OBJECTIVE: To estimate the association between immunologic response to antiretroviral therapy (ART) and non-AIDS defining cancer (NADC) incidence in HIV-infected patients. DESIGN: A prospective cohort including patients with at least 1 cell/μl CD4 cell count and HIV-1 RNA measure after ART initiation between 1996 and 2011 in the Centers for AIDS Research Network of Integrated Clinical Systems, a collaboration of eight HIV clinics at major academic medical centres in the United States. METHODS: Measures of immunologic response were 6-month CD4 post-ART, latest CD4 and CD4 count-years, a cumulative measure of CD4 lymphopenia. Cox regression with inverse probability-of-exposure weights was used to calculate adjusted hazard ratios of virus-related and virus-unrelated NADC incidence. RESULTS: Among 9389 patients at ART initiation, median CD4 cell count was 200 cells/μl [interquartile range (IQR) 60-332)], and median HIV-1 RNA was 4.8 log10 copies/ml (IQR 4.3-5.4). Median follow-up was 3.3 years (IQR 1.5-6.5). After 6 months of ART, median CD4 cell count was 304 cells/μl (IQR 163-469). One hundred and sixty-four NADCs were diagnosed during study follow-up, 65 (40%) considered virus-related. Virus-related NADCs were inversely associated with 6-month CD4 cell count (hazard ratio per 100 cells/μl increase=0.71), latest CD4 cell count (hazard ratio per 100 cells/μl increase=0.70) and CD4 cell count-years (hazard ratio per 200 cell-years/μl increase=0.91) independent of CD4 cell count at ART initiation, age and HIV-1 RNA response. No associations were found with virus-unrelated NADCs. CONCLUSION: Poor CD4 cell count response was strongly associated with virus-related NADC incidence, suggesting an important role for T-cell mediated immunity in pathogenesis. Lower CD4 cell count proximal to cancer diagnosis may be a result of subclinical cancer. Intensified cancer screening should be considered for patients on ART with low CD4 cell counts.
OBJECTIVE: To estimate the association between immunologic response to antiretroviral therapy (ART) and non-AIDS defining cancer (NADC) incidence in HIV-infectedpatients. DESIGN: A prospective cohort including patients with at least 1 cell/μl CD4 cell count and HIV-1 RNA measure after ART initiation between 1996 and 2011 in the Centers for AIDS Research Network of Integrated Clinical Systems, a collaboration of eight HIV clinics at major academic medical centres in the United States. METHODS: Measures of immunologic response were 6-month CD4 post-ART, latest CD4 and CD4 count-years, a cumulative measure of CD4lymphopenia. Cox regression with inverse probability-of-exposure weights was used to calculate adjusted hazard ratios of virus-related and virus-unrelated NADC incidence. RESULTS: Among 9389 patients at ART initiation, median CD4 cell count was 200 cells/μl [interquartile range (IQR) 60-332)], and median HIV-1 RNA was 4.8 log10 copies/ml (IQR 4.3-5.4). Median follow-up was 3.3 years (IQR 1.5-6.5). After 6 months of ART, median CD4 cell count was 304 cells/μl (IQR 163-469). One hundred and sixty-four NADCs were diagnosed during study follow-up, 65 (40%) considered virus-related. Virus-related NADCs were inversely associated with 6-month CD4 cell count (hazard ratio per 100 cells/μl increase=0.71), latest CD4 cell count (hazard ratio per 100 cells/μl increase=0.70) and CD4 cell count-years (hazard ratio per 200 cell-years/μl increase=0.91) independent of CD4 cell count at ART initiation, age and HIV-1 RNA response. No associations were found with virus-unrelated NADCs. CONCLUSION: Poor CD4 cell count response was strongly associated with virus-related NADC incidence, suggesting an important role for T-cell mediated immunity in pathogenesis. Lower CD4 cell count proximal to cancer diagnosis may be a result of subclinical cancer. Intensified cancer screening should be considered for patients on ART with low CD4 cell counts.
Authors: Emilie Lanoy; Philip S Rosenberg; Fabien Fily; Anne-Sophie Lascaux; Valerie Martinez; Maria Partisani; Isabelle Poizot-Martin; Elisabeth Rouveix; Eric A Engels; Dominique Costagliola; James J Goedert Journal: Blood Date: 2011-05-06 Impact factor: 22.113
Authors: Michael J Mugavero; Sonia Napravnik; Stephen R Cole; Joseph J Eron; Bryan Lau; Heidi M Crane; Mari M Kitahata; James H Willig; Richard D Moore; Steven G Deeks; Michael S Saag Journal: Clin Infect Dis Date: 2011-09-02 Impact factor: 9.079
Authors: Stephen R Cole; Sonia Napravnik; Michael J Mugavero; Bryan Lau; Joseph J Eron; Michael S Saag Journal: Am J Epidemiol Date: 2009-12-09 Impact factor: 4.897
Authors: Gary M Clifford; Martin Rickenbach; Jerry Polesel; Luigino Dal Maso; Ingrid Steffen; Bruno Ledergerber; Andri Rauch; Nicole M Probst-Hensch; Christine Bouchardy; Fabio Levi; Silvia Franceschi Journal: AIDS Date: 2008-10-18 Impact factor: 4.177
Authors: Jorge L Salinas; Christopher Rentsch; Vincent C Marconi; Janet Tate; Matthew Budoff; Adeel A Butt; Matthew S Freiberg; Cynthia L Gibert; Matthew Bidwell Goetz; David Leaf; Maria C Rodriguez-Barradas; Amy C Justice; David Rimland Journal: Clin Infect Dis Date: 2016-08-18 Impact factor: 9.079
Authors: Clare Meernik; Amr S Soliman; Twalib Ngoma; Crispin Kahesa; Julius Mwaiselage; Sofia D Merajver Journal: Infect Agent Cancer Date: 2014-12-09 Impact factor: 2.965