Relationship between current level of immunodeficiency and non-acquired immunodeficiency syndrome-defining malignancies
Joanne Reekie, Csaba Kosa, Frederik Engsig, Antonella d'Arminio Monforte, Alicja Wiercinska-Drapalo, Pere Domingo, Francisco Antunes, Nathan Clumeck, Ole Kirk, Jens D Lundgren, Amanda Mocroft, EuroSIDA Study Group, M Losso, C Elias, N Vetter, R Zangerle, I Karpov, A Vassilenko, V M Mitsura, O Suetnov, N Clumeck, S De Wit, M Delforge, R Colebunders, L Vanderkerckhove, V Hadziosmanovic, K Kostov, J Begovac, L Machala, H Rozsypal, D Sedlacek, J Nielsen, G Kronborg, T Benfield, M Larsen, J Gerstoft, T Katzenstein, A -B E Hansen, P Skinhoj, C Pedersen, O D Larsen, L Oestergaard, K Zilmer, J Smidt, M Ristola, C Katlama, J -P Viard, P -M Girard, J M Livrozet, P Vanhems, C Pradier, F Dabis, D Neau, J Rockstroh, R Schmidt, J van Lunzen, O Degen, H J Stellbrink, S Staszewski, J Bogner, G Fatkenheuer, J Kosmidis, P Gargalianos, G Xylomenos, J Perdios, G Panos, A Filandras, E Karabatsaki, H Sambatakou, D Banhegyi, F Mulcahy, I Yust, D Turner, M Burke, S Pollack, G Hassoun, S Mayyan, S Vella, R Esposito, I Mazeau, C Mussini, C Arici, R Pristera, F Mazzotta, A Gabbuti, V Vullo, M Lichtner, A Chirianni, E Montesarchio, M Gargiulo, G Antonucci, F Iacomi, P Narciso, C Vlassi, M Zacarelli, A Lazzarin, R Finazzi, M Galli, A Ridolfo, A d'Arminio Monforte, B Rozental, I Zeltina, S Chaplinskas, R Hemmer, T Staub, P Reiss, V Ormaasen, A Maeland, J Bruun, B Knysz, J Gasiorowski, A Horban, E Bakowska, A Grzeszczuk, R Flisiak, A Boron-Kaczmarska, M Pynka, M Parczewski, M Beniowski, E Mularska, H Trocha, E Jablonowska, E Malolepsza, K Wojcik, F Antunes, E Valadas, K Mansinho, F Maltez, D Duiculescu, A Rakhmanova, E Vinogradova, S Buzunova, D Jevtovic, M Mokras, D Stanekova, J Tomazic, J Gonzalez-Lahoz, V Soriano, P Labarga, J Medrano, S Moreno, B Clotet, A Jou, R Paredes, C Tural, J Puig, I Bravo, J M Gatell, J M Miro, P Domingo, M Gutierrez, G Mateo, M A Sambeat, A Karlsson, L Flamholc, B Ledergerber, R Weber, P Francioli, M Cavassini, B Hirschel, E Boffi, H Furrer, M Battegay, L Elzi, E Kravchenko, N Chentsova, G Kutsyna, S Servitskiy, S Antoniak, M Krasnov, S Barton, A M Johnson, D Mercey, A Phillips, M A Johnson, A Mocroft, M Murphy, J Weber, G Scullard, M Fisher, C Leen, Joanne Reekie, Csaba Kosa, Frederik Engsig, Antonella d'Arminio Monforte, Alicja Wiercinska-Drapalo, Pere Domingo, Francisco Antunes, Nathan Clumeck, Ole Kirk, Jens D Lundgren, Amanda Mocroft, EuroSIDA Study Group, M Losso, C Elias, N Vetter, R Zangerle, I Karpov, A Vassilenko, V M Mitsura, O Suetnov, N Clumeck, S De Wit, M Delforge, R Colebunders, L Vanderkerckhove, V Hadziosmanovic, K Kostov, J Begovac, L Machala, H Rozsypal, D Sedlacek, J Nielsen, G Kronborg, T Benfield, M Larsen, J Gerstoft, T Katzenstein, A -B E Hansen, P Skinhoj, C Pedersen, O D Larsen, L Oestergaard, K Zilmer, J Smidt, M Ristola, C Katlama, J -P Viard, P -M Girard, J M Livrozet, P Vanhems, C Pradier, F Dabis, D Neau, J Rockstroh, R Schmidt, J van Lunzen, O Degen, H J Stellbrink, S Staszewski, J Bogner, G Fatkenheuer, J Kosmidis, P Gargalianos, G Xylomenos, J Perdios, G Panos, A Filandras, E Karabatsaki, H Sambatakou, D Banhegyi, F Mulcahy, I Yust, D Turner, M Burke, S Pollack, G Hassoun, S Mayyan, S Vella, R Esposito, I Mazeau, C Mussini, C Arici, R Pristera, F Mazzotta, A Gabbuti, V Vullo, M Lichtner, A Chirianni, E Montesarchio, M Gargiulo, G Antonucci, F Iacomi, P Narciso, C Vlassi, M Zacarelli, A Lazzarin, R Finazzi, M Galli, A Ridolfo, A d'Arminio Monforte, B Rozental, I Zeltina, S Chaplinskas, R Hemmer, T Staub, P Reiss, V Ormaasen, A Maeland, J Bruun, B Knysz, J Gasiorowski, A Horban, E Bakowska, A Grzeszczuk, R Flisiak, A Boron-Kaczmarska, M Pynka, M Parczewski, M Beniowski, E Mularska, H Trocha, E Jablonowska, E Malolepsza, K Wojcik, F Antunes, E Valadas, K Mansinho, F Maltez, D Duiculescu, A Rakhmanova, E Vinogradova, S Buzunova, D Jevtovic, M Mokras, D Stanekova, J Tomazic, J Gonzalez-Lahoz, V Soriano, P Labarga, J Medrano, S Moreno, B Clotet, A Jou, R Paredes, C Tural, J Puig, I Bravo, J M Gatell, J M Miro, P Domingo, M Gutierrez, G Mateo, M A Sambeat, A Karlsson, L Flamholc, B Ledergerber, R Weber, P Francioli, M Cavassini, B Hirschel, E Boffi, H Furrer, M Battegay, L Elzi, E Kravchenko, N Chentsova, G Kutsyna, S Servitskiy, S Antoniak, M Krasnov, S Barton, A M Johnson, D Mercey, A Phillips, M A Johnson, A Mocroft, M Murphy, J Weber, G Scullard, M Fisher, C Leen
Abstract
Background: In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency syndrome (AIDS)-defining malignancies account for more morbidity and mortality in human immunodeficiency virus-infected patients than AIDS-defining malignancies. However, conflicting data have been reported on the relationship between immunodeficiency and the development of some non-AIDS-defining malignancies.
Methods: A total of 14,453 patients from the prospective, multinational EuroSIDA cohort were included. Malignancies were classified as virus-related, non-virus-related epithelial, and other. The incidence of non-AIDS-defining malignancies was calculated stratified by current CD4 count. Poisson regression was used to investigate factors associated with the development of non-AIDS-defining malignancies.
Results: A total of 356 non-AIDS-defining malignancies occurred, with an incidence rate of 4.3 per 1000 person years of follow-up (95% confidence interval [CI], 3.8-4.7); 172 (48.3%) were virus-related, 135 (37.9%) were non-virus-related epithelial, and 49 (13.7%) were classified as other. Anal (69 cases), lung (31 cases), and melanoma (13 cases), respectively, were the most common non-AIDS-defining malignancies within each group. After adjustment, current CD4 was associated with virus-related non-AIDS-defining malignancies (incidence rate ratio [IRR], 0.81 per doubling; 95% CI, 0.75-0.88; P < .0001) and non-virus-related epithelial non-AIDS-defining malignancies (IRR, 0.84; 95% CI, 0.75-0.95; P = .004), but not with other non-AIDS-defining malignancies (IRR, 1.04; 95% CI, 0.83-1.31; P = .73). Current CD4 count was also associated with anal cancer (IRR, 0.86; 95% CI, 0.75-0.99; P = .03), Hodgkin lymphoma (n = 52; IRR, 0.83; 95% CI, 0.73-0.95; P = .005), and lung cancer (IRR, 0.76; 95% CI, 0.64-0.90; P = .0002).
Conclusions: A low current CD4 count was associated with an increased incidence of certain non-AIDS-defining malignancies. Starting cART earlier to reduce the proportion of patients with a low CD4 count may decrease the rate of developing many common non-AIDS-related malignancies. A randomized trial to explore this strategy is urgently needed.
Copyright © 2010 American Cancer Society.
Source: PubMed