June 22, 2017
Patients with non-AIDS-defining cancers (NADCs) had more than twice higher odds of HIV suppression 12 and 24 months after cancer diagnosis than did patients with AIDS-defining cancers (ADCs) in a single-center 412-person analysis. CD4 counts were significantly higher at diagnosis and six months later in the NADC group.
Compared with the general population, people with HIV are at higher risk for the three ADCs (invasive cervical cancer, Kaposi sarcoma and non-Hodgkin lymphoma) and certain NADCs (including Hodgkin lymphoma and cancers of the lung, liver, oral cavity and anus). Research shows higher mortality in cancer patients with HIV than in the general population. Because little is known about HIV-specific outcomes (viral suppression and CD4 count) at and after cancer diagnosis, University of Maryland researchers compared those outcomes in HIV-positive people with NADCs versus ADCs.
HIV patients were eligible for this retrospective analysis if they had a cancer diagnosis between January 1, 2000 and December 31, 2011 and both a viral load and CD4 count around the time of the diagnosis. Researchers collected clinical and demographic data from medical records, defining viral suppression as HIV RNA ≤400 copies/mL. They confirmed cancer diagnoses with histopathologic reports. The researchers used adjusted logistic regression to identify independent predictors of viral suppression 12 and 24 months after cancer diagnosis.
Of the 412 study participants, 80% were men, 87% were African American and drug injecting was the most frequent HIV transmission route (43%). While 122 people (30%) had an ADC, 290 (70%) had an NADC. The most frequent NADCs were cancers of the lung in 59 patients, prostate in 46 and head and neck in 35.
The NADC group had a higher median age (54 versus 43 years), a higher median CD4 count at cancer diagnosis (314 versus 137 cells/mm3), a lower proportion with a CD4 count below 200 cells/mm3 (29% versus 58%), a higher proportion taking antiretroviral therapy (ART) at cancer diagnosis (75% versus 46%) and a higher proportion with viral suppression at cancer diagnosis (59% versus 25%) (P < .0001 for all comparisons). Hepatitis C (HCV) infection was more prevalent in the NADC group (52% versus 36%, P = .002), and the NADC group had a significantly longer time between HIV diagnosis and cancer diagnosis (11 versus 5 years, P < .0001).
An analysis adjusted for sex, baseline CD4 count, ART and hepatitis B or HCV infection determined that people with an NADC had a significantly higher CD4 count at cancer diagnosis (P < .0001) and six months later (P < .01) but not 12, 18 or 24 months after cancer diagnosis.
The proportion of people with virologic suppression improved after cancer diagnosis in the ADC group and reached about 60% from 12 to 24 months after diagnosis. But virologic suppression rates also improved after cancer diagnosis in the NADC group and always remained significantly higher than in the ADC group. An analysis adjusted for sex and HIV risk factor determined that people with an NADC versus an ADC had more than twice higher odds of viral suppression 12 months after cancer diagnosis (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.04 to 4.62). An analysis adjusted for race and HIV risk factor found a similar viral suppression advantage with NADCs at 24 months (OR 2.17, 95% CI 0.92 to 5.16).
The researchers calculate that 42% of patients with ADCs remained unsuppressed one year after cancer diagnosis. Because of the impact of ongoing viremia on mortality, they believe "this finding is concerning and may contribute to an increased likelihood of death in these dually affected patients." Failure to attain suppression in sizeable proportions of patients with either ADC or NADC indicates that "new strategies are urgently needed for engaging and treating HIV-infected patients who are diagnosed with cancer."
Mark Mascolini writes about HIV infection.
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