Journal Article

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

Mathias Bruyand, Rodolphe Thiébaut, Sylvie Lawson-Ayayi, Pierre Joly, Annie Jeanne Sasco, Patrick Mercié, Jean Luc Pellegrin, Didier Neau, François Dabis, Philippe Morlat, Geneviève Chêne and Fabrice Bonnet

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 7, pages 1109-1116
Published in print October 2009 | ISSN: 1058-4838
Published online October 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/605594
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

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Background.Human immunodeficiency virus (HIV)-infected patients are at higher risk of malignancies. In addition to traditional determinants, a specific deleterious effect of HIV and immunodeficiency is speculated. We aimed at studying the association between immunological and virological characteristics of HIV-infected patients in care and the risk of acquired immunodeficiency syndrome (AIDS)-defining and non-AIDS-defining malignancies.

Methods.Patients consecutively enrolled in the hospital-based Agence Nationale de Recherche sur le Sida (ANRS) CO3 Aquitaine Cohort were included if the duration of follow-up was >3 months during the period 1998–2006. Multivariate modeling used an extended Cox proportional hazards model for time-dependent covariates and delayed entry.

Results.The 4194 patients included in the study developed 251 first malignancies during 22,389 person-years. A higher incidence of AIDS-defining malignancies (107 cases) was independently associated with (1) both longer and current exposures to a plasma HIV RNA level >500 copies/mL (hazard ratio [HR], 1.27 per year [P<.001] and 3.30 [P<.001], respectively) and (2) both longer and current exposure to a CD4+cell count <200 cells/mm3(HR, 1.36 per year [P<.001] and 6.33 [P<.001], respectively). A higher incidence of non-AIDS-defining malignancies (144 cases) was independently associated with longer and current exposure to a CD4+cell count <500 cells/mm3(HR, 1.13 per year [P=.01] and 2.07 [P<.001], respectively) and male sex (HR, 1.69; P=.02) but not with plasma HIV RNA level (P=.49and P=.10for cumulative and current exposures, respectively).

Conclusions.Uncontrolled plasma HIV RNA level was independently associated with a higher likelihood of developing AIDS-defining malignancies, whereas immunosuppression was associated with a higher risk of developing any type of malignancies. Antiretroviral treatment should aim at reaching and maintaining a CD4+count >500 cells/mm3to prevent the occurrence of malignancy, this should be integrated to malignancy-prevention policies.

Journal Article.  4437 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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