Mathias Bruyand1, Lene Ryom, Leah Shepherd, Gerd Fatkenheuer, Andrew Grulich, Peter Reiss, Stéphane de Wit, Antonella D Arminio Monforte, Hansjakob Furrer, Christian Pradier, Jens Lundgren, Caroline Sabin. 1. *INSERM, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France; †Copenhagen HIV Programme, Department of Infectious Diseases and Rheumatology, Section 8632, Finsencenteret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; ‡Research Department of Infection and Population Health, UCL, London, United Kingdom; §First Department of Internal Medicine, University Hospital of Cologne, Köln, Germany; ‖German Center for Infection research (DZIF); ¶HIV Epidemiology and Prevention Program, Kirby Institute, UNSW Australia, Sydney, Australia; #Division of Infectious Diseases and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, the Netherlands; **Stichting HIV Monitoring, Amsterdam, the Netherlands; ††Department of Infectious Diseases, St Pierre University Hospital, Brussels, Belgium; ‡‡Infectious Diseases Unit, Department of Health Sciences, San Paolo University Hospital, Milan, Italy; §§Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland; and ‖‖Département de Santé Publique, Hôpital de l'Archet, CHU de Nice, Nice, France.
Abstract
BACKGROUND: The association between combination antiretroviral therapy (cART) and cancer risk, especially regimens containing protease inhibitors (PIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs), is unclear. METHODS: Participants were followed from the latest of D:A:D study entry or January 1, 2004, until the earliest of a first cancer diagnosis, February 1, 2012, death, or 6 months after the last visit. Multivariable Poisson regression models assessed associations between cumulative (per year) use of either any cART or PI/NNRTI, and the incidence of any cancer, non-AIDS-defining cancers (NADC), AIDS-defining cancers (ADC), and the most frequently occurring ADC (Kaposi sarcoma, non-Hodgkin lymphoma) and NADC (lung, invasive anal, head/neck cancers, and Hodgkin lymphoma). RESULTS: A total of 41,762 persons contributed 241,556 person-years (PY). A total of 1832 cancers were diagnosed [incidence rate: 0.76/100 PY (95% confidence interval: 0.72 to 0.79)], 718 ADC [0.30/100 PY (0.28-0.32)], and 1114 NADC [0.46/100 PY (0.43-0.49)]. Longer exposure to cART was associated with a lower ADC risk [adjusted rate ratio: 0.88/year (0.85-0.92)] but a higher NADC risk [1.02/year (1.00-1.03)]. Both PI and NNRTI use were associated with a lower ADC risk [PI: 0.96/year (0.92-1.00); NNRTI: 0.86/year (0.81-0.91)]. PI use was associated with a higher NADC risk [1.03/year (1.01-1.05)]. Although this was largely driven by an association with anal cancer [1.08/year (1.04-1.13)], the association remained after excluding anal cancers from the end point [1.02/year (1.01-1.04)]. No association was seen between NNRTI use and NADC [1.00/year (0.98-1.02)]. CONCLUSIONS: Cumulative use of PIs may be associated with a higher risk of anal cancer and possibly other NADC. Further investigation of biological mechanisms is warranted.
BACKGROUND: The association between combination antiretroviral therapy (cART) and cancer risk, especially regimens containing protease inhibitors (PIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs), is unclear. METHODS:Participants were followed from the latest of D:A:D study entry or January 1, 2004, until the earliest of a first cancer diagnosis, February 1, 2012, death, or 6 months after the last visit. Multivariable Poisson regression models assessed associations between cumulative (per year) use of either any cART or PI/NNRTI, and the incidence of any cancer, non-AIDS-defining cancers (NADC), AIDS-defining cancers (ADC), and the most frequently occurring ADC (Kaposi sarcoma, non-Hodgkin lymphoma) and NADC (lung, invasive anal, head/neck cancers, and Hodgkin lymphoma). RESULTS: A total of 41,762 persons contributed 241,556 person-years (PY). A total of 1832 cancers were diagnosed [incidence rate: 0.76/100 PY (95% confidence interval: 0.72 to 0.79)], 718 ADC [0.30/100 PY (0.28-0.32)], and 1114 NADC [0.46/100 PY (0.43-0.49)]. Longer exposure to cART was associated with a lower ADC risk [adjusted rate ratio: 0.88/year (0.85-0.92)] but a higher NADC risk [1.02/year (1.00-1.03)]. Both PI and NNRTI use were associated with a lower ADC risk [PI: 0.96/year (0.92-1.00); NNRTI: 0.86/year (0.81-0.91)]. PI use was associated with a higher NADC risk [1.03/year (1.01-1.05)]. Although this was largely driven by an association with anal cancer [1.08/year (1.04-1.13)], the association remained after excluding anal cancers from the end point [1.02/year (1.01-1.04)]. No association was seen between NNRTI use and NADC [1.00/year (0.98-1.02)]. CONCLUSIONS: Cumulative use of PIs may be associated with a higher risk of anal cancer and possibly other NADC. Further investigation of biological mechanisms is warranted.
Authors: Rachel M Presti; Sonia C Flores; Brent E Palmer; Jeffrey J Atkinson; Catherine R Lesko; Bryan Lau; Andrew P Fontenot; Jesse Roman; John F McDyer; Homer L Twigg Journal: Chest Date: 2017-04-17 Impact factor: 9.410
Authors: Álvaro H Borges; Jacqueline Neuhaus; Abdel G Babiker; Keith Henry; Mamta K Jain; Adrian Palfreeman; Peter Mugyenyi; Pere Domingo; Christian Hoffmann; Tim R H Read; Sanjay Pujari; Michael Meulbroek; Margaret Johnson; Timothy Wilkin; Ronald Mitsuyasu Journal: Clin Infect Dis Date: 2016-09-08 Impact factor: 9.079
Authors: David C Boettiger; Caroline A Sabin; Andrew Grulich; Lene Ryom; Fabrice Bonnet; Peter Reiss; Antonella d'arminio Monforte; Ole Kirk; Andrew Phillips; Mark Bower; Gerd Fätkenheuer; Jens D Lundgren; Matthew Law Journal: AIDS Date: 2016-06-19 Impact factor: 4.177