Low CD4 Cell Count Elevates Cancer Risk in Patients With HIV

Having a more compromised immune system is the biggest risk factor for both AIDS-defining and non-AIDS-defining cancers in HIV patients, a new study by French researchers finds.

Noting that "the relative roles of immunodeficiency, HIV viral load and cART [combination antiretroviral therapy] in the onset of individual cancer have rarely been examined," a team led by Dr. Dominique Costagliola of INSERM and Universite Pierre et Marie Curie in Paris examined the effect of these factors on the risk of specific cancers in HIV-1 patients.

Using data from the French Hospital Database on HIV cohort from 1998 to 2006, the researchers investigated the incidence of AIDS-defining cancers (Kaposi's sarcoma, non-Hodgkin's lymphoma and cervical cancer) and non-AIDS-defining cancers (Hodgkin's lymphoma, lung cancer, liver cancer, and anal cancer) in 52,278 patients with more than 250,000 person-years of follow-up.

The median baseline CD4 count was 325 cells per microliter, and median viral load was 4.18 log-10 copies per mL; 73 percent of subjects took cART for the total follow-up period. Each type of malignancy was analyzed separately, using Poisson regression to test 78 models.

"Current CD4 cell count was the only factor predictive of Hodgkin's lymphoma, lung cancer and liver cancer," the team reported, "whereas current CD4 cell count, current viral load and absence of cART were risk factors for Kaposi's sarcoma and non-Hodgkin lymphoma." Cervical cancer was associated with current CD4 cell count and absence of cART, while the risk of anal cancer increased with cumulative duration of CD4 counts less than 200 cells per microliter and with the cumulative duration of viral load more than 5 log-10 copies per mL.

"cART would be most beneficial if it restores or maintains CD4 counts above 500 cells per [microliter], thereby indicating an earlier diagnosis of HIV infection and an earlier treatment initiation," the team concluded. "Cancer-specific programs need to be assessed in patients with HIV."

The study, "Effect of Immunodeficiency, HIV Viral Load, and Antiretroviral Therapy on the Risk of Individual Malignancies (FHDH-ANRS C04): a Prospective Cohort Study," was published online ahead of print in the Lancet Oncology (2009;doi:10.1016/S1470-2045(09)70282-7).