Infection-related and -unrelated malignancies, HIV and the aging population

L Shepherd, Áh Borges, B Ledergerber, P Domingo, A Castagna, J Rockstroh, B Knysz, J Tomazic, I Karpov, O Kirk, J Lundgren, A Mocroft, EuroSIDA in EuroCoord, Court Pedersen (Member of author group)

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVES: HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-unrelated malignancies (IURMs). The aim of the study was to determine the impact of aging on future IRM and IURM incidence.

METHODS: People enrolled in EuroSIDA 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 IRMs and IURMs, 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 [IRMs: 388 (60%); IURMs: 255 (40%)]. After adjustment, a higher IRM incidence was associated with a lower CD4 count [adjusted incidence rate ratio (aIRR) CD4 count < 200 cells/μL: 3.77; 95% confidence interval (CI) 2.59, 5.51; compared with ≥ 500 cells/μL], independent of age, while a CD4 count < 200 cells/μL was associated with IURMs in people aged < 50 years only (aIRR: 2.51; 95% CI 1.40-4.54). Smoking was associated with IURMs (aIRR: 1.75; 95% CI 1.23, 2.49) compared with never smokers in people aged ≥ 50 years only, and not with IRMs. The incidences of both IURMs and IRMs increased with older age. It was projected that the incidence of IRMs 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 IURMs (aging and smoking) and IRMs (immunodeficiency and ongoing viral replication) differ markedly and the contribution from IURMs relative to IRMs 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 IURMs in HIV-infected populations.

Original languageEnglish
JournalHIV Medicine
Volume17
Issue number8
Pages (from-to)590-600
ISSN1464-2662
DOIs
Publication statusPublished - 2016

Fingerprint

HIV
Population
Neoplasms
Incidence
Confidence Intervals
Smoking
Social Adjustment
Cost-Benefit Analysis

Cite this

Shepherd, L., Borges, Á., Ledergerber, B., Domingo, P., Castagna, A., Rockstroh, J., ... Pedersen, C. (2016). Infection-related and -unrelated malignancies, HIV and the aging population. HIV Medicine, 17(8), 590-600. https://doi.org/10.1111/hiv.12359
Shepherd, L ; Borges, Áh ; Ledergerber, B ; Domingo, P ; Castagna, A ; Rockstroh, J ; Knysz, B ; Tomazic, J ; Karpov, I ; Kirk, O ; Lundgren, J ; Mocroft, A ; EuroSIDA in EuroCoord ; Pedersen, Court. / Infection-related and -unrelated malignancies, HIV and the aging population. In: HIV Medicine. 2016 ; Vol. 17, No. 8. pp. 590-600.
@article{f279fbcc92be417886cde6d2786662f6,
title = "Infection-related and -unrelated malignancies, HIV and the aging population",
abstract = "OBJECTIVES: HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-unrelated malignancies (IURMs). The aim of the study was to determine the impact of aging on future IRM and IURM incidence.METHODS: People enrolled in EuroSIDA 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 IRMs and IURMs, 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 [IRMs: 388 (60{\%}); IURMs: 255 (40{\%})]. After adjustment, a higher IRM incidence was associated with a lower CD4 count [adjusted incidence rate ratio (aIRR) CD4 count < 200 cells/μL: 3.77; 95{\%} confidence interval (CI) 2.59, 5.51; compared with ≥ 500 cells/μL], independent of age, while a CD4 count < 200 cells/μL was associated with IURMs in people aged < 50 years only (aIRR: 2.51; 95{\%} CI 1.40-4.54). Smoking was associated with IURMs (aIRR: 1.75; 95{\%} CI 1.23, 2.49) compared with never smokers in people aged ≥ 50 years only, and not with IRMs. The incidences of both IURMs and IRMs increased with older age. It was projected that the incidence of IRMs 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 IURMs (aging and smoking) and IRMs (immunodeficiency and ongoing viral replication) differ markedly and the contribution from IURMs relative to IRMs 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 IURMs in HIV-infected populations.",
author = "L Shepherd and {\'A}h Borges and B Ledergerber and P Domingo and A Castagna and J Rockstroh and B Knysz and J Tomazic and I Karpov and O Kirk and J Lundgren and A Mocroft and {EuroSIDA in EuroCoord} and Court Pedersen",
note = "{\circledC} 2016 British HIV Association.",
year = "2016",
doi = "10.1111/hiv.12359",
language = "English",
volume = "17",
pages = "590--600",
journal = "HIV Medicine",
issn = "1464-2662",
publisher = "Wiley-Blackwell",
number = "8",

}

Shepherd, L, Borges, Á, Ledergerber, B, Domingo, P, Castagna, A, Rockstroh, J, Knysz, B, Tomazic, J, Karpov, I, Kirk, O, Lundgren, J, Mocroft, A, EuroSIDA in EuroCoord & Pedersen, C 2016, 'Infection-related and -unrelated malignancies, HIV and the aging population', HIV Medicine, vol. 17, no. 8, pp. 590-600. https://doi.org/10.1111/hiv.12359

Infection-related and -unrelated malignancies, HIV and the aging population. / Shepherd, L; Borges, Áh; Ledergerber, B; Domingo, P; Castagna, A; Rockstroh, J; Knysz, B; Tomazic, J; Karpov, I; Kirk, O; Lundgren, J; Mocroft, A; EuroSIDA in EuroCoord ; Pedersen, Court (Member of author group).

In: HIV Medicine, Vol. 17, No. 8, 2016, p. 590-600.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Infection-related and -unrelated malignancies, HIV and the aging population

AU - Shepherd, L

AU - Borges, Áh

AU - Ledergerber, B

AU - Domingo, P

AU - Castagna, A

AU - Rockstroh, J

AU - Knysz, B

AU - Tomazic, J

AU - Karpov, I

AU - Kirk, O

AU - Lundgren, J

AU - Mocroft, A

AU - EuroSIDA in EuroCoord

A2 - Pedersen, Court

N1 - © 2016 British HIV Association.

PY - 2016

Y1 - 2016

N2 - OBJECTIVES: HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-unrelated malignancies (IURMs). The aim of the study was to determine the impact of aging on future IRM and IURM incidence.METHODS: People enrolled in EuroSIDA 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 IRMs and IURMs, 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 [IRMs: 388 (60%); IURMs: 255 (40%)]. After adjustment, a higher IRM incidence was associated with a lower CD4 count [adjusted incidence rate ratio (aIRR) CD4 count < 200 cells/μL: 3.77; 95% confidence interval (CI) 2.59, 5.51; compared with ≥ 500 cells/μL], independent of age, while a CD4 count < 200 cells/μL was associated with IURMs in people aged < 50 years only (aIRR: 2.51; 95% CI 1.40-4.54). Smoking was associated with IURMs (aIRR: 1.75; 95% CI 1.23, 2.49) compared with never smokers in people aged ≥ 50 years only, and not with IRMs. The incidences of both IURMs and IRMs increased with older age. It was projected that the incidence of IRMs 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 IURMs (aging and smoking) and IRMs (immunodeficiency and ongoing viral replication) differ markedly and the contribution from IURMs relative to IRMs 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 IURMs in HIV-infected populations.

AB - OBJECTIVES: HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-unrelated malignancies (IURMs). The aim of the study was to determine the impact of aging on future IRM and IURM incidence.METHODS: People enrolled in EuroSIDA 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 IRMs and IURMs, 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 [IRMs: 388 (60%); IURMs: 255 (40%)]. After adjustment, a higher IRM incidence was associated with a lower CD4 count [adjusted incidence rate ratio (aIRR) CD4 count < 200 cells/μL: 3.77; 95% confidence interval (CI) 2.59, 5.51; compared with ≥ 500 cells/μL], independent of age, while a CD4 count < 200 cells/μL was associated with IURMs in people aged < 50 years only (aIRR: 2.51; 95% CI 1.40-4.54). Smoking was associated with IURMs (aIRR: 1.75; 95% CI 1.23, 2.49) compared with never smokers in people aged ≥ 50 years only, and not with IRMs. The incidences of both IURMs and IRMs increased with older age. It was projected that the incidence of IRMs 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 IURMs (aging and smoking) and IRMs (immunodeficiency and ongoing viral replication) differ markedly and the contribution from IURMs relative to IRMs 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 IURMs in HIV-infected populations.

U2 - 10.1111/hiv.12359

DO - 10.1111/hiv.12359

M3 - Journal article

C2 - 26890156

VL - 17

SP - 590

EP - 600

JO - HIV Medicine

JF - HIV Medicine

SN - 1464-2662

IS - 8

ER -

Shepherd L, Borges Á, Ledergerber B, Domingo P, Castagna A, Rockstroh J et al. Infection-related and -unrelated malignancies, HIV and the aging population. HIV Medicine. 2016;17(8):590-600. https://doi.org/10.1111/hiv.12359