Trends in infection-related and infection-unrelated cancer incidence among people with and without HIV infection in Ontario, Canada, 1996-2020: a population-based matched cohort study using health administrative data.

CMAJ open Pub Date : 2023-10-10 Print Date: 2023-09-01 DOI:10.9778/cmajo.20220230
Ioana A Nicolau, Rahim Moineddin, Tony Antoniou, Jennifer D Brooks, Jennifer L Gillis, Claire E Kendall, Curtis Cooper, Michelle Cotterchio, Kate Salters, Marek Smieja, Abigail E Kroch, Joanne D Lindsay, Colleen Price, Anthony Mohamed, Ann N Burchell
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引用次数: 0

Abstract

Background: People with HIV infection are at higher risk for certain cancers than the general population. We compared trends in infection-related and infection-unrelated cancers among people with and without HIV infection.

Methods: We conducted a retrospective population-based matched cohort study of adults with and without HIV infection using linked health administrative databases in Ontario, Canada. Participants were matched on birth year, sex, census division (rurality), neighbourhood income quintile and region of birth. We followed participants from cohort entry until the earliest of date of cancer diagnosis, date of death, Nov. 1, 2020, or date of loss to follow-up. Incident cancers identified from Jan. 1, 1996, to Nov. 1, 2020, were categorized as infection-related or-unrelated. We examined calendar periods 1996-2003, 2004-2011 and 2012-2020, corresponding to the early combination antiretroviral therapy (cART), established cART and contemporary cART eras, respectively. We used competing risk analyses to examine trends in cumulative incidence by calendar period, age and sex, and cause-specific hazard ratios (HRs).

Results: We matched 20 304 people with HIV infection to 20 304 people without HIV infection. A total of 2437 cancers were diagnosed, 1534 (62.9%) among infected people and 903 (37.0%) among uninfected people. The risk of infection-related cancer by age 65 years for people with HIV infection decreased from 19.0% (95% confidence interval [CI] 15.6%-22.3%) in 1996-2011 to 10.0% (95% CI 7.9%-12.1%) in 2012-2020. Compared to uninfected people, those with HIV infection had similar HRs of infection-unrelated cancer but increased rates of infection-related cancer, particularly among younger age groups (25.1 [95% CI 13.2-47.4] v. 1.9 [95% CI 1.0-3.7] for age 18-39 yr v. ≥ 70 yr); these trends were consistent when examined by sex.Interpretation: We observed significantly higher rates of infection-related, but not infection-unrelated, cancer among people with HIV infection than among uninfected people. The elevated rate of infection-related cancer in 2012-2020 highlights the importance of early and sustained antiretroviral therapy along with cancer screening and prevention measures.

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1996-2020年加拿大安大略省艾滋病毒感染者和非艾滋病毒感染者中与感染相关和与感染无关的癌症发病率趋势:一项使用卫生管理数据的基于人群的匹配队列研究。
背景:艾滋病毒感染者比普通人群患某些癌症的风险更高。我们比较了艾滋病毒感染者和未感染者中与感染相关和与感染无关的癌症的趋势。方法:我们使用加拿大安大略省的相关卫生管理数据库,对感染和未感染艾滋病毒的成年人进行了一项基于人群的回顾性匹配队列研究。参与者根据出生年份、性别、人口普查划分(农村)、邻里收入五分位数和出生地区进行匹配。我们从进入队列到癌症诊断日期、死亡日期、2020年11月1日或失去随访日期的最早时间对参与者进行了跟踪。1996年1月1日至2020年11月1日期间发现的偶发癌症被归类为感染相关或无关。我们检查了1996-2003年、2004-2011年和2012-2020年的日历期,分别对应于早期联合抗逆转录病毒疗法(cART)、已建立的cART和当代cART时代。我们使用竞争风险分析来检查按日历期、年龄和性别以及病因特异性危险比(HR)划分的累计发病率趋势。共诊断出2437种癌症,1534种(62.9%)在感染者中,903种(37.0%)在未感染者中。艾滋病毒感染者65岁时感染相关癌症的风险从1996-2011年的19.0%(95%置信区间为15.6%-22.3%)降至2012-2020年的10.0%(95%可信区间为7.9%-12.1%)。与未感染者相比,艾滋病毒感染者的感染无关的癌症HR相似,但感染相关的癌症发病率增加,尤其是在年轻组中(18-39岁组为25.1[95%CI 13.2-47.4],1.9[95%CI 1.0-3.7],≥70岁组);从性别角度来看,这些趋势是一致的。解释:我们观察到,艾滋病毒感染者中与感染相关但与感染无关的癌症发生率明显高于未感染者。2012-2020年感染相关癌症发病率的上升突出了早期和持续抗逆转录病毒治疗以及癌症筛查和预防措施的重要性。
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