jules levin, NATAP: JAIDS october 2009 report on HIV/AIDS & cancer in post-HAART era (abstract) (037)

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Incidence of Non-AIDS-Defining Malignancies Higher in HIV-Infected Versus Noninfected Patients in the HAART Era: Impact of Immunosuppression

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 2009


jaids-bannerBedimo, Roger J MD, MS, FACP; McGinnis, Kathleen A MS; Dunlap, Melinda MD; Rodriguez-Barradas, Maria C MD; Justice, Amy C MD, PhD From the *Department of Medicine, Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX; Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX; Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX; and Department of Medicine, VA Connecticut Healthcare System and Yale University Schools of Medicine and Public Health, West Haven, CT.

“non-AIDS-defining malignancies (non-ADMs)…

…In conclusion, after adjusting for age, race and gender, the incidence of non-ADMs is significantly higher among HIV-infected than HIV-uninfected patients in the HAART era. This pattern is consistent throughout the observation period and is not only true of cancers associated with HCV infection or homosexual orientation. These trends warrant a high index of suspicion for malignancies among HIV providers and a renewed focus on understanding the mechanisms underlying the increased rates…..

….The incidence rate ratio of HIV infected to HIV uninfected was 1.6 (1260 vs. 841 per 100,000 person-years; 95% confidence interval: 1.5 to 1.7). Incidence rate ratio for individual cancers was highest for anal cancer (14.9; confidence interval: 10.1 to 22.1). Among HIV-infected patients, median CD4 counts were lower for those with non-ADM (249 vs. 270, P = 0.02), anal cancer (156 vs. 270; P < 0.001), and Hodgkin lymphoma (217 vs. 269; P = 0.03). Prostate cancer was associated with a higher CD4 count (311 vs. 266; P < 0.001)…..

….Compared with HIV-infected patients without cancer, the median CD4 counts were lower for patients with non-ADM (249 vs. 270, P = 0.02), anal cancer (156 vs. 270; P < 0.001), and Hodgkin lymphoma (217 vs. 269; P = 0.03)”

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Abstract

Background: The incidence of non-AIDS-defining malignancies (non-ADMs) is reported as unchanged or increasing in the highly active antiretroviral therapy era. Whether incidence of non-ADM is significantly higher in HIV-infected than in HIV-uninfected patients remains unclear.

Methods: Incidence rates of malignancies were calculated in a cohort of veterans in care for HIV-infected and age, race, and gender-matched uninfected patients from 1997 to 2004. For HIV-infected patients, CD4 counts closest to first observation date were compared between those with and without cancer.

Results: Thirty three thousand four hundred twenty HIV-infected and 66,840 HIV-uninfected patients were followed for a median of 5.1 and 6.4 years. The incidence rate ratio of HIV infected to HIV uninfected was 1.6 (1260 vs. 841 per 100,000 person-years; 95% confidence interval: 1.5 to 1.7). Incidence rate ratio for individual cancers was highest for anal cancer (14.9; confidence interval: 10.1 to 22.1). Among HIV-infected patients, median CD4 counts were lower for those with non-ADM (249 vs. 270, P = 0.02), anal cancer (156 vs. 270; P < 0.001), and Hodgkin lymphoma (217 vs. 269; P = 0.03). Prostate cancer was associated with a higher CD4 count (311 vs. 266; P < 0.001).

Conclusions: In the highly active antiretroviral therapy era, the incidence of non-ADMs is higher among HIV-infected than HIV-uninfected patients, adjusting for age, race, and gender. Some non-ADMs do not seem to be associated with significantly lower CD4 counts.

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