Cumulative Incidence of Cancer Among Persons With HIV in North America: A Cohort Study
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
Abstract
Background:
Cancer is increasingly common among persons with HIV.
Objective:
To examine calendar trends in cumulative cancer incidence and hazard rate by HIV status.
Design:
Cohort study.
Setting:
North American AIDS Cohort Collaboration on Research and Design during 1996 to 2009.
Participants:
86 620 persons with HIV and 196 987 uninfected adults.
Measurements:
Cancer type–specific cumulative incidence by age 75 years and calendar trends in cumulative incidence and hazard rates, each by HIV status.
Results:
Cumulative incidences of cancer by age 75 years for persons with and without HIV, respectively, were as follows: Kaposi sarcoma, 4.4% and 0.01%; non-Hodgkin lymphoma, 4.5% and 0.7%; lung cancer, 3.4% and 2.8%; anal cancer, 1.5% and 0.05%; colorectal cancer, 1.0% and 1.5%; liver cancer, 1.1% and 0.4%; Hodgkin lymphoma, 0.9% and 0.09%; melanoma, 0.5% and 0.6%; and oral cavity/pharyngeal cancer, 0.8% and 0.8%. Among persons with HIV, calendar trends in cumulative incidence and hazard rate decreased for Kaposi sarcoma and non-Hodgkin lymphoma. For anal, colorectal, and liver cancer, increasing cumulative incidence, but not hazard rate trends, were due to the decreasing mortality rate trend (−9% per year), allowing greater opportunity to be diagnosed. Despite decreasing hazard rate trends for lung cancer, Hodgkin lymphoma, and melanoma, cumulative incidence trends were not seen because of the compensating effect of the declining mortality rate.
Limitation:
Secular trends in screening, smoking, and viral co-infections were not evaluated.
Conclusion:
Cumulative cancer incidence by age 75 years, approximating lifetime risk in persons with HIV, may have clinical utility in this population. The high cumulative incidences by age 75 years for Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer support early and sustained antiretroviral therapy and smoking cessation.
Primary Funding Source:
National Institutes of Health.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, et al; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8:e81355. [PMID: 24367482] doi: 10.1371/journal.pone.0081355
2.
Wada N, Jacobson LP, Cohen M, French A, Phair J, Muñoz A. Cause-specific life expectancies after 35 years of age for human immunodeficiency syndrome-infected and human immunodeficiency syndrome-negative individuals followed simultaneously in long-term cohort studies, 1984-2008. Am J Epidemiol. 2013;177:116-25. [PMID: 23287403] doi: 10.1093/aje/kws321
3.
Justice AC. HIV and aging: time for a new paradigm. Curr HIV/AIDS Rep. 2010;7:69-76. [PMID: 20425560] doi: 10.1007/s11904-010-0041-9
4.
Shiels MS, Pfeiffer RM, Gail MH, Hall HI, Li J, Chaturvedi AK, et al. Cancer burden in the HIV-infected population in the United States. J Natl Cancer Inst. 2011;103:753-62. [PMID: 21483021] doi: 10.1093/jnci/djr076
5.
Guiguet M, Boué F, Cadranel J, Lang JM, Rosenthal E, Costagliola D; Clinical Epidemiology Group of the FHDH-ANRS CO4 cohort. Effect of immunodeficiency, HIV viral load, and antiretroviral therapy on the risk of individual malignancies (FHDH-ANRS CO4): a prospective cohort study. Lancet Oncol. 2009;10:1152-9. [PMID: 19818686] doi: 10.1016/S1470-2045(09)70282-7
6.
Kesselring A, Gras L, Smit C, van Twillert G, Verbon A, de Wolf F, et al. Immunodeficiency as a risk factor for non-AIDS-defining malignancies in HIV-1–infected patients receiving combination antiretroviral therapy. Clin Infect Dis. 2011;52:1458-65. [PMID: 21628488] doi: 10.1093/cid/cir207
7.
Reekie J, Kosa C, Engsig F, Monforte Ad, Wiercinska-Drapalo A, Domingo P, et al; EuroSIDA Study Group. Relationship between current level of immunodeficiency and non-acquired immunodeficiency syndrome-defining malignancies. Cancer. 2010;116:5306-15. doi: 10.1002/cncr.25311
8.
Silverberg MJ, Chao C, Leyden WA, Xu L, Horberg MA, Klein D, et al. HIV infection, immunodeficiency, viral replication, and the risk of cancer. Cancer Epidemiol Biomarkers Prev. 2011;20:2551-9. [PMID: 22109347] doi: 10.1158/1055-9965.EPI-11-0777
9.
Bruyand M, Thiébaut R, Lawson-Ayayi S, Joly P, Sasco AJ, Mercié P, et al; Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA). Role of uncontrolled HIV RNA level and immunodeficiency in the occurrence of malignancy in HIV-infected patients during the combination antiretroviral therapy era: Agence Nationale de Recherche sur le Sida (ANRS) CO3 Aquitaine Cohort. Clin Infect Dis. 2009;49:1109-16. [PMID: 19705973] doi: 10.1086/605594
10.
Dubrow R, Silverberg MJ, Park LS, Crothers K, Justice AC. HIV infection, aging, and immune function: implications for cancer risk and prevention. Curr Opin Oncol. 2012;24:506-16. [PMID: 22759737]
11.
Borges AH, Dubrow R, Silverberg MJ. Factors contributing to risk for cancer among HIV-infected individuals, and evidence that earlier combination antiretroviral therapy will alter this risk. Curr Opin HIV AIDS. 2014;9:34-40. [PMID: 24225382] doi: 10.1097/COH.0000000000000025
12.
Borges ÁH, Silverberg MJ, Wentworth D, Grulich AE, Fätkenheuer G, Mitsuyasu R, et al; INSIGHT SMART. Predicting risk of cancer during HIV infection: the role of inflammatory and coagulation biomarkers. AIDS. 2013;27:1433-41. [PMID: 23945504] doi: 10.1097/QAD.0b013e32835f6b0c
13.
Tesoriero JM, Gieryic SM, Carrascal A, Lavigne HE. Smoking among HIV positive New Yorkers: prevalence, frequency, and opportunities for cessation. AIDS Behav. 2010;14:824-35. [PMID: 18777131] doi: 10.1007/s10461-008-9449-2
14.
Engsig FN, Kronborg G, Larsen CS, Pedersen G, Pedersen C, Gerstoft J, et al. Lung cancer in HIV patients and their parents: a Danish cohort study. BMC Cancer. 2011;11:272. [PMID: 21702995] doi: 10.1186/1471-2407-11-272
15.
Rahmanian S, Wewers ME, Koletar S, Reynolds N, Ferketich A, Diaz P. Cigarette smoking in the HIV-infected population. Proc Am Thorac Soc. 2011;8:313-9. [PMID: 21653534] doi: 10.1513/pats.201009-058WR
16.
Helleberg M, Gerstoft J, Afzal S, Kronborg G, Larsen CS, Pedersen C, et al. Risk of cancer among HIV-infected individuals compared to the background population: impact of smoking and HIV. AIDS. 2014;28:1499-508. [PMID: 24785952] doi: 10.1097/QAD.0000000000000283
17.
Kojic EM, Cu-Uvin S. Update: human papillomavirus infection remains highly prevalent and persistent among HIV-infected individuals. Curr Opin Oncol. 2007;19:464-9. [PMID: 17762572]
18.
Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol. 2006;44:S6-9. [PMID: 16352363]
19.
Bagni R, Whitby D. Kaposi's sarcoma-associated herpesvirus transmission and primary infection. Curr Opin HIV AIDS. 2009;4:22-6. [PMID: 19339936] doi: 10.1097/COH.0b013e32831add5a
20.
Simard EP, Pfeiffer RM, Engels EA. Cumulative incidence of cancer among individuals with acquired immunodeficiency syndrome in the United States. Cancer. 2011;117:1089-96. [PMID: 20960504] doi: 10.1002/cncr.25547
21.
Simard EP, Pfeiffer RM, Engels EA. Spectrum of cancer risk late after AIDS onset in the United States. Arch Intern Med. 2010;170:1337-45. [PMID: 20696958] doi: 10.1001/archinternmed.2010.253
22.
Bedimo R, Chen RY, Accortt NA, Raper JL, Linn C, Allison JJ, et al. Trends in AIDS-defining and non-AIDS-defining malignancies among HIV-infected patients: 1989-2002. Clin Infect Dis. 2004;39:1380-4. [PMID: 15494916]
23.
Engels EA, Pfeiffer RM, Goedert JJ, Virgo P, McNeel TS, Scoppa SM, et al; HIV/AIDS Cancer Match Study. Trends in cancer risk among people with AIDS in the United States 1980-2002. AIDS. 2006;20:1645-54. [PMID: 16868446]
24.
Grulich AE, vanLeeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370:59-67. [PMID: 17617273]
25.
Shiels MS, Cole SR, Kirk GD, Poole C. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr. 2009;52:611-22. [PMID: 19770804] doi: 10.1097/QAI.0b013e3181b327ca
26.
Patel P, Hanson DL, Sullivan PS, Novak RM, Moorman AC, Tong TC, et al; Adult and Adolescent Spectrum of Disease Project and HIV Outpatient Study Investigators. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992-2003. Ann Intern Med. 2008;148:728-36. [PMID: 18490686]
27.
Robbins HA, Shiels MS, Pfeiffer RM, Engels EA. Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States. AIDS. 2014;28:881-90. [PMID: 24300545] doi: 10.1097/QAD.0000000000000163
28.
Patel P, Armon C, Chmiel JS, Brooks JT, Buchacz K, Wood K, et al. Factors associated with cancer incidence and with all-cause mortality after cancer diagnosis among human immunodeficiency virus-infected persons during the combination antiretroviral therapy era. Open Forum Infect Dis. 2014;1:ofu012. [PMID: 25734086] doi: 10.1093/ofid/ofu012
29.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496-509.
30.
Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data. New York: J Wiley; 1980.
31.
Allignol A, Schumacher M, Wanner C, Drechsler C, Beyersmann J. Understanding competing risks: a simulation point of view. BMC Med Res Methodol. 2011;11:86. [PMID: 21639902] doi: 10.1186/1471-2288-11-86
32.
Latouche A, Allignol A, Beyersmann J, Labopin M, Fine JP. A competing risks analysis should report results on all cause-specific hazards and cumulative incidence functions. J Clin Epidemiol. 2013;66:648-53. [PMID: 23415868] doi: 10.1016/j.jclinepi.2012.09.017
33.
Gange SJ, Kitahata MM, Saag MS, Bangsberg DR, Bosch RJ, Brooks JT, et al. Cohort profile: the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Int J Epidemiol. 2007;36:294-301. [PMID: 17213214]
34.
Korn EL, Graubard BI, Midthune D. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol. 1997;145:72-80. [PMID: 8982025]
35.
Arias E. United States life tables, 2010. Natl Vital Stat Rep. 2014;63:1-63. [PMID: 25383611]
36.
Lau B, Gange SJ, Moore RD. Risk of non-AIDS-related mortality may exceed risk of AIDS-related mortality among individuals enrolling into care with CD4+ counts greater than 200 cells/mm3. J Acquir Immune Defic Syndr. 2007;44:179-87. [PMID: 17075385]
37.
Gaynor JJ, Feuer EJ, Tan CC, Wu DH, Little CR, Straus DJ, et al. On the use of cause-specific failure and conditional failure probabilities—examples from clinical oncology data. J Am Stat Assoc. 1993;88:400-9.
38.
Efron B. An Introduction to the Bootstrap. London, UK: Chapman & Hall/CRC; 1993.
39.
Schoenfeld D. Partial residuals for the proportional hazards regression model. Biometrika. 1982;69:239-41.
40.
Lau B, Cole SR, Gange SJ. Competing risk regression models for epidemiologic data. Am J Epidemiol. 2009;170:244-56. [PMID: 19494242] doi: 10.1093/aje/kwp107
41.
World Health Organization. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Volume 90—Human Papillomaviruses. Lyon, France: International Agency for Research on Cancer; 2007. Accessed at http://monographs.iarc.fr/ENG/Monographs/vol90/mono90.pdf on 10 August 2015.
42.
Silverberg MJ, Lau B, Justice AC, Engels E, Gill MJ, Goedert JJ, et al; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA. Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America. Clin Infect Dis. 2012;54:1026-34. [PMID: 22291097] doi: 10.1093/cid/cir1012
43.
Silverberg MJ, Chao C, Leyden WA, Xu L, Tang B, Horberg MA, et al. HIV infection and the risk of cancers with and without a known infectious cause. AIDS. 2009;23:2337-45. [PMID: 19741479] doi: 10.1097/QAD.0b013e3283319184
44.
Piketty C, Selinger-Leneman H, Bouvier AM, Belot A, Mary-Krause M, Duvivier C, et al. Incidence of HIV-related anal cancer remains increased despite long-term combined antiretroviral treatment: results from the French hospital database on HIV. J Clin Oncol. 2012;30:4360-6. [PMID: 23091098] doi: 10.1200/JCO.2012.44.5486
45.
Hleyhel M, Hleyhel M, Bouvier AM, Belot A, Tattevin P, Pacanowski J, et al; Cancer Risk Group of the French Hospital Database on HIV (FHDH-ANRS CO4). Risk of non-AIDS-defining cancers among HIV-1-infected individuals in France between 1997 and 2009: results from a French cohort. AIDS. 2014;28:2109-18. [PMID: 25265077] doi: 10.1097/QAD.0000000000000382
46.
Worm SW, Bower M, Reiss P, Bonnet F, Law M, Fätkenheuer G, et al; D:A:D Study Group. Non-AIDS defining cancers in the D:A:D Study—time trends and predictors of survival: a cohort study. BMC Infect Dis. 2013;13:471. [PMID: 24106926] doi: 10.1186/1471-2334-13-471
47.
Moorman AC, Gordon SC, Rupp LB, Spradling PR, Teshale EH, Lu M, et al; Chronic Hepatitis Cohort Study Investigators. Baseline characteristics and mortality among people in care for chronic viral hepatitis: the chronic hepatitis cohort study. Clin Infect Dis. 2013;56:40-50. [PMID: 22990852] doi: 10.1093/cid/cis815
48.
Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, et al. Annual Report to the Nation on the status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014;120:1290-314. [PMID: 24343171] doi: 10.1002/cncr.28509
49.
Stock C, Haug U, Brenner H. Population-based prevalence estimates of history of colonoscopy or sigmoidoscopy: review and analysis of recent trends. Gastrointest Endosc. 2010;71:366-381. [PMID: 19846082] doi: 10.1016/j.gie.2009.06.018
50.
Jemal A, Thun MJ, Ries LA, Howe HL, Weir HK, Center MM, et al. Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst. 2008;100:1672-94. [PMID: 19033571] doi: 10.1093/jnci/djn389
51.
Auluck A, Hislop G, Bajdik C, Poh C, Zhang L, Rosin M. Trends in oropharyngeal and oral cavity cancer incidence of human papillomavirus (HPV)-related and HPV-unrelated sites in a multicultural population: the British Columbia experience. Cancer. 2010;116:2635-44. [PMID: 20336792] doi: 10.1002/cncr.25087
52.
Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin Oncol. 2008;26:612-9. [PMID: 18235120] doi: 10.1200/JCO.2007.14.1713
53.
Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29:4294-301. [PMID: 21969503] doi: 10.1200/JCO.2011.36.4596
54.
Franceschi S, Maso LD, Rickenbach M, Polesel J, Hirschel B, Cavassini M, et al. Kaposi sarcoma incidence in the Swiss HIV Cohort Study before and after highly active antiretroviral therapy. Br J Cancer. 2008;99:800-4. [PMID: 18665172] doi: 10.1038/sj.bjc.6604520
55.
Polesel J, Clifford GM, Rickenbach M, DalMaso L, Battegay M, Bouchardy C, et al; Swiss HIV Cohort Study. Non-Hodgkin lymphoma incidence in the Swiss HIV Cohort Study before and after highly active antiretroviral therapy. AIDS. 2008;22:301-6. [PMID: 18097233]
56.
Hleyhel M, Belot A, Bouvier AM, Tattevin P, Pacanowski J, Genet P, et al; French Hospital Database on HIV–ANRS CO4 Cohort. Risk of AIDS-defining cancers among HIV-1-infected patients in France between 1992 and 2009: results from the FHDH-ANRS CO4 cohort. Clin Infect Dis. 2013;57:1638-47. [PMID: 23899679] doi: 10.1093/cid/cit497
57.
Hall EC, Pfeiffer RM, Segev DL, Engels EA. Cumulative incidence of cancer after solid organ transplantation. Cancer. 2013;119:2300-8. [PMID: 23559438] doi: 10.1002/cncr.28043
58.
Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160:330-8. [PMID: 24378917] doi: 10.7326/M13-2771
59.
Sigel K, Wisnivesky J, Shahrir S, Brown ST, Justice A, Kim J, et al. Findings in asymptomatic HIV-infected patients undergoing chest computed tomography testing: implications for lung cancer screening. AIDS. 2014;28:1007-14. [PMID: 24401647] doi: 10.1097/QAD.0000000000000189
60.
U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149:627-37. [PMID: 18838716]
61.
Wells JS, Holstad MM, Thomas T, Bruner DW. An integrative review of guidelines for anal cancer screening in HIV-infected persons. AIDS Patient Care STDS. 2014;28:350-7. [PMID: 24936878] doi: 10.1089/apc.2013.0358
62.
U.S. Food and Drug Administration. Gardasil approved to prevent anal cancer [news release]. Silver Spring, MD: U.S. Food and Drug Administration; 22 December 2010. Accessed at www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm237941.htm on 20 April 2015.
63.
Kahn JA, Xu J, Kapogiannis BG, Rudy B, Gonin R, Liu N, et al. Immunogenicity and safety of the human papillomavirus 6, 11, 16, 18 vaccine in HIV-infected young women. Clin Infect Dis. 2013;57:735-44. [PMID: 23667266] doi: 10.1093/cid/cit319
64.
Kojic EM, Kang M, Cespedes MS, Umbleja T, Godfrey C, Allen RT, et al. Immunogenicity and safety of the quadrivalent human papillomavirus vaccine in HIV-1-infected women. Clin Infect Dis. 2014;59:127-35. [PMID: 24723284] doi: 10.1093/cid/ciu238
65.
Wilkin T, Lee JY, Lensing SY, Stier EA, Goldstone SE, Berry JM, et al. Safety and immunogenicity of the quadrivalent human papillomavirus vaccine in HIV-1-infected men. J Infect Dis. 2010;202:1246-53. [PMID: 20812850] doi: 10.1086/656320
66.
Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H; Centers for Disease Control and Prevention (CDC). Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58:1-207; quiz CE1-4. [PMID: 19357635]
67.
Osinusi A, Townsend K, Kohli A, Nelson A, Seamon C, Meissner EG, et al. Virologic response following combined ledipasvir and sofosbuvir administration in patients with HCV genotype 1 and HIV co-infection. JAMA. 2015;313:1232-9. [PMID: 25706232] doi: 10.1001/jama.2015.1373
68.
Sulkowski MS, Eron JJ, Wyles D, Trinh R, Lalezari J, Wang C, et al. Ombitasvir, paritaprevir co-dosed with ritonavir, dasabuvir, and ribavirin for hepatitis C in patients co-infected with HIV-1: a randomized trial. JAMA. 2015;313:1223-31. [PMID: 25706092] doi: 10.1001/jama.2015.1328
69.
Overton ET, Kitch D, Benson CA, Hunt PW, Stein JH, Smurzynski M, et al. Effect of statin therapy in reducing the risk of serious non–AIDS-defining events and nonaccidental death. Clin Infect Dis. 2013;56:1471-9. [PMID: 23386631] doi: 10.1093/cid/cit053
70.
Galli L, Spagnuolo V, Poli A, Salpietro S, Gianotti N, Cossarini F, et al. Use of statins and risk of AIDS-defining and non–AIDS-defining malignancies among HIV-1 infected patients on antiretroviral therapy. AIDS. 2014;28:2407-15. [PMID: 25160933] doi: 10.1097/QAD.0000000000000443
71.
Chao C, Xu L, Abrams DI, Towner WJ, Horberg MA, Leyden WA, et al. HMG-CoA reductase inhibitors (statins) use and risk of non-Hodgkin lymphoma in HIV-positive persons. AIDS. 2011;25:1771-7. [PMID: 21681055] doi: 10.1097/QAD.0b013e328349c67a
72.
Ganesan A, Crum-Cianflone N, Higgins J, Qin J, Rehm C, Metcalf J, et al. High dose atorvastatin decreases cellular markers of immune activation without affecting HIV-1 RNA levels: results of a double-blind randomized placebo controlled clinical trial. J Infect Dis. 2011;203:756-64. [PMID: 21325137] doi: 10.1093/infdis/jiq115
73.
U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services; 2014:151-86.
74.
Althoff KN, Gange SJ. A critical epidemiological review of cardiovascular disease risk in HIV-infected adults: the importance of the HIV-uninfected comparison group, confounding, and competing risks [Letter]. HIV Med. 2013;14:191-2. [PMID: 23368691] doi: 10.1111/hiv.12007
75.
Park LS, Tate JP, Rodriguez-Barradas MC, Rimland D, Goetz MB, Gibert C, et al. Cancer incidence in HIV-infected versus uninfected veterans: comparison of cancer registry and ICD-9 code diagnoses. J AIDS Clin Res. 2014;5:1000318. [PMID: 25580366]
Information & Authors
Information
Published In
Annals of Internal Medicine
Volume 163 • Number 7 • 6 October 2015
Pages: 507 - 518
History
Published online: 6 October 2015
Published in issue: 6 October 2015
Keywords
Copyright
© 2015 American College of Physicians.
Authors
Metrics & Citations
Metrics
Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
Download article citation data for:
Cumulative Incidence of Cancer Among Persons With HIV in North America: A Cohort Study. Ann Intern Med.2015;163:507-518. [Epub 6 October 2015]. doi:10.7326/M14-2768
Cumulative Incidence of Cancer Among Persons With HIV in North America: A Cohort Study. Ann Intern Med.2015;163:507-518. [Epub 6 October 2015]. doi:10.7326/M14-2768
View More
Get Access
Login Options:
Purchase
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.
Create your Free Account
You will be redirected to acponline.org to create an account that will provide access to Annals.
Comments
0 Comments