Cause-specific mortality after diagnosis of cancer among HIV-positive patients: A collaborative analysis of cohort studies.

Adam Trickey,Christoph Wyen,Janne Vehreschild,Katharina Grabmeier‐Pfistershammer,Matthias Cavassini,Juan Berenguer,Julia Del Amo,Peter Reiss,M John Gill,Leah Shepherd,Dominique Costagliola,Sophie Abgrall,Sophie Grabar,Fabrice Bonnet,Ramón Teira ,Amy C Justice ,Jodie L Guest ,Margaret T May ,Ferdinand W N M Wit ,Antonella D’arminio Monforte ,Jonathan A C Sterne

doi:10.1002/ijc.32895

Abstract

People living with HIV (PLHIV) are more likely than the general population to develop AIDS‐defining malignancies (ADMs) and several non‐ADMs (NADMs). Information is lacking on survival outcomes and cause‐specific mortality after cancer diagnosis among PLHIV. We investigated causes of death within 5 years of cancer diagnosis in PLHIV enrolled in European and North American HIV cohorts starting antiretroviral therapy (ART) 1996–2015, aged ≥16 years, and subsequently diagnosed with cancer. Cancers were grouped: ADMs, viral NADMs and nonviral NADMs. We calculated cause‐specific mortality rates (MR) after diagnosis of specific cancers and compared 5‐year survival with the UK and France general populations. Among 83,856 PLHIV there were 4,436 cancer diagnoses. Of 603 deaths after ADM diagnosis, 292 (48%) were due to an ADM. There were 467/847 (55%) and 74/189 (39%) deaths that were due to an NADM after nonviral and viral NADM diagnoses, respectively. MR were higher for diagnoses between 1996 and 2005 versus 2006–2015: ADMs 102 (95% CI 92–113) per 1,000 years versus 88 (78–100), viral NADMs 134 (106–169) versus 111 (93–133) and nonviral NADMs 264 (232–300) versus 226 (206–248). Estimated 5‐year survival for PLHIV diagnosed with liver (29% [19–39%]), lung (18% [13–23%]) and cervical (75% [63–84%]) cancer was similar to general populations. Survival after Hodgkin's lymphoma diagnosis was lower in PLHIV (75% [67–81%]). Among ART‐treated PLHIV diagnosed with cancer, MR and causes of death varied by cancer type, with mortality highest for liver and lung cancers. Deaths within 5 years of NADM diagnoses were more likely to be from cancer than AIDS.

Highlights

People living with HIV (PLHIV) are more likely to develop cancer than those not infected with HIV.[1]
Both median age and median CD4 count at cancer diagnosis were lower for individuals diagnosed with an AIDS-defining malignancy (ADM) than with an Non-AIDS defining malignancy (NADM), and for viral NADM compared to nonviral NADM
The viral load when starting antiretroviral therapy (ART) was similar across cancer groups and the two time periods, but the viral load at diagnosis of cancer was higher for patients diagnosed with ADMs than for those diagnosed with NADMs

Summary

Introduction

People living with HIV (PLHIV) are more likely to develop cancer than those not infected with HIV.[1]. The incidence of ADMs and NADMs among PLHIV has been well-studied[2,9,10,11] but there is a lack of information on survival outcomes after specific cancer diagnoses. Few studies have analysed 5-year survival after specific cancer diagnoses among PLHIV12–20 and they were limited to prognosis after diagnosis of ADMs,[12,19] or included untreated PLHIV14,15 who have worse prognosis than those on ART.[5] Little information is available on causes of death among PLHIV after diagnosis of cancer. Patterns of survival after cancer diagnosis are affected by several factors. Mortality rates vary considerably between different types of cancer and stages of cancer.[21] In the general population, a death after a diagnosis of cancer may be more likely due to that cancer than in PLHIV because of the competing risks of death due to AIDS and other HIV-related conditions. There are differences in the demographics of those diagnosed with cancer in the general population compared to PLHIV, which may explain differences in patterns of death.[22,23]

Methods

Results

Conclusion