title: Incidence and timing of cancer in HIV-infected individuals following initiation of combination antiretroviral therapy.
abstract: BACKGROUND
  Cancer is an important cause of morbidity and mortality in individuals infected with human immunodeficiency virus (HIV), but patterns of cancer incidence after combination antiretroviral therapy (ART) initiation remain poorly characterized.
  
  
  METHODS
  We evaluated the incidence and timing of cancer diagnoses among patients initiating ART between 1996 and 2011 in a collaboration of 8 US clinical HIV cohorts. Poisson regression was used to estimate incidence rates. Cox regression was used to identify demographic and clinical characteristics associated with cancer incidence after ART initiation.
  
  
  RESULTS
  At initiation of first combination ART among 11 485 patients, median year was 2004 (interquartile range [IQR], 2000-2007) and median CD4 count was 202 cells/mm(3) (IQR, 61-338). Incidence rates for Kaposi sarcoma (KS) and lymphomas were highest in the first 6 months after ART initiation (P < .001) and plateaued thereafter, while incidence rates for all other cancers combined increased from 416 to 615 cases per 100 000 person-years from 1 to 10 years after ART initiation (average 7% increase per year; 95% confidence interval, 2%-13%). Lower CD4 count at ART initiation was associated with greater risk of KS, lymphoma, and human papillomavirus-related cancer. Calendar year of ART initiation was not associated with cancer incidence.
  
  
  CONCLUSIONS
  KS and lymphoma rates were highest immediately following ART initiation, particularly among patients with low CD4 cell counts, whereas other cancers increased with time on ART, likely reflecting increased cancer risk with aging. Our results underscore recommendations for earlier HIV diagnosis followed by prompt ART initiation along with ongoing aggressive cancer screening and prevention efforts throughout the course of HIV care.
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA. elizabeth_yanik@med.unc.edu
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Yanik
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Achenbach
authors.forename: Satish
authors.initials: S
authors.lastname: Gopal
authors.forename: Andrew
authors.initials: A
authors.lastname: Olshan
authors.forename: Dirk P
authors.initials: DP
authors.lastname: Dittmer
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: Michael
authors.initials: M
authors.lastname: Saag
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.forename: W Christopher
authors.initials: WC
authors.lastname: Mathews
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.forename: Benigno
authors.initials: B
authors.lastname: Rodriguez
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS-defining cancer; HIV-associated malignancies; combination antiretroviral therapy; non-AIDS-defining cancer