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

Bruyand, Mathias; Thie'baut, Rodolphe; Lawson-Ayayi, Sylvie; Joly, Pierre; Sasco, Annie Jeanne; Mercie', Patrick; Pellegrin, Jean Luc; Neau, Didier; Dabis, François; Morlat, Philippe; Chêne, Geneviève; Bonnet, Fabrice
October 2009
Clinical Infectious Diseases;10/1/2009, Vol. 49 Issue 7, p1109
Academic Journal
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 13 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 1500 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=.49 and P=.10 for 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/ mm³ to prevent the occurrence of malignancy, this should be integrated to malignancy-prevention policies.


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