TY - JOUR T1 - The burden of cancer among people living with HIV in Ontario, Canada, 1997–2020: a retrospective population-based cohort study using administrative health data JF - CMAJ Open JO - CMAJ SP - E666 LP - E674 DO - 10.9778/cmajo.20220012 VL - 10 IS - 3 AU - Ioana A. Nicolau AU - Tony Antoniou AU - Jennifer D. Brooks AU - Rahim Moineddin AU - Curtis Cooper AU - Michelle Cotterchio AU - Jennifer L. Gillis AU - Claire E. Kendall AU - Abigail E. Kroch AU - Joanne D. Lindsay AU - Colleen Price AU - Kate Salters AU - Marek Smieja AU - Ann N. Burchell Y1 - 2022/07/01 UR - http://www.cmajopen.ca/content/10/3/E666.abstract N2 - Background: With combination antiretroviral therapy (ART) and increased longevity, cancer is a leading cause of morbidity among people with HIV. We characterized trends in cancer burden among people with HIV in Ontario, Canada, between 1997 and 2020.Methods: We conducted a population-based, retrospective cohort study of adults with HIV using linked administrative health databases from Jan. 1, 1997, to Nov. 1, 2020. We grouped cancers as infection-related AIDS-defining cancers (ADCs), infection-related non-ADCs (NADCs) and infection-unrelated cancers. We calculated age-standardized incidence rates per 100 000 person-years with 95% confidence intervals (CIs) using direct standardization, stratified by calendar period and sex. We also calculated limited-duration prevalence.Results: Among 19 403 adults living with HIV (79% males), 1275 incident cancers were diagnosed. From 1997–2000 to 2016– 2020, we saw a decrease in the incidence of all cancers (1113.9 [95% CI 657.7–1765.6] to 683.5 [95% CI 613.4–759.4] per 100 000 person-years), ADCs (403.1 [95% CI 194.2–739.0] to 103.8 [95% CI 79.2–133.6] per 100 000 person-years) and infection-related NADCs (196.6 [95% CI 37.9–591.9] to 121.9 [95% CI 94.3–154.9] per 100 000 person-years). The incidence of infection-unrelated cancers was stable at 451.0 per 100 000 person-years (95% CI 410.3–494.7). The incidence of cancer among females increased over time but was similar to that of males in 2016–2020.Interpretation: Over a 24-year period, the incidence of cancer decreased overall, largely driven by a considerable decrease in the incidence of ADC, whereas the incidence of infection-unrelated cancer remained unchanged and contributed to the greatest burden of cancer. These findings could reflect combination ART–mediated changes in infectious comorbidity and increased life expectancy; targeted cancer screening and prevention strategies are needed. ER -