Evidence map›Paper›PMID 30683625›Full record

ArticleThe lancet. HIV2019

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.

Keri N Althoff, Kelly A Gebo, Richard D Moore, Cynthia M Boyd, Amy C Justice, Cherise Wong, Gregory M Lucas, Marina B Klein, Mari M Kitahata, Heidi Crane and 27 more

Erratum issuedOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. HIV, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 89 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
89citing papers in PubMed, 2 pooled it
19.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

89 citing papers in PubMed, 2 syntheses or guidelines pooled it, 137 citations in OpenAlex.

  1. Guideline
  2. Guideline
  3. Trial
  4. Trial
  5. Trial
  6. Article
  7. Review
  8. Observational
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Changes in the Prevalence of Non-AIDS Conditions Among Hospitalized Persons With HIV in the United States and Canada, 2008-2018.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025
    Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Review
  20. Article

29 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

37 authors at 20 institutions in 3 countries.

Keri N AlthoffDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: kalthoff@jhu.edu.
Kelly A GeboJohns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Richard D MooreJohns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Cynthia M BoydJohns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Amy C JusticeYale School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
Cherise WongDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Gregory M LucasJohns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Marina B KleinMcGill University, Montreal, QC, Canada, USA.
Mari M KitahataUniversity of Washington, Seattle, WA, USA.
Heidi CraneUniversity of Washington, Seattle, WA, USA.
Michael J SilverbergKaiser Permanente Northern California, Oakland, CA, USA.
M John GillUniversity of Calgary, Calgary, AB, Canada.
William Christopher MathewsUniversity of California San Diego, San Diego, CA, USA.
Robert DubrowYale School of Public Health, New Haven, CT, USA.
Michael A HorbergKaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD, USA.
Charles S RabkinNational Cancer Institute, Bethesda, MD, USA.
Daniel B KleinKaiser Permanente Northern California, Oakland, CA, USA.
Vincent Lo ReUniversity of Pennsylvania, Philadelphia, PA, USA.
Timothy R SterlingVanderbilt University Medical Center, Nashville, TN, USA.
Fidel A DesirDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Kenneth LichtensteinNational Jewish Health, Denver, CO, USA.
James WilligUniversity of Alabama, Birmingham, AL, USA.
Anita R RachlisSunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Gregory D KirkDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Kathryn AnastosAlbert Einstein College of Medicine, New York, NY, USA.
Frank J PalellaNorthwestern University, Chicago, IL, USA.
Jennifer E ThorneJohns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Joseph EronUniversity of North Carolina, Chapel Hill, NC, USA.
Lisa P JacobsonDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Sonia NapravnikUniversity of North Carolina, Chapel Hill, NC, USA.
Chad AchenbachNorthwestern University, Chicago, IL, USA.
Angel M MayorUniversidad Central del Caribe, Puerto Rico, USA.
Pragna PatelCenters for Disease Control and Prevention, Atlanta, GA, USA.
Kate BuchaczCenters for Disease Control and Prevention, Atlanta, GA, USA.
Yuezhou JingDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Stephen J GangeDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
North American AIDS Cohort Collaboration on Research and Design
Johns Hopkins University · USJohns Hopkins Medicine · USKaiser Permanente · USCenters for Disease Control and Prevention · USNorthwestern University · USUniversity of North Carolina at Chapel Hill · USUniversity of Washington · USAlbert Einstein College of Medicine · USCentral University of the Caribbean · PRMcGill University · CANational Cancer Institute · USNational Jewish Health · USUniversity of Alabama at Birmingham · USUniversity of Calgary · CAUniversity of California, San Diego · USUniversity of Pennsylvania · USUniversity of Toronto · CAVA Connecticut Healthcare System · USVanderbilt University Medical Center · USYale University · US

Funding

Leadership and Operations Center (LOC), AIDS Clinical Trials Group (ACTG); LOC 1/UM1AI068636 · NIAID · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Joseph J Eron, RAJESH T GANDHI · 2011 to 2026
$1073.1M
Statistical and Data Management Center (SDMC), AIDS Clinical Trials Group (ACTG)UM1AI068634 · NIAID · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI Marlene Ann Cooper, Michael David Hughes · 2011 to 2026
$246.6M
Translational Research Central ServicesP30CA006973 · NCI · JOHNS HOPKINS UNIVERSITY · PI WILLIAM George NELSON · 1985 to 2026
$208.6M
WOMEN'S HEALTH AGENDAU01AI038858 · NIAID · SOCIAL AND SCIENTIFIC SYSTEMS, INC. · PI BENSON, CONSTANCE ANN · 1996 to 2008
$157.5M
AIDS Clinical Trials Group NetworkU01AI068636 · NIAID · SOCIAL AND SCIENTIFIC SYSTEMS, INC. · PI KURITZKES, DANIEL R. · 2006 to 2010
$147.1M
UCSF CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTEUL1RR024131 · NCRR · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI JOHNSTON, S. CLAIBORNE · 2006 to 2011
$111.2M
University of Washington/Fred Hutch Center for AIDS ResearchP30AI027757 · NIAID · UNIVERSITY OF WASHINGTON · PI EDWIN ROBERTO ORELLANA · 1988 to 2026
$104.9M
Unsolicited R24 for the CFAR-Network of Integrated Clinical Sciences, CNICSR24AI067039 · NIAID · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI Michael S. Saag · 2006 to 2026
$99.4M
Virology CoreP30AI027763 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MALLORY O JOHNSON · 1988 to 2026
$93.6M
Virology CoreP30AI027767 · NIAID · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI Latesha Ellen Elopre · 1988 to 2026
$84.1M
STATISTICAL AND DATA MANAGEMENT CENTERU01AI038855 · NIAID · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI HUGHES, MICHAEL DAVID · 1996 to 2006
$78.1M
Engaging University of California Stakeholders for Biorespository ResearchUL1TR000004 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GRANDIS, JENNIFER RUBIN · 2012 to 2015
$78.0M
CIHR CBR-86906CIHR CBR-94036CIHR HCP-97105CIHR TGF-96118Intramural NIH HHS Z01 CP010176NCATS NIH HHS KL2 TR000421NCATS NIH HHS KL2 TR002317NCATS NIH HHS UL1 TR000004NCATS NIH HHS UL1 TR000083NCATS NIH HHS UL1 TR000454NCI NIH HHS N01 CP001004NCI NIH HHS N02 CP055504NCI NIH HHS P30 CA006973NCI NIH HHS R01 CA165937NCRR NIH HHS M01 RR000052NCRR NIH HHS UL1 RR024131NEI NIH HHS K23 EY013707NEI NIH HHS U10 EY008052NEI NIH HHS U10 EY008057NEI NIH HHS U10 EY008067NHLBI NIH HHS R01 HL126538NHLBI NIH HHS U01 HL146201NIAAA NIH HHS R01 AA016893NIAAA NIH HHS U01 AA013566NIAAA NIH HHS U01 AA020790NIAAA NIH HHS U24 AA020794NIAID NIH HHS F31 AI124794NIAID NIH HHS K01 AI093197NIAID NIH HHS K24 AI065298NIAID NIH HHS K24 AI118591NIAID NIH HHS P30 AI027757NIAID NIH HHS P30 AI027763NIAID NIH HHS P30 AI027767NIAID NIH HHS P30 AI036219NIAID NIH HHS P30 AI050410NIAID NIH HHS P30 AI094189NIAID NIH HHS P30 AI110527NIAID NIH HHS P30 AI117943NIAID NIH HHS R24 AI067039NIAID NIH HHS U01 AI031834NIAID NIH HHS U01 AI034989NIAID NIH HHS U01 AI034993NIAID NIH HHS U01 AI034994NIAID NIH HHS U01 AI035004NIAID NIH HHS U01 AI035039NIAID NIH HHS U01 AI035040NIAID NIH HHS U01 AI035041NIAID NIH HHS U01 AI035042NIAID NIH HHS U01 AI037613NIAID NIH HHS U01 AI037984NIAID NIH HHS U01 AI038855NIAID NIH HHS U01 AI038858NIAID NIH HHS U01 AI042590NIAID NIH HHS U01 AI068634NIAID NIH HHS U01 AI068636NIAID NIH HHS U01 AI069432NIAID NIH HHS U01 AI069434NIAID NIH HHS U01 AI069918NIAID NIH HHS U01 AI103390NIAID NIH HHS U01 AI103397NIAID NIH HHS U01 AI103401NIAID NIH HHS U01 AI103408NIAID NIH HHS UM1 AI035043NIAID NIH HHS UM1 AI068634NIAID NIH HHS UM1 AI068636NIA NIH HHS R01 AG053100NIA NIH HHS R24 AG044325NICHD NIH HHS U01 HD032632NIDA NIH HHS F31 DA037788NIDA NIH HHS K24 DA000432NIDA NIH HHS K24 DA035684NIDA NIH HHS R01 DA011602NIDA NIH HHS R01 DA012568NIDA NIH HHS R01 DA026770NIDA NIH HHS U01 DA036935NIMHD NIH HHS G12 MD007583NIMHD NIH HHS U54 MD007587NIMH NIH HHS P30 MH062246
6 · The paper itself

Abstract

backgroundAdults with HIV have an increased burden of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease. The objective of this study was to estimate the population attributable fractions (PAFs) of preventable 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.

methodsWe included participants receiving care in academic and community-based outpatient HIV clinical cohorts in the USA and Canada from Jan 1, 2000, to Dec 31, 2014, who contributed to the North American AIDS Cohort Collaboration on Research and Design and who had validated non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, or end-stage renal disease outcomes. Traditional risk factors were tobacco smoking, hypertension, elevated total cholesterol, type 2 diabetes, renal impairment (stage 4 chronic kidney disease), and hepatitis C virus and hepatitis B virus infections. HIV-related risk factors were low CD4 count (<200 cells per μL), detectable plasma HIV RNA (>400 copies per mL), and history of a clinical AIDS diagnosis. PAFs and 95% CIs were estimated to quantify the proportion of outcomes that could be avoided if the risk factor was prevented.

findingsIn each of the study populations for the four outcomes (1405 of 61 500 had non-AIDS-defining cancer, 347 of 29 515 had myocardial infarctions, 387 of 35 044 had end-stage liver disease events, and 255 of 35 620 had end-stage renal disease events), about 17% were older than 50 years at study entry, about 50% were non-white, and about 80% were men. Preventing smoking would avoid 24% (95% CI 13-35) of these cancers and 37% (7-66) of the myocardial infarctions. Preventing elevated total cholesterol and hypertension would avoid the greatest proportion of myocardial infarctions: 44% (30-58) for cholesterol and 42% (28-56) for hypertension. For liver disease, the PAF was greatest for hepatitis C infection (33%; 95% CI 17-48). For renal disease, the PAF was greatest for hypertension (39%; 26-51) followed by elevated total cholesterol (22%; 13-31), detectable HIV RNA (19; 9-31), and low CD4 cell count (13%; 4-21).

interpretationThe substantial proportion of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes that could be prevented with interventions on traditional risk factors elevates the importance of screening for these risk factors, improving the effectiveness of prevention (or modification) of these risk factors, and creating sustainable care models to implement such interventions during the decades of life of adults living with HIV who are receiving care.

fundingNational Institutes of Health, US Centers for Disease Control and Prevention, the US Agency for Healthcare Research and Quality, the US Health Resources and Services Administration, the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long Term Care, and the Government of Alberta.

Indexed as

AdolescentAdultAgedAged, 80 and overCanadaEnd Stage Liver DiseaseFemaleHIV InfectionsHumansKidney Failure, ChronicMaleMiddle AgedMyocardial InfarctionNeoplasmsRisk FactorsUnited States

Identifiers

PMID30683625
PMCPMC6589140
OpenAlexW2911306684

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.