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International Epidemiology Databases to Evaluate AIDS

Home >> Publications >> Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era: 1997-2012.

Publication

Author(s):

Park LS, Tate JP, Sigel K, Rimland D, Crothers K, Gibert C, Rodriguez-Barradas MC, Goetz MB, Bedimo RJ, Brown ST, Justice AC, Dubrow R.

Pub Title:

Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era: 1997-2012.

Pub Date:

Jul 17 2016

Page Number:
Epub

Journal:

Title: 
AIDS

PubMed: 27064994
Pub PDF:
OBJECTIVE:
Utilizing the Veterans Aging Cohort Study, the largest HIV cohort in North America, we conducted one of the few comprehensive comparisons of cancer incidence time trends in HIV-infected (HIV+) versus uninfected persons during the antiretroviral therapy (ART) era.
DESIGN:
Prospective cohort study.
METHODS:
We followed 44,787 HIV+ and 96,852 demographically-matched uninfected persons during 1997-2012. We calculated age-, sex-, and race/ethnicity-standardized incidence rates (IR) and incidence rate ratios (IRR, HIV+ versus uninfected) over four calendar periods with IR and IRR period trend p-values for cancer groupings and specific cancer types.
RESULTS:
We observed 3,714 incident cancer diagnoses in HIV+ and 5,760 in uninfected persons. The HIV+ all cancer crude IR increased between 1997-2000 and 2009-2012 (p-trend = 0.0019). However, after standardization, we observed highly significant HIV+ IR declines for all cancer (25% decline; p-trend<0.0001), AIDS-defining cancers (ADC; 55% decline; p-trend<0.0001), non-AIDS-defining cancers (NADC; 15% decline; p-trend = 0.0003), and non-virus-related NADC (20% decline; p-trend<0.0001); significant IRR declines for all cancer (from 2.0 to 1.6; p-trend<0.0001), ADC (from 19 to 5.5; p-trend<0.0001), and non-virus-related NADC (from 1.4 to 1.2; p-trend = 0.049); and borderline significant IRR declines for NADC (from 1.6 to 1.4; p-trend = 0.078) and virus-related NADC (from 4.9 to 3.5; p-trend = 0.071).
CONCLUSION:
Improved HIV care resulting in improved immune function most likely contributed to the HIV+ IR and the IRR declines. Further promotion of early and sustained ART, improved ART regimens, reduction of traditional cancer risk factor (e.g., smoking) prevalence, and evidence-based screening could contribute to future cancer incidence declines among HIV+ persons.
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Citation:

Park LS, Tate JP, Sigel K, Rimland D, Crothers K, Gibert C, Rodriguez-Barradas MC, Goetz MB, Bedimo RJ, Brown ST, et al. Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era: 1997-2012. AIDS. 2016 Apr 8. [Epub ahead of print] PubMed PMID: 27064994.