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Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study

BACKGROUND: Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004–2010, and described subsequent mortality and predictors o...

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Autores principales: Worm, Signe W, Bower, Mark, Reiss, Peter, Bonnet, Fabrice, Law, Matthew, Fätkenheuer, Gerd, d’Arminio Monforte, Antonella, Abrams, Donald I, Grulich, Andrew, Fontas, Eric, Kirk, Ole, Furrer, Hansjakob, Wit, Stephane De, Phillips, Andrew, Lundgren, Jens D, Sabin, Caroline A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3852673/
https://www.ncbi.nlm.nih.gov/pubmed/24106926
http://dx.doi.org/10.1186/1471-2334-13-471
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author Worm, Signe W
Bower, Mark
Reiss, Peter
Bonnet, Fabrice
Law, Matthew
Fätkenheuer, Gerd
d’Arminio Monforte, Antonella
Abrams, Donald I
Grulich, Andrew
Fontas, Eric
Kirk, Ole
Furrer, Hansjakob
Wit, Stephane De
Phillips, Andrew
Lundgren, Jens D
Sabin, Caroline A
author_facet Worm, Signe W
Bower, Mark
Reiss, Peter
Bonnet, Fabrice
Law, Matthew
Fätkenheuer, Gerd
d’Arminio Monforte, Antonella
Abrams, Donald I
Grulich, Andrew
Fontas, Eric
Kirk, Ole
Furrer, Hansjakob
Wit, Stephane De
Phillips, Andrew
Lundgren, Jens D
Sabin, Caroline A
author_sort Worm, Signe W
collection PubMed
description BACKGROUND: Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004–2010, and described subsequent mortality and predictors of these. METHODS: Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient’s last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient’s death, 1st February 2010 or 6 months after the patient’s last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression. RESULTS: Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin’s lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004–2010 in this large observational cohort. CONCLUSIONS: The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC.
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spelling pubmed-38526732013-12-06 Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study Worm, Signe W Bower, Mark Reiss, Peter Bonnet, Fabrice Law, Matthew Fätkenheuer, Gerd d’Arminio Monforte, Antonella Abrams, Donald I Grulich, Andrew Fontas, Eric Kirk, Ole Furrer, Hansjakob Wit, Stephane De Phillips, Andrew Lundgren, Jens D Sabin, Caroline A BMC Infect Dis Research Article BACKGROUND: Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004–2010, and described subsequent mortality and predictors of these. METHODS: Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient’s last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient’s death, 1st February 2010 or 6 months after the patient’s last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression. RESULTS: Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin’s lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004–2010 in this large observational cohort. CONCLUSIONS: The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC. BioMed Central 2013-10-09 /pmc/articles/PMC3852673/ /pubmed/24106926 http://dx.doi.org/10.1186/1471-2334-13-471 Text en Copyright © 2013 Worm et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Worm, Signe W
Bower, Mark
Reiss, Peter
Bonnet, Fabrice
Law, Matthew
Fätkenheuer, Gerd
d’Arminio Monforte, Antonella
Abrams, Donald I
Grulich, Andrew
Fontas, Eric
Kirk, Ole
Furrer, Hansjakob
Wit, Stephane De
Phillips, Andrew
Lundgren, Jens D
Sabin, Caroline A
Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study
title Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study
title_full Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study
title_fullStr Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study
title_full_unstemmed Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study
title_short Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival: a cohort study
title_sort non-aids defining cancers in the d:a:d study - time trends and predictors of survival: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3852673/
https://www.ncbi.nlm.nih.gov/pubmed/24106926
http://dx.doi.org/10.1186/1471-2334-13-471
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