title: Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era: 1997-2012.
abstract: Utilizing the Veterans Aging Cohort Study, the largest HIV cohort in North America, we conducted one of the few comprehensive comparisons of cancer incidence time trends in HIV-infected (HIV+) versus uninfected persons during the antiretroviral therapy (ART) era.
  
  
  
  Prospective cohort study.
  
  
  
  We followed 44 787 HIV+ and 96 852 demographically matched uninfected persons during 1997-2012. We calculated age-, sex-, and race/ethnicity-standardized incidence rates and incidence rate ratios (IRR, HIV+ versus uninfected) over four calendar periods with incidence rate and IRR period trend P values for cancer groupings and specific cancer types.
  
  
  
  We observed 3714 incident cancer diagnoses in HIV+ and 5760 in uninfected persons. The HIV+ all-cancer crude incidence rate increased between 1997-2000 and 2009-2012 (P trend = 0.0019). However, after standardization, we observed highly significant HIV+ incidence rate declines for all cancer (25% decline; P trend <0.0001), AIDS-defining cancers (55% decline; P trend <0.0001), nonAIDS-defining cancers (NADC; 15% decline; P trend = 0.0003), and nonvirus-related NADC (20% decline; P trend <0.0001); significant IRR declines for all cancer (from 2.0 to 1.6; P trend <0.0001), AIDS-defining cancers (from 19 to 5.5; P trend <0.0001), and nonvirus-related NADC (from 1.4 to 1.2; P trend = 0.049); and borderline significant IRR declines for NADC (from 1.6 to 1.4; P trend = 0.078) and virus-related NADC (from 4.9 to 3.5; P trend = 0.071).
  
  
  
  Improved HIV care resulting in improved immune function most likely contributed to the HIV+ incidence rate and the IRR declines. Further promotion of early and sustained ART, improved ART regimens, reduction of traditional cancer risk factor (e.g. smoking) prevalence, and evidence-based screening could contribute to future cancer incidence declines among HIV+ persons.
authors.affiliation: aStanford University School of Medicine, Stanford, California bVeterans Affairs Connecticut Healthcare System, West Haven cYale School of Medicine, New Haven, Connecticut dIcahn School of Medicine at Mt. Sinai, New York, New York eAtlanta Veterans Affairs Medical Center fEmory University School of Medicine, Atlanta, Georgia gUniversity of Washington School of Medicine, Seattle, Washington hWashington DC Veterans Affairs Medical Center iGeorge Washington University School of Medicine and Health Sciences, Washington, District of Columbia jMichael E. DeBakey Veterans Affairs Medical Center kBaylor College of Medicine, Houston, Texas lVeterans Affairs Greater Los Angeles Healthcare System mDavid Geffen School of Medicine, University of California, Los Angeles, California nVeterans Affairs North Texas Healthcare System oUniversity of Texas Southwestern Medical Center, Dallas, Texas pJames J. Peters Veterans Affairs Medical Center, New York, New York qYale School of Public Health, New Haven, Connecticut, USA.
authors.forename: Lesley S
authors.initials: LS
authors.lastname: Park
authors.forename: Janet P
authors.initials: JP
authors.lastname: Tate
authors.forename: Keith
authors.initials: K
authors.lastname: Sigel
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Bedimo
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Robert
authors.initials: R
authors.lastname: Dubrow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009656:North America / Q000453:epidemiology; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents