title: Elevated Cancer-Specific Mortality Among HIV-Infected Patients in the United States.
abstract: OBJECTIVE
  Despite advances in the treatment of HIV, HIV-infected people remain at increased risk for many cancers, and the number of non-AIDS-defining cancers is increasing with the aging of the HIV-infected population. No prior study has comprehensively evaluated the effect of HIV on cancer-specific mortality.
  
  
  METHODS
  We identified cases of 14 common cancers occurring from 1996 to 2010 in six US states participating in a linkage of cancer and HIV/AIDS registries. We used Cox regression to examine the association between patient HIV status and death resulting from the presenting cancer (ascertained from death certificates), adjusting for age, sex, race/ethnicity, year of cancer diagnosis, and cancer stage. We included 1,816,461 patients with cancer, 6,459 (0.36%) of whom were HIV infected.
  
  
  RESULTS
  Cancer-specific mortality was significantly elevated in HIV-infected compared with HIV-uninfected patients for many cancers: colorectum (adjusted hazard ratio [HR], 1.49; 95% CI, 1.21 to 1.84), pancreas (HR, 1.71; 95% CI, 1.35 to 2.18), larynx (HR, 1.62; 95% CI, 1.06 to 2.47), lung (HR, 1.28; 95% CI, 1.17 to 1.39), melanoma (HR, 1.72; 95% CI, 1.09 to 2.70), breast (HR, 2.61; 95% CI, 2.06 to 3.31), and prostate (HR, 1.57; 95% CI, 1.02 to 2.41). HIV was not associated with increased cancer-specific mortality for anal cancer, Hodgkin lymphoma, or diffuse large B-cell lymphoma. After further adjustment for cancer treatment, HIV remained associated with elevated cancer-specific mortality for common non-AIDS-defining cancers: colorectum (HR, 1.40; 95% CI, 1.09 to 1.80), lung (HR, 1.28; 95% CI, 1.14 to 1.44), melanoma (HR, 1.93; 95% CI, 1.14 to 3.27), and breast (HR, 2.64; 95% CI, 1.86 to 3.73).
  
  
  CONCLUSIONS
  HIV-infected patients with cancer experienced higher cancer-specific mortality than HIV-uninfected patients, independent of cancer stage or receipt of cancer treatment. The elevation in cancer-specific mortality among HIV-infected patients may be attributable to unmeasured stage or treatment differences as well as a direct relationship between immunosuppression and tumor progression.
authors.affiliation: Anna E. Coghill, Meredith S. Shiels, and Eric A. Engels, National Cancer Institute, Rockville, MD; and Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT. anna.coghill@nih.gov.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Coghill
authors.affiliation: Anna E. Coghill, Meredith S. Shiels, and Eric A. Engels, National Cancer Institute, Rockville, MD; and Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Meredith S
authors.initials: MS
authors.lastname: Shiels
authors.affiliation: Anna E. Coghill, Meredith S. Shiels, and Eric A. Engels, National Cancer Institute, Rockville, MD; and Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Gita
authors.initials: G
authors.lastname: Suneja
authors.affiliation: Anna E. Coghill, Meredith S. Shiels, and Eric A. Engels, National Cancer Institute, Rockville, MD; and Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D012042:Registries; D012307:Risk Factors; D014481:United States / Q000453:epidemiology