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Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era: 1997-2012.
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. Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era: 1997-2012. AIDS. 2016 Jul 17; 30(11):1795-806.
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.
Prospective cohort study.
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 and incidence rate ratios (IRR, HIV+ versus uninfected) over four calendar periods with incidence rate and IRR period trend P values for cancer groupings and specific cancer types.
We observed 3714 incident cancer diagnoses in HIV+ and 5760 in uninfected persons. The HIV+ all-cancer crude incidence rate increased between 1997-2000 and 2009-2012 (P trend? = 0.0019). However, after standardization, we observed highly significant HIV+ incidence rate declines for all cancer (25% decline; P trend < 0.0001), AIDS-defining cancers (55% decline; P trend < 0.0001), nonAIDS-defining cancers (NADC; 15% decline; P trend? = 0.0003), and nonvirus-related NADC (20% decline; P trend < 0.0001); significant IRR declines for all cancer (from 2.0 to 1.6; P trend < 0.0001), AIDS-defining cancers (from 19 to 5.5; P trend < 0.0001), and nonvirus-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).
Improved HIV care resulting in improved immune function most likely contributed to the HIV+ incidence rate 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.