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Infection‐related and ‐unrelated malignancies, HIV and the aging population
Author(s) -
Shepherd L,
Borges ÁH,
Ledergerber B,
Domingo P,
Castagna A,
Rockstroh J,
Knysz B,
Tomazic J,
Karpov I,
Kirk O,
Lundgren J,
Mocroft A
Publication year - 2016
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12359
Subject(s) - medicine , incidence (geometry) , poisson regression , confidence interval , confounding , rate ratio , population , demography , physics , environmental health , sociology , optics
Objectives HIV ‐positive people have increased risk of infection‐related malignancies ( IRM s) and infection‐unrelated malignancies ( IURM s). The aim of the study was to determine the impact of aging on future IRM and IURM incidence. Methods People enrolled in Euro SIDA and followed from the latest of the first visit or 1 January 2001 until the last visit or death were included in the study. Poisson regression was used to investigate the impact of aging on the incidence of IRM s and IURM s, adjusting for demographic, clinical and laboratory confounders. Linear exponential smoothing models forecasted future incidence. Results A total of 15 648 people contributed 95 033 person‐years of follow‐up, of whom 610 developed 643 malignancies [ IRM s: 388 (60%); IURM s: 255 (40%)]. After adjustment, a higher IRM incidence was associated with a lower CD 4 count [ adjusted incidence rate ratio (aIRR) CD 4 count < 200 cells/μL: 3.77; 95% confidence interval ( CI ) 2.59, 5.51; compared with ≥ 500 cells/μL], independent of age, while a CD 4 count < 200 cells/μL was associated with IURM s in people aged < 50 years only (aIRR: 2.51; 95% CI 1.40–4.54). Smoking was associated with IURM s (aIRR: 1.75; 95% CI 1.23, 2.49) compared with never smokers in people aged ≥ 50 years only, and not with IRM s. The incidences of both IURM s and IRM s increased with older age. It was projected that the incidence of IRM s would decrease by 29% over a 5‐year period from 3.1 (95% CI 1.5–5.9) per 1000 person‐years in 2011, whereas the IURM incidence would increase by 44% from 4.1 (95% CI 2.2–7.2) per 1000 person‐years over the same period. Conclusions Demographic and HIV ‐related risk factors for IURM s (aging and smoking) and IRM s (immunodeficiency and ongoing viral replication) differ markedly and the contribution from IURM s relative to IRM s will continue to increase as a result of aging of the HIV ‐infected population, high smoking and lung cancer prevalence and a low prevalence of untreated HIV infection. These findings suggest the need for targeted preventive measures and evaluation of the cost−benefit of screening for IURM s in HIV ‐infected populations.