Clinical Topics

Early Therapy Helps Prevent Non-Hodgkin lymphoma, Other AIDS-related Cancer

by U.S. Medicine

August 19, 2018

PALO ALTO, CA—Prevention of AIDS-defining cancers, such as non-Hodgkin lymphoma, can be helped by early, sustained antiretroviral therapy, which results in long-term viral suppression, a new study found.

The treatment also helps ward off non-AIDS-defining cancers, but to a lesser degree, according to the report in Annals of Internal Medicine, which added that patients with long-term viral suppression still had greater cancer risk vs. uninfected patients.1

A study team led by Stanford University School of Medicine researchers included participation from VAMCs in New York, Washington, Los Angeles, Atlanta, Houston, Dallas and New Haven, CT. The researchers touted their study as the first to examine the effects of prolonged periods of viral suppression for an aging population of HIV patients and how that might prevent cancer.

Background information in the study pointed out that HIV patients are at increased risk for AIDS-defining cancers, including Kaposi sarcoma, non-Hodgkin lymphoma and invasive cervical cancer, as well as non-AIDS-defining cancers, including lung, larynx, melanoma, leukemia and those affecting other organs. The reported noted that some of those cancers, including Hodgkin lymphoma, liver cancer and anal cancer are known to be caused by viruses that are common among persons with HIV.

As a result, they wrote that viral suppression is a pivotal component of HIV treatment, with studies indicating an association between prolonged viral suppression and decreased risk for some types of cancer. Until now, no studies had specifically focused on the effect of sustained viral suppression on overall cancer risk.

To determine whether long-term viral suppression was associated with decreased cancer risk, the researchers compared cancer rates for 42,441 HIV-positive veterans with those of 104,712 demographically-matched uninfected veterans from 1999-2015.

Results suggested that cancer risk was highest in the unsuppressed persons (RR, 2.35 [95% CI, 2.19 to 2.51]), lower with early suppression (RR, 1.99 [CI, 1.87 to 2.12]), and lowest with long-term suppression (RR, 1.52 [CI, 1.44 to 1.61]).

In addition, the study team pointed out that the 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]), while 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.

“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,” study authors wrote.

1. Park LS, Tate JP, Sigel K, Brown ST, Crothers K, Gibert C, Goetz MB, Rimland D, Rodriguez-Barradas MC, Bedimo RJ, Justice AC, Dubrow R. Association of Viral Suppression With Lower AIDS-Defining and Non-AIDS-Defining Cancer Incidence in HIV-Infected Veterans: A Prospective Cohort Study. Ann Intern Med. 2018 Jun 12. doi: 10.7326/M16-2094. [Epub ahead of print] PubMed PMID: 29893768.

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