Cause‐specific mortality after diagnosis of cancer among HIV‐positive patients: A collaborative analysis of cohort studies

Abstract

People living with HIV (PLHIV) are more likely than the general population to develop AIDS‐defining malignancies (ADMs) and several non‐ADMs (NADMs). Information is lacking on survival outcomes and cause‐specific mortality after cancer diagnosis among PLHIV. We investigated causes of death within 5 years of cancer diagnosis in PLHIV enrolled in European and North American HIV cohorts starting antiretroviral therapy (ART) 1996–2015, aged ≥16 years, and subsequently diagnosed with cancer. Cancers were grouped: ADMs, viral NADMs and nonviral NADMs. We calculated cause‐specific mortality rates (MR) after diagnosis of specific cancers and compared 5‐year survival with the UK and France general populations. Among 83,856 PLHIV there were 4,436 cancer diagnoses. Of 603 deaths after ADM diagnosis, 292 (48%) were due to an ADM. There were 467/847 (55%) and 74/189 (39%) deaths that were due to an NADM after nonviral and viral NADM diagnoses, respectively. MR were higher for diagnoses between 1996 and 2005 versus 2006–2015: ADMs 102 (95% CI 92–113) per 1,000 years versus 88 (78–100), viral NADMs 134 (106–169) versus 111 (93–133) and nonviral NADMs 264 (232–300) versus 226 (206–248). Estimated 5‐year survival for PLHIV diagnosed with liver (29% [19–39%]), lung (18% [13–23%]) and cervical (75% [63–84%]) cancer was similar to general populations. Survival after Hodgkin's lymphoma diagnosis was lower in PLHIV (75% [67–81%]). Among ART‐treated PLHIV diagnosed with cancer, MR and causes of death varied by cancer type, with mortality highest for liver and lung cancers. Deaths within 5 years of NADM diagnoses were more likely to be from cancer than AIDS.

Malignancies among children and young people with HIV in Western and Eastern Europe and Thailand

“…This association was not explained by key characteristics, such as age at diagnosis, type of malignancy (ADM vs. NADM) or level of immunosuppression; vertically acquired HIV was the only other factor explored which was associated. In adults with HIV, malignancy outcomes have been shown to be broadly similar to the general population, although with poorer outcomes for some cancer types, including Hodgkin lymphoma [ 27 , 28 ]. Delayed malignancy diagnosis was believed to have contributed to poor outcomes in young adults diagnosed with a malignancy in the UK (some of whom are included here) [ 7 ].…”

Patient Experience Evaluation of the CMO-Based Pharmaceutical Care Model vs Usual Care in People Living with HIV

“…3 Antiretroviral treatment (ART) increases life expectancy in these patients and HIV has become a chronic infection for most of them. 4,5 As a consequence, patients with HIV develop other comorbidities earlier than their HIV-negative counterparts. 4,6 Some of these comorbidities are associated with age, which may lead to polypharmacy.…”

“…4,5 As a consequence, patients with HIV develop other comorbidities earlier than their HIV-negative counterparts. 4,6 Some of these comorbidities are associated with age, which may lead to polypharmacy. 5,7 Many studies over the years have suggested that HIV, ART treatment, or both, increase the risk of metabolic disorders, [8][9][10] which explains why clinical outcomes such as cholesterol, high-density lipoproteins (HDL), triglycerides, glycated haemoglobin A1c (HbA1c) and blood pressure have been assessed in PLWH.…”

Impact of an enhanced screening program on the detection of non-AIDS neoplasias in patients with human immunodeficiency virus infection

“…It is estimated that at least 1 in 3 PLWH will die due to malignant neoplasms in the coming years [ 15 , 16 ]. The causes of this increased incidence of NADC are not well known and there are several factors that could play a role, including immunosuppression, chronic inflammation and immune activation, ART exposure, higher rates of coinfection with oncogenic viruses, and traditional cancer risk factors such as smoking [ 17 , 18 ].…”