by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

August 11, 2020

Featured Literature:

Horner MJ et al. Deaths attributable to cancer in the United States HIV population during 2001-2015. Clin Infect Dis. 2020 Jul 25; doi: 10.1093/cid/ciaa1016. Online ahead of print.

The majority of persons with HIV (PWH) and receiving ART are purported to have a “normal” life expectancy. However, as PWH age, comorbidities including cancer are occurring with a greater prevalence. This study from the National Cancer Institute utilized data from population-based HIV and cancer registries. The cohort included 521,623 PWH followed during 2001-2015 (3,577,916 person-years). Cox regression models were used to estimate hazard ratios (HRs) associating cancer diagnoses and overall mortality with adjustment for demographics and AIDS status. The study also applied population-attributable fractions (PAFs) which characterize the relative importance of cancer as a cause of death.

Mortality attributed to cancer was 387 per 100,000 person-years, with 9.2% of deaths attributed to non-AIDS-defining cancers (NADC) and 5% for AIDS-defining cancers. The leading causes of cancer deaths included lymphoma (3.5%), lung cancer (2.4%), KS (1.3%), liver cancer (1.1%), anal cancer (0.6%). Cancer-attributable mortality declined from 484.0 during 2001-2005 to 314 per 100,000 person-years from 2011-15, while the PAF increased from about 13% to 17%. The PAF for NADCs increased from 7% to 12% in 2011-2015. Cancer-attributable mortality was highest among ≥60-year-olds, with 19.0% of deaths in this group from NADCs. Cancer-attributable mortality in PWH has declined over time but remains high and represents a growing portion of deaths in PWH.

Author’s Commentary:

Cancer continues to account for a growing number of deaths in PWH, although this is true for persons without HIV as well. Cancer-attributable mortality remains higher in the HIV population than the general population, and the fraction of deaths due to cancer has been increasing over time. Non-Hodgkin lymphoma (NHL) and Kaposi sarcoma (KS) are the leading causes of cancer deaths in the HIV population although there is shifting towards NADC, including lung cancer. The evolving patterns of cancer deaths underscores the importance of ART access, which can reduce virally-mediated cancers such as KS and NHL, along with the need for data to guide cancer screening efforts and effective cancer treatments for PWH.

The author has no conflicts of interest to disclose.

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