The Association of HIV Control and Immunosuppression With Risk of Non-AIDS-Defining Cancer Risk Among Patients on Antiretroviral Therapy.
J Acquir Immune Defic Syndr
; 95(3): 275-282, 2024 03 01.
Article
em En
| MEDLINE
| ID: mdl-37977197
ABSTRACT
BACKGROUND:
People living with HIV (PWH) are experiencing an increased prevalence of non-AIDS-defining cancers (NADCs). Our study investigated the association of immunosuppression and HIV control with NADCs among PWH on antiretroviral therapy (ART) in the United States.METHODS:
Among patients across 8 clinical cohorts on ART between 1996 and 2016, we assessed immune function and HIV control using 3 parameterizations of CD4 count and HIV-RNA viral load (VL) (1) CD4 or VL at ART initiation; (2) change in CD4 or VL after ART initiation; and (3) proportion of follow-up time at CD4 >500 cells/µL or VL <50 copies/mL. Cox models were used to ascertain the association of these measures with risk of a viral NADC or nonviral NADC.RESULTS:
Among 29,568 patients on ART, there were 410 nonviral NADCs and 213 viral NADCs. PWH with a CD4 <200 cells/µL at ART initiation had an 80% elevated risk for developing a viral NADC. Each increase of 100 cells/µL in CD4 after ART initiation decreased risk by 14%. For viral and nonviral NADCs, 10% more follow-up time spent with a CD4 >500 cells/µL was associated with decreased risk [viral, adjusted hazard ratio (aHR) 0.82; 95% confidence intervals (CI) 0.78 to 0.86; nonviral, aHR 0.88; 95% CI 0.86 to 91], even after accounting for CD4 at ART initiation. When examining HIV control only, 10% more time with VL <50 copies/mL was significantly associated with decreased viral (aHR 0.85; 95% CI 0.82 to 0.89) and nonviral NADC risk (aHR 0.88; 95% CI 0.85 to 0.90).CONCLUSIONS:
This study demonstrates that even for PWH on ART therapy, maintaining HIV control is associated with lower risk of both viral and nonviral NADCs.
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Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Síndrome da Imunodeficiência Adquirida
/
Fármacos Anti-HIV
/
Neoplasias
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article