OAKLAND, CA – Cancer is a significant problem for patients diagnosed with HIV. indicates that earlier initiation of antiretroviral therapy (ART) in persons living with HIV (PLWH) can reduce cancer incidence, but it has not been clear which cancer types are affected.
A report in Clinical Infectious Diseases discussed the results of a study evaluating AIDS-free, ART-naive PLWH during 1996-2014. Included were patients from 22 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design.1
Kaiser Permanent Northern California researchers and colleagues, including participation from the VA Connecticut Healthcare System in West Haven, followed participants from first observed CD4 of 350-500 cells/µl (baseline) until incident cancer, death, lost-to-follow-up or December 2014.
Defined as outcomes were six cancer groups and five individual cancers that were confirmed by chart review or cancer registry linkage.
“We evaluated the effect of earlier (in the first 6 months after baseline) versus deferred ART initiation on cancer risk,” the authors explained. “Marginal structural models were used with inverse probability weighting to account for time-dependent confounding and informative right-censoring, with weights informed by subject’s age, sex, cohort, baseline year, race/ethnicity, HIV transmission risk, smoking, viral hepatitis, CD4, and AIDS diagnoses.”
Results indicated that protective results for earlier ART were found for any cancer (adjusted hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.37-0.86), AIDS-defining cancers (HR 0.23; 95% CI 0.11-0.49), any virus-related cancer (HR 0.30; 95% CI 0.16-0.54), Kaposi sarcoma (HR 0.25; 95% CI 0.10-0.61) and non-Hodgkin lymphoma (HR 0.22; 95% CI 0.06-0.73).
In addition, by 15 years, researchers observed a reduced risk with earlier ART for virus-related non-AIDS-defining cancers (NADC) (0.6% vs. 2.3%; adjusted risk difference -1.6; 95% CI -2.8, -0.5).
“Earlier ART initiation has potential to reduce the burden of virus-related cancers in PLWH, but not NADCs without known or suspected viral etiology,” the authors concluded.
- Silverberg MJ, Leyden W, Hernández-Ramírez RU, et al. Timing of Antiretroviral Therapy Initiation and Risk of Cancer among Persons Living with HIV [published online ahead of print, 2020 Aug 12]. Clin Infect Dis. 2020;ciaa1046. doi:10.1093/cid/ciaa1046