Retrospective cohort study of cancer incidence and mortality by HIV status in a Georgia, USA, prisoner cohort during the HAART era
OBJECTIVE:
Non-AIDS-defining
cancers (NADCs) have emerged as significant contributors to cancer mortality
and morbidity among persons living with HIV (PLWH). Because NADCs are also
associated with many social and behavioural risk factors that underlie HIV,
determining the extent to which each of these factors contributes to NADC risk
is difficult. We examined cancer incidence and mortality among persons with a
history of incarceration, because distributions of other cancer risk factors
are likely similar between prisoners living with HIV and non-infected prisoners.
DESIGN:
Registry-based
retrospective cohort study.
PARTICIPANTS:
Cohort
of 22 422 persons incarcerated in Georgia, USA, prisons on 30 June 1991, and
still alive in 1998.
OUTCOME MEASURES:
Cancer
incidence and mortality were assessed between 1998 and 2009, using cancer and
death registry data matched to prison administrative records. Age, race and
sex-adjusted standardised mortality and incidence ratios, relative to the
general population, were calculated for AIDS-defining cancers, viral-associated
NADCs and non-infection-associated NADCs, stratified by HIV status.
RESULTS:
There
were no significant differences in cancer mortality relative to the general
population in the cohort, regardless of HIV status. In contrast, cancer
incidence was elevated among the PLWH. Furthermore, incidence of
viral-associated NADCs was significantly higher among PLWH versus those without
HIV infection (standardised incidence ratio=6.1, 95% CI 3.0 to 11.7,
p<0.001).
CONCLUSIONS:
Among
PLWH with a history of incarceration, cancer incidence was elevated relative to
the general population, likely related to increased prevalence of oncogenic
viral co-infections. Cancer prevention and screening programmes within prisons
may help to reduce the cancer burden in this high-risk population.
- 1Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
- 2University of Texas Medical Branch, Galveston, Texas, USA.
- 3Rollins School of Public Health, Emory University, Atlanta, Georgia, USA Division of Applied Research, Allina Health, Minneapolis, Minnesota, USA.
- BMJ Open. 2016 Apr 11;6(4):e009778. doi: 10.1136/bmjopen-2015-009778.
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