBV-infected lymphocytes. : Several studies addressed the direct relationship between immunosuppression and cancer progression, showing that subjects with HIV infection experience higher cancer-specific mortality, as compared to the general population, independently of cancer stage or cancer treatment. : In the HIV population, for many NADCs, the prognosis is still worse as compared to the general population. However, an improvement has been reported over the last decades, mainly thanks to more available and adequate treatment chances.

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Section: Introductionmentioning

confidence: 96%

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

Franzetti

Ricci

Bonfanti

2019

CHR

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“…They also have a more severe clinical course of cancer and lower survival rate compared to the noninfected population . In HIV+ patients, 10–20% of all deaths are attributable to cancer …”

Section: Introductionmentioning

confidence: 99%

“…2,3 In HIV+ patients, 10-20% of all deaths are attributable to cancer. 4,5 Given the higher risks for HIV-positive population, developing cancer control strategies for this group is a rising challenge to public health. To provide the context for further research, we will discuss clinical aspects related to the cancer burden in patients with HIV-infection and highlight details on the role of antiretroviral drugs in the development of cancer, which is not limited to viral suppression.…”

Section: Introductionmentioning

confidence: 99%

HIV‐1, HAART and cancer: A complex relationship

Шмакова

Germini

Vassetzky

2019

Intl Journal of Cancer

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HIV infected people are at higher risk of developing cancer, although it is globally diminished in the era of highly active antiretroviral treatment (HAART). Recently, antioncogenic properties of some HAART drugs were discovered. We discuss the role of HAART in the prevention and improvement of treatment outcomes of cancers in HIV‐infected people. We describe different trends in HAART–cancer relationships: cancer‐predisposing as well as cancer‐preventing. We cover the roles of particular drug regimens in cancer prevention. We also describe the causes of cancer treatment with HAART drugs in HIV‐negative people, including ongoing clinical studies that may directly point to a possible independent anti‐oncogenic activity of HAART drugs. We conclude that despite potent antioncogenic activities of every class of HAART drugs reported in preclinical models, the evidence to date indicates that their independent clinical impact in HIV‐infected people is limited. Improved cancer prevention strategies besides HAART are needed to reduce HIV‐cancer‐related mortality.

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“…Hepatocellular carcinoma (HCC) is a growing cause of cancer death among people living with HIV infection. 1 Driven largely by hepatitis C virus (HCV) coinfection, hepatitis B virus (HBV) coinfection, and alcoholic liver disease, the incidence of HCC among HIV-infected persons in North America has risen more than 4-fold from 1995-2009. 2 Moreover, HIV-infected individuals have a 4-fold higher risk of HCC than uninfected persons.…”

Section: Introductionmentioning

confidence: 99%

HIV RNA, CD4+ Percentage, and Risk of Hepatocellular Carcinoma by Cirrhosis Status

Torgersen

Kallan

Carbonari

et al. 2019

JNCI: Journal of the National Cancer Institute

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Background Despite increasing incidence of hepatocellular carcinoma (HCC) among HIV-infected patients, it remains unclear if HIV-related factors contribute to development of HCC. We examined if higher or prolonged HIV viremia and lower CD4+ cell percentage were associated with HCC. Methods We conducted a cohort study of HIV-infected individuals who had HIV RNA, CD4+, and CD8+ cell counts and percentages assessed in the Veterans Aging Cohort Study (1999–2015). HCC was ascertained using Veterans Health Administration cancer registries and electronic records. Cox regression was used to determine hazard ratios (HR, 95% confidence interval [CI]) of HCC associated with higher current HIV RNA, longer duration of detectable HIV viremia (≥500 copies/mL), and current CD4+ cell percentage less than 14%, adjusting for traditional HCC risk factors. Analyses were stratified by previously validated diagnoses of cirrhosis prior to start of follow-up. Results Among 35 659 HIV-infected patients, 302 (0.8%) developed HCC over 281 441 person-years (incidence rate = 107.3 per 100 000 person-years). Among patients without baseline cirrhosis, higher HIV RNA (HR = 1.25, 95% CI = 1.12 to 1.40, per 1.0 log10 copies/mL) and 12 or more months of detectable HIV (HR = 1.47, 95% CI = 1.02 to 2.11) were independently associated with higher risk of HCC. CD4+ percentage less than 14% was not associated with HCC in any model. Hepatitis C coinfection was a statistically significant predictor of HCC regardless of baseline cirrhosis status. Conclusion Among HIV-infected patients without baseline cirrhosis, higher HIV RNA and longer duration of HIV viremia increased risk of HCC, independent of traditional HCC risk factors. This is the strongest evidence to date that HIV viremia contributes to risk of HCC in this group.

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Cancer-Attributable Mortality Among People With Treated Human Immunodeficiency Virus Infection in North America

Cited by 76 publications

References 34 publications

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

HIV‐1, HAART and cancer: A complex relationship

HIV RNA, CD4+ Percentage, and Risk of Hepatocellular Carcinoma by Cirrhosis Status

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