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

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Abstract
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.
Keywords
IMMUNODEFICIENCY, ANAL CANCER, RISK, MALIGNANCIES, BONE-MARROW-TRANSPLANTATION, ACTIVE ANTIRETROVIRAL THERAPY, SWISS HIV COHORT, Incidence, Prognosis, Trends, HODGKINS-DISEASE, INFECTED PATIENTS, UNITED-STATES, HIV, Non-AIDS defining cancers

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Chicago
Worm, Signe W, Mark Bower, Peter Reiss, Fabrice Bonnet, Matthew Law, Gerd Fätkenheuer, Antonella d’Arminio Monforte, et al. 2013. “Non-AIDS Defining Cancers in the D:A:D Study : Time Trends and Predictors of Survival: a Cohort Study.” Bmc Infectious Diseases 13.
APA
Worm, S. W., Bower, M., Reiss, P., Bonnet, F., Law, M., Fätkenheuer, G., Monforte, A. d’Arminio, et al. (2013). Non-AIDS defining cancers in the D:A:D Study : time trends and predictors of survival: a cohort study. BMC INFECTIOUS DISEASES, 13.
Vancouver
1.
Worm SW, Bower M, Reiss P, Bonnet F, Law M, Fätkenheuer G, et al. Non-AIDS defining cancers in the D:A:D Study : time trends and predictors of survival: a cohort study. BMC INFECTIOUS DISEASES. 2013;13.
MLA
Worm, Signe W et al. “Non-AIDS Defining Cancers in the D:A:D Study : Time Trends and Predictors of Survival: a Cohort Study.” BMC INFECTIOUS DISEASES 13 (2013): n. pag. Print.
@article{4351892,
  abstract     = {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.},
  articleno    = {471},
  author       = {Worm, Signe W and Bower, Mark and Reiss, Peter and Bonnet, Fabrice and Law, Matthew and Fätkenheuer, Gerd and Monforte, Antonella d'Arminio and Abrams, Donald I and Grulich, Andrew and Fontas, Eric and Kirk, Ole and Furrer, Hansjakob and De Wit, Stephane and Phillips, Andrew and Lundgren, Jens D and Sabin, Caroline A and D:A:D Study group, for the  and Vandekerckhove, Linos},
  issn         = {1471-2334},
  journal      = {BMC INFECTIOUS DISEASES},
  keywords     = {IMMUNODEFICIENCY,ANAL CANCER,RISK,MALIGNANCIES,BONE-MARROW-TRANSPLANTATION,ACTIVE ANTIRETROVIRAL THERAPY,SWISS HIV COHORT,Incidence,Prognosis,Trends,HODGKINS-DISEASE,INFECTED PATIENTS,UNITED-STATES,HIV,Non-AIDS defining cancers},
  language     = {eng},
  pages        = {15},
  title        = {Non-AIDS defining cancers in the D:A:D Study : time trends and predictors of survival: a cohort study},
  url          = {http://dx.doi.org/10.1186/1471-2334-13-471},
  volume       = {13},
  year         = {2013},
}

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