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Contributions of traditional and HIV-related risk factors on non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults with HIV in the USA and Canada: A collaboration of cohort studies

The Lancet HIV Feb 08, 2019

Althoff KN, et al. - Researchers sought to determine the population attributable fractions (PAFs) of avoidable or modifiable HIV-related and traditional risk factors for non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes. They assessed participants getting care in academic and community-based outpatient HIV clinical cohorts in the US and Canada from January 1, 2000, to December 31, 2014, who contributed to the North American AIDS Cohort Collaboration on Research and Design. About 24% (95% CI 13–35) of these cancers and 37% (7–66) of myocardial infarctions could be avoided by smoking prevention. Prevention of elevated total cholesterol and hypertension may prevent the highest proportion of myocardial infarctions. The greatest PAF for liver disease was noted to be hepatitis C infection. For renal disease, greatest PAF was noted to be hypertension followed by elevated total cholesterol, detectable HIV RNA, and low CD4 cell count. These findings stress the importance of screening for these risk factors, improving prevention (or modification) measures for these risk factors, and generating sustainable care models to enact such interventions.

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