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Ann Intern Med. 2018 Jul 17;169(2):87-96. doi: 10.7326/M16-2094. Epub 2018 Jun 12.

Association of Viral Suppression With Lower AIDS-Defining and Non-AIDS-Defining Cancer Incidence in HIV-Infected Veterans: A Prospective Cohort Study.

Author information

1
Stanford Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California (L.S.P.).
2
Veterans Affairs Connecticut Healthcare System, West Haven, and Yale School of Medicine, New Haven, Connecticut (J.P.T., A.C.J.).
3
Icahn School of Medicine at Mount Sinai, New York, New York (K.S.).
4
James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York, New York (S.T.B.).
5
Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington (K.C.).
6
Washington DC Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences, Washington, DC (C.G.).
7
Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (M.B.G.).
8
Atlanta Veterans Affairs Medical Center, Decatur, and Emory University School of Medicine, Atlanta, Georgia (D.R.).
9
Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (M.C.R.).
10
Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas (R.J.B.).
11
Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut (R.D.).

Abstract

Background:

Viral suppression is a primary marker of HIV treatment success. Persons with HIV are at increased risk for AIDS-defining cancer (ADC) and several types of non-AIDS-defining cancer (NADC), some of which are caused by oncogenic viruses.

Objective:

To determine whether viral suppression is associated with decreased cancer risk.

Design:

Prospective cohort.

Setting:

Department of Veterans Affairs.

Participants:

HIV-positive veterans (n = 42 441) and demographically matched uninfected veterans (n = 104 712) from 1999 to 2015.

Measurements:

Standardized cancer incidence rates and Poisson regression rate ratios (RRs; HIV-positive vs. uninfected persons) by viral suppression status (unsuppressed: person-time with HIV RNA levels ≥500 copies/mL; early suppression: initial 2 years with HIV RNA levels <500 copies/mL; long-term suppression: person-time after early suppression with HIV RNA levels <500 copies/mL).

Results:

Cancer incidence for HIV-positive versus uninfected persons was highest for unsuppressed persons (RR, 2.35 [95% CI, 2.19 to 2.51]), lower among persons with early suppression (RR, 1.99 [CI, 1.87 to 2.12]), and lowest among persons with long-term suppression (RR, 1.52 [CI, 1.44 to 1.61]). This trend was strongest for ADC (unsuppressed: RR, 22.73 [CI, 19.01 to 27.19]; early suppression: RR, 9.48 [CI, 7.78 to 11.55]; long-term suppression: RR, 2.22 [CI, 1.69 to 2.93]), much weaker for NADC caused by viruses (unsuppressed: RR, 3.82 [CI, 3.24 to 4.49]; early suppression: RR, 3.42 [CI, 2.95 to 3.97]; long-term suppression: RR, 3.17 [CI, 2.78 to 3.62]), and absent for NADC not caused by viruses.

Limitation:

Lower viral suppression thresholds, duration of long-term suppression, and effects of CD4+ and CD8+ T-cell counts were not thoroughly evaluated.

Conclusion:

Antiretroviral therapy resulting in long-term viral suppression may contribute to cancer prevention, to a greater degree for ADC than for NADC. Patients with long-term viral suppression still had excess cancer risk.

Primary Funding Source:

National Cancer Institute and National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.

PMID:
29893768
DOI:
10.7326/M16-2094

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