October 14, 2016
This week, a study finds that several biomarkers of inflammation were associated with a higher mortality risk among HIV-positive men who have sex with men, regardless of whether they were virally suppressed or not. Another study finds that people diagnosed with AIDS are more likely to die from non-AIDS-related cancer than the general population. To beat HIV, you have to follow the science!
Several inflammation-related biomarkers were associated with a higher mortality risk among men who have sex with men, live with HIV, and are virally suppressed, according to an analysis of serum collected by the Multicenter AIDS Cohort Study and published in Clinical Infectious Diseases.
The specific biomarkers related to a higher mortality risk were interleukin 6 (IL-6), soluble IL 2Rα, soluble CD14, and chemokine ligand 13. Men with concentrations in the highest quartile for each of these markers were two to three times more likely to die than were their peers. Since "normal" levels have not been established for these biomarkers, threshold concentrations above which mortality risk increases cannot be determined. However, the IL-6 concentration showed the strongest correlation with mortality risk, a fact that has also been observed in other groups, such as cancer patients.
Study authors theorize that the residual inflammation indicated by these biomarkers is the result of ongoing low-level viremia or immunologic processes due to damage during early infection.
The death certificates of about a tenth of 1,229 people who had lived with AIDS (PWA) listed non-AIDS-defining cancers (non-ADCs) as cause of death, an analysis of Italian data from 2006-2011 published in Journal of Acquired Immune Deficiency Syndromes found. PWA mortality risk from non-ADCs was 7.3 times that of the general population.
Those who had acquired HIV through injection drug use (IDU) were even more likely to die from non-ADCs. Other studies have shown higher rates of coinfection with hepatitis C among IDUs, which may explain this finding. PWA were much more likely to die from Hodgkin's lymphoma and anal carcinoma -- both associated with viruses -- and significantly more likely to die from liver cancer, as well as tobacco smoking-related cancers of the lung, head and neck, than people not living with HIV.
Liver and lung cancers were even more prevalent causes of death in PWA younger than 50 years old. By comparison, a similar study conducted for 1999-2006 found mortality risk from non-ADCs to be about 6.6 times greater among PWA.
Taking nelfinavir (NFV) does not substantially change the risk of developing cancer, an analysis of data from the D:A:D study found.
NFV shows potent anticancer properties in the lab, but was contaminated with a carcinogen in 2006/2007. This data analysis considered 42,006 persons between January 2004 and February 2014, 8,305 of whom had taken NFV before enrolling in D:A:D, which collects information on adverse events for antiretrovirals across three continents. The adjusted risk ratio (aRR) for any type of cancer was 0.98 for those taking NFV compared to participants who took other protease inhibitors.
The 1,063 study participants who were exposed to NFV while it was contaminated had an aRR of 1.07 for cancer, compared to those taking other antiretrovirals. This supports toxicology studies of the contaminant that showed much higher levels than those found in the medication would be necessary for a carcinogenic effect in humans. Follow-up past 2014 might show different results, cautioned the authors of the analysis, which was published in AIDS. They also noted that NFV did not appear to be related to lower cancer rates, despite its in vitro properties.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
Copyright © 2016 Remedy Health Media, LLC. All rights reserved.
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