by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

February 9, 2021

Featured Literature:

Hessol NA et al. Risk of smoking-related cancers among women and men living with and without HIV. AIDS. 2021 Jan 1; 35(1): 101-114. doi: 10.1097/QAD.0000000000002717. PMID: 33048871.

Non-AIDS defining cancers remain a common cause of morbidity and mortality among persons with HIV, and high rates of established risk factors (e.g., tobacco use, oncogenic viral co-infection) have been described among PWH. This study examined data collected through September 2019 from two large, well-characterized U.S. cohorts (Women’s Interagency HIV Study and Multicenter AIDS Cohort Study) to determine whether the effect of smoking on incidence of smoking-related cancers differed by HIV status, if sex modifies impact of risk factors for smoking-related cancers, and the sex-specific attributable risk of smoking. A unique feature of this analysis was availability of information for a highly-similar but HIV-seronegative comparison group. Incidence rates, relative risks, and adjusted population attributable fractions were calculated based on data from 4,423 WIHS and 6,789 MACS participants (representing over 139,500 person-years of follow-up). Investigators observed 214 smoking-related incident cancers among MACS participants and 192 among WIHS participants, with the majority involving the lung/bronchus and diagnosed in the modern ART era (defined as 2001-2018). Age-adjusted incidence rates were significantly higher among PWH than seronegative participants, and were also higher among women versus men. Further, adjusted interaction models demonstrated that effects of cumulative pack-years were significantly stronger in women. Authors estimated that 31% of all smoking-related cancers were attributed to smoking more than 5 pack-years in a lifetime among PWH. 

Author’s Commentary:

This is one of the largest studies examining the contribution of smoking on cancer burden among PWH, and its findings reaffirm our understanding that HIV appears to be an independent risk factor for smoking-related cancer development. The observation of higher incidence rates among women with HIV compared to men with HIV warrants further investigation. Among PWH, current motivations to quit smoking may be very different from historical ones; pandemic-related stress has also led to increased smoking for some. Tobacco use screening and evidence-based treatment strategies for smoking cessation are among the most impactful health interventions HIV providers can offer.

The author has no conflicts of interest to disclose.

View archived Clinical Research Update entries here.