Advanced

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

Shepherd, L.; Borges, H.; Ledergerber, B.; Domingo, P.; Castagna, A.; Rockstroh, J.; Knysz, B.; Tomazic, J.; Karpov, I. and Kirk, O., et al. (2016) In HIV Medicine 17(8). p.590-600
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:... (More)

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.

(Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
aging, HIV, malignancies, virus-associated malignancies
in
HIV Medicine
volume
17
issue
8
pages
11 pages
publisher
Wiley-Blackwell
external identifiers
  • Scopus:84983565599
ISSN
1464-2662
DOI
10.1111/hiv.12359
language
English
LU publication?
yes
id
ee676ae3-dccb-4914-ae50-6fe58a158462
date added to LUP
2016-09-20 16:50:00
date last changed
2016-11-03 14:33:40
@misc{ee676ae3-dccb-4914-ae50-6fe58a158462,
  abstract     = {<p>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 &lt; 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 &lt; 200 cells/μL was associated with IURMs in people aged &lt; 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.</p>},
  author       = {Shepherd, L. and Borges,  H. and Ledergerber, B. and Domingo, P. and Castagna, A. and Rockstroh, J. and Knysz, B. and Tomazic, J. and Karpov, I. and Kirk, O. and Lundgren, Jens D and Mocroft, A. and Losso, M. and Kundro, M. and Vetter, N. and Zangerle, R. and Karpov, I. and Vassilenko, A. and Mitsura, V. M. and Suetnov, O. and Clumeck, N. and De Wit, S. and Delforge, M. and Florence, E. and Vandekerckhove, L. and Hadziosmanovic, V. and Kostov, K. and Begovac, J. and Machala, L. and Jilich, D. and Sedlacek, D. and Nielsen, J. and Kronborg, G. and Benfield, T. and Larsen, M. and Gerstoft, J. and Katzenstein, T. and Hansen, A. B E and Skinhøj, P. and Pedersen, C. and Ostergaard, L. and Dragsted, U. B. and Nielsen, L. N. and Zilmer, K. and Smidt, J. and Ristola, M. and Katlama, C. and Viard, J. P. and Girard, P. M. and Vanhems, P. and Pradier, C. and Dabis, F. and Neau, D. and Duvivier, C. and Rockstroh, J. and Schmidt, R. and van Lunzen, J. and Degen, O. and Stellbrink, H. J. and Bickel, M. and Bogner, J. and Fätkenheuer, G. and Kosmidis, J. and Gargalianos, P. and Xylomenos, G. and Perdios, J. and Sambatakou, H. and Banhegyi, D. and Gottfredsson, M. and Mulcahy, F. and Yust, I. and Turner, D. and Burke, M. and Pollack, S. and Hassoun, G. and Elinav, H. and Haouzi, M. and D’Arminio Monforte, A. and Esposito, R. and Mazeu, I. and Mussini, C. and Arici, C. and Pristera, R. and Mazzotta, F. and Gabbuti, A. and Vullo, V. and Lichtner, M. and Chirianni, A. and Montesarchio, E. and Gargiulo, M. and D‘Offizi, G. and Taibi, C. and Antinori, A. and Lazzarin, A. and Castagna, A. and Gianotti, N. and Galli, M. and Ridolfo, A. and Rozentale, B. and Zeltina, I. and Chaplinskas, S. and Staub, T. and Hemmer, R. and Reiss, P. and Ormaasen, V. and Maeland, A. and Bruun, J. and Knysz, B. and Gasiorowski, J. and Horban, A. and Bakowska, E. and Grzeszczuk, A. and Flisiak, R. and Boron-Kaczmarska, A. and Pynka, M. and Parczewski, M. and Beniowski, M. and Mularska, E. and Trocha, H. and Jablonowska, E. and Malolepsza, E. and Wojcik, K. and Doroana, M. and Caldeira, L. and Mansinho, K. and Maltez, F. and Duiculescu, D. and Rakhmanova, A. and Rakhmanova, A. and Buzunova, S. and Khromova, I. and Kuzovatova, E. and Jevtovic, D. and Mokráš, M. and Staneková, D. and Tomazic, J. and González-Lahoz, J. and Soriano, V. and Labarga, P. and Moreno, S. and Rodriguez, J. M. and Clotet, B. and Jou, A. and Paredes, R. and Tural, C. and Puig, J. and Bravo, I. and Gatell, J. M. and Miró, J. M. and Domingo, P. and Gutierrez, M. and Mateo, G. and Sambeat, M. A. and Medrano, J. and BlaxhultBlaxhult, A. and Flamholc, L. and Thalme, A. and Sonnerborg, A. and Ledergerber, B. and Weber, R. and Francioli, P. and Cavassini, M. and Hirschel, B. and Boffi, E. and Furrer, H. and Battegay, M. and Elzi, L. and Vernazza, P. and Kravchenko, E. and Chentsova, N. and Frolov, V. and Kutsyna, G. and Servitskiy, S. and Kuznetsova, A. and Kyselyova, G. and Gazzard, B. and Johnson, A. M. and Simons, E. and Phillips, A. and Johnson, M. A. and Mocroft, A. and Orkin, C. and Weber, J. and Scullard, G. and Fisher, M. and Leen, C. and Gatell, J. and Gazzard, B. and Horban, A. and Karpov, I. and Ledergerber, B. and Losso, M. and D’Arminio Monforte, A. and Pedersen, C. and Rakhmanova, A. and Ristola, M. and Rockstroh, J. and De Witt, S. and Lundgren, J. and Phillips, A. and Reiss, P. and Kirk, O. and Mocroft, A. and Cozzi-Lepri, A. and Grint, D. and Schultze, A. and Shepherd, L. and Raben, D. and Podlekareva, D. and Kjær, J. and Peters, L. and Nielsen, J. E. and Matthews, C. and Fischer, A. H. and Bojesen, A. and Kirk, O. and Mocroft, A. and Grarup, J. and Reiss, P. and Cozzi-Lepri, A. and Thiebaut, R. and Rockstroh, J. and Burger, D. and Paredes, R. and Kjær, J. and Peters, L.},
  issn         = {1464-2662},
  keyword      = {aging,HIV,malignancies,virus-associated malignancies},
  language     = {eng},
  month        = {09},
  number       = {8},
  pages        = {590--600},
  publisher    = {ARRAY(0x8dcde08)},
  series       = {HIV Medicine},
  title        = {Infection-related and -unrelated malignancies, HIV and the aging population},
  url          = {http://dx.doi.org/10.1111/hiv.12359},
  volume       = {17},
  year         = {2016},
}