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Cancer burden attributable to cigarette smoking among HIV-infected people in North America.

Cancer burden attributable to cigarette smoking among HIV-infected people in North America.
Author Information (click to view)

Altekruse SF, Shiels MS, Modur SP, Land SR, Crothers KA, Kitahata MM, Thorne JE, Mathews WC, Fernández-Santos DM, Mayor AM, Gill JM, Horberg MA, Brooks JT, Moore RD, Silverberg MJ, Althoff KN, Engels EA,


Altekruse SF, Shiels MS, Modur SP, Land SR, Crothers KA, Kitahata MM, Thorne JE, Mathews WC, Fernández-Santos DM, Mayor AM, Gill JM, Horberg MA, Brooks JT, Moore RD, Silverberg MJ, Althoff KN, Engels EA, (click to view)

Altekruse SF, Shiels MS, Modur SP, Land SR, Crothers KA, Kitahata MM, Thorne JE, Mathews WC, Fernández-Santos DM, Mayor AM, Gill JM, Horberg MA, Brooks JT, Moore RD, Silverberg MJ, Althoff KN, Engels EA,

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AIDS (London, England) 2017 12 12() doi 10.1097/QAD.0000000000001721

Abstract
OBJECTIVE
With combination-antiretroviral therapy, HIV-infected individuals live longer with an elevated burden of cancer. Given the high prevalence of smoking among HIV-infected populations, we examined the risk of incident cancers attributable to ever smoking cigarettes.

DESIGN
Observational cohort of HIV-infected participants with 270,136 person-years of follow-up in the North American AIDS Cohort Collaboration on Research and Design consortium. Among 52,441 participants; 2306 were diagnosed with cancer during 2000-2015.

MAIN OUTCOME MEASURES
Estimated hazard ratios (HR) and population-attributable fractions (PAF) associated with ever cigarette smoking for all cancers combined, smoking-related cancers, and cancers that were not attributed to smoking.

RESULTS
People with cancer were more frequently ever smokers (79%) compared to people without cancer (73%). Adjusting for demographic and clinical factors, cigarette smoking was associated with increased risk of cancer overall (HR = 1.33 [95% confidence interval: 1.18-1.49]); smoking-related cancers (HR = 2.31 [1.80-2.98]), lung cancer (HR = 17.80 [5.60-56.63]); but not non-smoking-related cancers (HR = 1.12 [0.98-1.28]). Adjusted PAFs associated with ever cigarette smoking were as follows: all cancers combined, PAF = 19% [95% confidence interval: 13%-25%]; smoking-related cancers, PAF = 50% [39%-59%]; lung cancer, PAF = 94% [82%-98%]; and non-smoking-related cancers, PAF = 9% [1%-16%].

CONCLUSIONS
Among HIV-infected persons, approximately one fifth of all incident cancer, including half of smoking-related cancer, and 94% of lung cancer diagnoses could potentially be prevented by eliminating cigarette smoking. Cigarette smoking could contribute to some cancers that were classified as non-smoking-related cancers in this report. Enhanced smoking cessation efforts targeted to HIV-infected individuals are needed.

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