Article Figures & Tables
Figures
- Figure 1:
Flow chart showing participant selection. *Matched on birth year (within 1 yr), sex, census division (rurality), neighbourhood income quintile and region of birth (Canadian born or immigrated to Canada before 1986, born outside Canada in a country with low HIV infection prevalence, or born outside Canada in a region with high HIV infection prevalence).
- Figure 2:
Cumulative incidence of infection-related cancer and infection-unrelated cancer among people with (A, C) and without (B, D) HIV infection, by calendar period and age.
- Figure 3:
Cause-specific hazard ratios (HRs) of infection-unrelated and infection-related cancer for people with and without HIV infection, by age group. Associated 95% confidence intervals (CIs) are represented by whiskers. Red line represents null value of HR = 1.
Tables
- Table 1:
Characteristics of people from Ontario, Canada, with and without HIV infection at cohort entry, 1996–2020
Characteristic No. (%) of people* Standardized difference† With HIV infection
n = 20 304Without HIV infection
n = 20 304Age, median (IQR), yr‡ 37 (30–45) 37 (30–45) 0 Age category‡ 18–29 4878 (24.0) 4875 (24.0) 0 30–39 7372 (36.3) 7338 (36.1) 0 40–49 4937 (24.3) 4959 (24.4) 0 50–59 2079 (10.2) 2094 (10.3) 0 60–69 660 (3.2) 672 (3.3) 0 70–79 243 (1.2) 230 (1.1) 0.01 ≥ 80 135 (0.7) 136 (0.7) 0 Sex‡ Female 4396 (21.6) 4396 (21.6) 0 Male 15 908 (78.3) 15 908 (78.3) 0 Period of cohort entry‡ 1996–1999 3532 (17.4) 3534 (17.4) 0 2000–2003 3071 (15.1) 3074 (15.1) 0 2004–2007 3314 (16.3) 3305 (16.3) 0 2008–2011 3305 (16.3) 3305 (16.3) 0 2012–2015 3330 (16.4) 3338 (16.4) 0 2016–2020 3752 (18.5) 3748 (18.5) 0 Neighbourhood income quintile‡ 1 (lowest) 6872 (33.8) 6872 (33.8) 0 2 4486 (22.1) 4486 (22.1) 0 3 3372 (16.6) 3372 (16.6) 0 4 2789 (13.7) 2789 (13.7) 0 5 (highest) 2785 (13.7) 2785 (13.7) 0 Rurality‡ Urban 19 550 (96.3) 19 420 (95.6) 0.03 Rural 754 (3.7) 884 (4.4) 0.03 Comorbidity burden§ No comorbid conditions 0 (0.0) 2405 (11.8) 0.52 Low 7902 (38.9) 10 191 (50.2) 0.23 Moderate 4013 (19.8) 1109 (5.5) 0.44 High 8389 (41.3) 6599 (32.5) 0.18 Resource Utilization Band¶ 0 (lowest expected resource use)** 1–5 2399–2403 0.52 1** 1–5 1581–1585 0.41 2 16 (0.1) 4356 (21.4) 0.73 3 11 273 (55.5) 9548 (47.0) 0.17 4 6025 (29.7) 2027 (10.0) 0.51 5 (highest expected resource use) 2985 (14.7) 388 (1.9) 0.48 Immigration status duration†† Long-term resident 15 273 (75.2) 15 273 (75.2) 0 Long-term immigrant 1337 (6.6) 2413 (11.9) 0.18 Recent immigrant to Canada 2471 (12.2) 2475 (12.2) 0 Immigrated after index date‡‡ 1223 (6.0) 143 (0.7) 0.30 Region of birth‡ Canada 15 273 (75.2) 15 273 (75.2) 0 Outside Canada in country with low HIV infection prevalence 2738 (13.5) 2738 (13.5) 0 Outside Canada in country with high HIV infection prevalence§§ 2293 (11.3) 2293 (11.3) 0 Note: IQR = interquartile range.
↵* Except where noted otherwise.
↵† A value greater than 0.1 was considered a meaningful difference.
↵‡ Matched on sex, birth year, year of cohort entry, census division (rurality), region of birth and neighbourhood income quintile.
↵§ Based on the type of illness in the 2 years preceding cohort entry, assessed with the Johns Hopkins Adjusted Clinical Group (ACG) system collapsed Aggregated Diagnosis Groups (ADGs). HIV infection is included as a comorbidity in the ADG algorithm.
↵¶ Expected use of health care resources was assessed with the Johns Hopkins ACG Resource Utilization Bands based on 6 categories, with 0 being no use and 5 being the highest expected use. Resources include those used owing to HIV infection.
↵** Range is shown to suppress a small cell count.
↵†† Categorized as long-term resident if Canadian born or immigrated before 1986, long-term immigrant if residing in Canada for 10 or more years, and recent immigrant to Canada if residing in Canada for less than 10 years.
↵‡‡ Date of entry into the study, defined as the earliest record of an HIV-related diagnostic code for people with HIV infection and used in the matching process as the same date (within 1 yr) for people without HIV infection.
↵§§ Regions of Africa and the Caribbean were considered regions with high HIV infection prevalence.
- Table 2:
Distribution of incident first primary cancers diagnosed among people with and without HIV infection
Cancer group No. (%) of people* Standardized difference With HIV infection Without HIV infection Totsal All cancers 1534 (100.0) 903 (100.0) 2437 (100.0) – Infection-unrelated cancer 696 (45.4) 784 (86.8) 1480 (60.7) 0.97 Infection-related cancer 838 (54.6) 119 (13.2) 957 (39.3) 0.97 ADC 559 (36.4) 45 (5.0) 604 (24.8) 0.84 Non-Hodgkin lymphoma 305 (19.9) 37 (4.1) 342 (14.0) 0.50 Kaposi sarcoma† 235–241 < 6 241 (9.9) 0.58 Cervix† 15–21 < 6 21 (0.9) 0.08 Infection-related NADC 279 (18.2) 74 (8.2) 353 (14.5) 0.30 Most common site-specific NADCs among people with HIV infection Prostate 116 (7.6) 186 (20.6) 302 (12.4) 0.38 Lung 121 (7.9) 98 (10.8) 219 (9.0) 0.10 Colorectal 80 (5.2) 106 (11.7) 186 (7.6) 0.24 Anal† 106–112 (6.9–7.3) < 6 112 (4.6) 0.36 Liver 49 (3.2) 19 (2.1) 68 (2.8) 0.07 - Table 3:
Cumulative risk of being diagnosed with an infection-related cancer by age 65 years for people with and without HIV infection, by calendar period
Variable Cumulative risk, % (95% CI) People with HIV infection; period People without HIV infection; period 1996–2003 2004–2011 2012–2020 1996–2003 2004–2011 2012–2020 Cancer group All cancers 25.3 (21.6–29.1) 25.6 (22.5–28.8) 18.3 (16.1–20.5) 11.0 (5.9–10.1) 14.2 (9.3–9.3) 13.9 (12.5–15.2) Infection-unrelated cancer 7.0 (4.8–9.3) 9.4 (7.4–11.4) 8.7 (7.6–9.7) 10.8 (5.7–15.9) 12.4 (10.2–14.6) 11.8 (10.5–13.1) Infection-related cancer 19.0 (15.6–22.3) 17.0 (14.1–19.9) 10.0 (7.9–12.1) 0.2 (0.0–0.4) 2.0 (0.9–2.9) 2.2 (1.6–2.8) ADC 14.8 (11.9–17.7) 12.0 (9.2–14.8) 6.0 (4.0–8.1) 0.2 (0.0–0.4) 0.5 (0.01–1.1) 0.8 (0.5–1.2) Infection-related NADC 5.1 (2.7–7.5) 5.8 (4.3–7.2) 4.2 (3.4–5.0) 0.0 1.4 (0.5–2.2) 1.4 (0.9–1.8) Most common site-specific NADCs among people with HIV infection Prostate* 1.7 (0.3–3.1) 1.2 (0.5–2.0) 2.1 (1.5–2.8) 5.9 (1.2–10.6) 5.5 (3.6–7.3) 3.4 (2.6–4.2) Lung 0.9 (0.2–1.6) 2.6 (1.6–3.6) 1.5 (1.0–1.9) 1.7 (0.0–3.6) 1.0 (0.3–1.7) 1.4 (0.9–1.9) Colorectal 1.3 (0.4–2.3) 0.9 (0.3–1.6) 1.0 (0.7–1.4) 2.0 (0.0–4.0) 1.3 (0.5–2.1) 1.4 (1.0–1.8) Anal 1.9 (0.6–3.1) 1.3 (0.7–2.0) 1.8 (1.3–2.3) 0.0 0.03 (0.0–0.1) 0.02 (0.0–0.1) Liver 1.1 (0.0–2.3) 0.7 (0.3–1.2) 0.6 (0.3–0.9) 0.0 0.4 (0.0–0.9) 0.3 (0.1–0.5) Sex Female Infection-unrelated cancer 6.6 (2.4–10.8) 11.4 (7.1–15.7) 10.2 (7.7–12.6) 4.4 (0.8–8.1) 8.4 (4.5–12.3) 13.2 (10.4–16.0) Infection-related cancer 9.7 (4.9–14.4) 8.9 (5.5–12.3) 6.4 (4.3–8.5) 0.5 (0.0–1.5) 1.7 (0.0–4.1) 0.9 (0.3–1.6) Male Infection-unrelated cancer 7.4 (4.7–10.1) 9.4 (6.4–12.4) 8.3 (7.1–9.4) 12.2 (6.0–18.4) 13.0 (10.5–15.5) 11.4 (10.0–12.8) Infection-related cancer 20.2 (16.3–24.0) 18.2 (14.2–22.3) 10.7 (8.0–13.3) 0.1 (0.0–0.3) 1.9 (0.7–3.1) 2.2 (1.6–2.9) Note: ADC = AIDS-defining cancer, CI = confidence interval, NADC = non–AIDS defining cancer.
↵* Restricted to males.
- Table 4:
Cause-specific hazard ratios for infection-related and infection-unrelated cancers comparing people with and without HIV infection, by age group and sex*
Outcome; sex Age, yr; HR (95% CI) 18–39 40–49 50–59 60–69 ≥ 70 Both sexes combined Death 6.9 (5.0–9.5) 4.1 (3.3–5.0) 3.0 (2.4–3.6) 2.1 (1.7–2.7) 1.4 (1.1–1.7) Infection-related cancer 25.1 (13.2–47.7) 15.1 (9.6–23.7) 6.8 (4.7–9.9) 3.1 (2.0–4.9) 1.9 (1.0–3.7) Infection-unrelated cancer 1.3 (0.9–1.9) 1.0 (0.8–1.3) 1.0 (0.8–1.2) 0.7 (0.6–0.9) 1.3 (1.0–1.6) Females Death 11.6 (5.7–23.8) 15.9 (7.9–32.3) 9.3 (4.7–18.5) 2.8 (1.6–5.2) 1.7 (1.2–2.4) Infection-related cancer 22.2 (5.7–87.5) 6.4 (2.4–17.2) 35.6 (4.9–259.5) 4.5 (1.2–16.9) 3.7 (0.9–16.1) Infection-unrelated cancer 1.1 (0.6–2.0) 1.0 (0.6–1.5) 1.5 (1.0–2.4) 1.3 (0.8–2.1) 1.9 (1.0–3.4) Males Death 5.6 (3.9–8.1) 3.1 (2.5–3.9) 2.5 (2.0–3.0) 2.0 (1.5–2.6) 1.2 (0.9–1.5) Infection-related cancer 25.7 (12.2–54.0) 18.3 (10.8–31.1) 5.7 (3.9–8.4) 2.9 (1.9–4.6) 1.6 (0.8–3.2) Infection-unrelated cancer 1.5 (0.9–2.4) 1.0 (0.8–1.4) 0.9 (0.8–1.2) 0.7 (0.5–0.8) 1.1 (0.8–1.6) Note: CI = confidence interval, HR = hazard ratio.
↵* Models were adjusted for calendar period, comorbidity, expected use of health care resources and immigration status, and included attained age at follow-up (categoric) and HIV status interaction term.
In this issue
Article tools
Related Articles
Cited By...
- No citing articles found.