The Link Between Protease Inhibitors and Cancer

June 18, 2015

A large, multinational study published in JAIDS reports an increased risk of some cancers for people taking protease inhibitor-based combination antiretroviral therapy (PI-based cART) compared to non-nucleoside reverse transcriptase inhibitor-based cART (NNRTI-based cART). While any successful cART is known to decrease the risk of "AIDS-defining" cancers such as Kaposi sarcoma, the relationship between cART and other cancers has not been well understood.

The D:A:D study -- which included 41,762 participants with HIV from 11 cohorts across Europe, Australia and the United States -- investigated this issue. In this observational study, researchers collected information from participants about any non-AIDS related cancer experienced and antiretroviral treatments used between 2004 and 2012.

A total of 1,832 cancer diagnoses were included in the study: 718 were AIDS-defining cancers, while 1,114 were not. As expected, any type of cART use decreased risk of AIDS-defining cancers. But while use of NNRTI-based cART decreased risk of non-AIDS defining cancers too, exposure to protease inhibitor (PI)-based cART actually seemed to increase risk of non-AIDS defining cancers.

"Each additional year of exposure to NNRTI-based cART was associated with a 2% reduction in cancer risk. In contrast, each additional year of exposure to PI-based cART was associated with a 2% increase in cancer risk," explain Mathias Bruyand, MD, PhD and colleagues in the article.

This increased risk associated with PI use -- though small -- may compound and produce a noticeable clinical effect if cART is taken long-term. If there is a causal link between PIs and non-AIDS-defining cancer (which the prospective, observational nature of this study does not prove), the authors say exposure to PIs for five years could result in a 16% increased risk of developing a non-AIDS-defining cancer.

This excerpt was cross-posted with the permission of Read the full article.

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