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Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States
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Details:
  • Pubmed ID:
    24300545
  • Pubmed Central ID:
    PMC5015650
  • Funding:
    HHSN261201000027C/CA/NCI NIH HHS/United States
    U58 DP003875/DP/NCCDPHP CDC HHS/United States
    Z99 CA999999/Intramural NIH HHS/United States
    U58 DP000848/DP/NCCDPHP CDC HHS/United States
    U58 DP000812/DP/NCCDPHP CDC HHS/United States
    HHSN261201000024C/CA/NCI NIH HHS/United States
    U58 DP000824/DP/NCCDPHP CDC HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Objective

    HIV-infected people have elevated risk for some cancers. Changing incidence of these cancers over time may reflect changes in three factors: HIV population demographic structure (e.g. age distribution), general population (background) cancer rates, and HIV-associated relative risks. We assessed the contributions of these factors to time trends for 10 cancers during 1996–2010.

    Design

    Population-based registry linkage study.

    Methods

    We applied Poisson models to data from the U.S. HIV/AIDS Cancer Match Study to estimate annual percent changes (APCs) in incidence rates of AIDS-defining cancers (ADCs: Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL), and cervical cancer) and 7 non-AIDS-defining cancers (NADCs). We evaluated HIV-infected cancer trends with and without adjustment for demographics, trends in background rates, and trends in standardized incidence ratios (SIRs, to capture relative risk).

    Results

    Cancer rates among HIV-infected people rose over time for anal (APC 3.8%), liver (8.5%), and prostate (9.8%) cancers, but declined for KS (1996–2000: −29.3%; 2000–2010: −7.8%), NHL (1996–2003: −15.7%; 2003–2010: −5.5%), cervical cancer (−11.1%), Hodgkin lymphoma (HL, −4.0%), and lung cancer (−2.8%). Breast and colorectal cancer incidence did not change over time. Based on comparison to adjusted models, changing demographics contributed to trends for KS and breast, colorectal, liver, lung, and prostate cancers (all p<0.01). Trends in background rates were notable for liver (APC 5.6%) and lung (−3.2%) cancers. SIRs declined for ADCs, HL (APC −3.2%), and lung cancer (−4.4%).

    Conclusions

    Demographic shifts influenced several cancer trends among HIV-infected individuals. Falling relative risks largely explained ADC declines, while background incidence contributed to some NADC trends.