Lee Kamaria L, Sarovar Varada, Lam Jennifer O, Leyden Wendy A, Alexeeff Stacey E, Lea Alexandra N, Hechter Rulin C, Hu Haihong, Marcus Julia L, Yuan Qing, Kramer Jennifer R, Lin Lilie L, Chiao Elizabeth Y, Towner William J, Horberg Michael A, Silverberg Michael J
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Division of Research, Kaiser Permanente Northern California, Pleasanton, California.
Cancer Epidemiol Biomarkers Prev. 2024 Dec 2;33(12):1698-1705. doi: 10.1158/1055-9965.EPI-24-0478.
With extended lifespans for people with human immunodeficiency virus (PWH), there is a corresponding increased burden of chronic illnesses, including cancer. Our objective was to estimate the excess mortality among PWH with cancer compared with people without HIV (PWoH), accounting for the higher background mortality in the general PWH population.
We identified 39,000 PWH and 387,767 demographically matched PWoH in three integrated healthcare systems from 2000 to 2016. We estimated excess mortality among PWH with cancer, computed as the cancer mortality rate difference-in-difference comparing PWH and PWoH. We evaluated five cancer groups: any cancer; virus-, human papillomavirus-, and Epstein-Barr virus -related cancers; virus-unrelated cancers, and common individual cancers. We fitted a multivariable additive Poisson model to estimate excess mortality among PWH with cancer.
PWH with any cancer had excess mortality compared with PWoH [41.3/1,000 person-years (py), 95% confidence interval (CI), 34.0-48.7]. The highest excess mortality was observed for Epstein-Barr virus-related cancers (63.2/1,000 py, 95% CI, 47.8-78.7), lung cancer (147.7/1,000 py, 95% CI, 41.1-254.3), and non-Hodgkin lymphoma (70.5/1,000 py, 95% CI, 51.4-89.6). Excess mortality among PWH was attenuated from 2009 to 2016, and PWH with cancer had no excess mortality 5 years after diagnosis.
PWH in care may have excess mortality from certain cancer types, although disparities may have attenuated over time and do not persist beyond 5 years after diagnosis.
Findings may guide improved clinical practice and suggest further research is needed to investigate whether cancer treatment or other factors contribute to mortality disparities for PWH with cancer.
随着人类免疫缺陷病毒感染者（PWH）寿命的延长，包括癌症在内的慢性病负担相应增加。我们的目标是估计患癌症的PWH与未感染艾滋病毒者（PWoH）相比的超额死亡率，同时考虑到一般PWH人群较高的背景死亡率。
我们在2000年至2016年期间，从三个综合医疗系统中识别出39,000名PWH和387,767名人口统计学匹配的PWoH。我们估计了患癌症的PWH的超额死亡率，计算方法是比较PWH和PWoH的癌症死亡率差值。我们评估了五个癌症组：任何癌症；病毒、人乳头瘤病毒和爱泼斯坦-巴尔病毒相关癌症；病毒无关癌症，以及常见的个体癌症。我们拟合了一个多变量加法泊松模型，以估计患癌症的PWH的超额死亡率。
与PWoH相比，患任何癌症的PWH都有超额死亡率[41.3/1000人年（py），95%置信区间（CI），34.0 - 48.7]。爱泼斯坦-巴尔病毒相关癌症（63.2/1000 py，95% CI，47.8 - 78.7）、肺癌（147.7/1000 py，95% CI，41.1 - 254.3）和非霍奇金淋巴瘤（70.5/1000 py，95% CI，51.4 - 89.6）的超额死亡率最高。2009年至2016年期间，PWH的超额死亡率有所下降，患癌症的PWH在诊断后5年没有超额死亡率。
接受治疗的PWH可能因某些癌症类型而有超额死亡率，尽管差异可能随着时间的推移而减弱，并且在诊断后5年以上不会持续存在。
研究结果可能指导改进临床实践，并表明需要进一步研究，以调查癌症治疗或其他因素是否导致患癌症的PWH的死亡率差异。
