Cause-specific mortality after diagnosis of cancer among HIV-positive patients: A Collaborative analysis of cohort studies. International Journal of Cancer
Trickey et al. on behalf of COHERE in EuroCoord aimed to investigate causes of death within 5 years of cancer diagnosis in people living with HIV (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 in AIDS-defining malignancies (ADMs), viral non-ADMs (NADMs) and nonviral NADMs.
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. Cause-specific mortality rates (MR) were higher for diagnoses between 1996 and 2005 versus 2006–2015: ADMs 102 (95%CI92–113) 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.
In conclusion, among PLHIV diagnosed with cancer, deaths due to an ADM were the leading cause of death after an ADM diagnosis while deaths due to an NADM were the leading cause of death after diagnosis of nonviral NADMs. Deaths after diagnosis with viral NADMs were most likely to be due to a NADM or due to other causes, many of which were classified as due to viral hepatitis. As the cohort of PLHIV ages, they will be at increased risk of cancers not considered related to HIV and many of these cancers are linked to lifestyle factors and comorbidities such as smoking and hepatitis C virus, Hence, emphasis should be placed on targeting such behaviours and treating co-morbidities such as chronic viral hepatitis in order to prevent cancer.