TY - JOUR
T1 - Association of viral suppression with lower aids-defining and non–AIDS-defining cancer incidence in HIV-infected veterans
T2 - A prospective cohort study
AU - Park, Lesley S.
AU - Tate, Janet P.
AU - Sigel, Keith
AU - Brown, Sheldon T.
AU - Crothers, Kristina
AU - Gibert, Cynthia
AU - Goetz, Matthew Bidwell
AU - Rimland, David
AU - Rodriguez-Barradas, Maria C.
AU - Bedimo, Roger J.
AU - Justice, Amy C.
AU - Dubrow, Robert
N1 - Funding Information:
Disclosures: Dr. Park reports grants from the National Cancer Institute, National Institute of Diabetes and Digestive and Kid- ney Diseases, and National Institute of Mental Health of the NIH during the conduct of the study. Dr. Tate reports grants from the NIH during the conduct of the study. Dr. Brown reports grants from the National Institute on Alcohol Abuse and Alcoholism of the NIH during the conduct of the study. Dr. Goetz reports grants from the National Institute on Alcohol Abuse and Alcoholism during the conduct of the study. Dr. Rodriguez-Barradas reports grants and travel support from the NIH outside the submitted work. Dr. Bedimo reports grants and personal fees from Merck and ViiV Healthcare, grants from Bristol-Myers Squibb, and personal fees from Gilead Sciences outside the submitted work. Dr. Dubrow reports grants from the National Cancer Institute during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms .do?msNum=M16-2094.
Funding Information:
Financial Support: By the VA and by grants U01-AA020790, U24-AA020794, and U10-AA013566 from the National Institute on Alcohol Abuse and Alcoholism; T32-MH020031 and P30-MH062294 from the National Institute of Mental Health; U01-A1069918 from the National Institute of Allergy and Infectious Diseases; F31-CA180775, R01-CA165937, and R01-CA173754 from the National Cancer Institute; and 3T32-DK007217 from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH).
Publisher Copyright:
© 2018 American College of Physicians.
PY - 2018/7/17
Y1 - 2018/7/17
N2 - Background: Viral suppression is a primary marker of HIV treatment success. Persons with HIV are at increased risk for AIDS-defining cancer (ADC) and several types of non–AIDS-defining cancer (NADC), some of which are caused by oncogenic viruses. Objective: To determine whether viral suppression is associated with decreased cancer risk. Design: Prospective cohort. Setting: Department of Veterans Affairs. Participants: HIV-positive veterans (n = 42 441) and demographically matched uninfected veterans (n = 104 712) from 1999 to 2015. Measurements: Standardized cancer incidence rates and Poisson regression rate ratios (RRs; HIV-positive vs. uninfected persons) by viral suppression status (unsuppressed: person-time with HIV RNA levels ≥500 copies/mL; early suppression: initial 2 years with HIV RNA levels <500 copies/mL; long-term suppression: person-time after early suppression with HIV RNA levels <500 copies/mL). Results: Cancer incidence for HIV-positive versus uninfected persons was highest for unsuppressed persons (RR, 2.35 [95% CI, 2.19 to 2.51]), lower among persons with early suppression (RR, 1.99 [CI, 1.87 to 2.12]), and lowest among persons with long-term suppression (RR, 1.52 [CI, 1.44 to 1.61]). This trend was strongest for ADC (unsuppressed: RR, 22.73 [CI, 19.01 to 27.19]; early suppression: RR, 9.48 [CI, 7.78 to 11.55]; long-term suppression: RR, 2.22 [CI, 1.69 to 2.93]), much weaker for NADC caused by viruses (unsuppressed: RR, 3.82 [CI, 3.24 to 4.49]; early suppression: RR, 3.42 [CI, 2.95 to 3.97]; long-term suppression: RR, 3.17 [CI, 2.78 to 3.62]), and absent for NADC not caused by viruses. Limitation: Lower viral suppression thresholds, duration of long-term suppression, and effects of CD4+ and CD8+ T-cell counts were not thoroughly evaluated. Conclusion: Antiretroviral therapy resulting in long-term viral suppression may contribute to cancer prevention, to a greater degree for ADC than for NADC. Patients with long-term viral suppression still had excess cancer risk.
AB - Background: Viral suppression is a primary marker of HIV treatment success. Persons with HIV are at increased risk for AIDS-defining cancer (ADC) and several types of non–AIDS-defining cancer (NADC), some of which are caused by oncogenic viruses. Objective: To determine whether viral suppression is associated with decreased cancer risk. Design: Prospective cohort. Setting: Department of Veterans Affairs. Participants: HIV-positive veterans (n = 42 441) and demographically matched uninfected veterans (n = 104 712) from 1999 to 2015. Measurements: Standardized cancer incidence rates and Poisson regression rate ratios (RRs; HIV-positive vs. uninfected persons) by viral suppression status (unsuppressed: person-time with HIV RNA levels ≥500 copies/mL; early suppression: initial 2 years with HIV RNA levels <500 copies/mL; long-term suppression: person-time after early suppression with HIV RNA levels <500 copies/mL). Results: Cancer incidence for HIV-positive versus uninfected persons was highest for unsuppressed persons (RR, 2.35 [95% CI, 2.19 to 2.51]), lower among persons with early suppression (RR, 1.99 [CI, 1.87 to 2.12]), and lowest among persons with long-term suppression (RR, 1.52 [CI, 1.44 to 1.61]). This trend was strongest for ADC (unsuppressed: RR, 22.73 [CI, 19.01 to 27.19]; early suppression: RR, 9.48 [CI, 7.78 to 11.55]; long-term suppression: RR, 2.22 [CI, 1.69 to 2.93]), much weaker for NADC caused by viruses (unsuppressed: RR, 3.82 [CI, 3.24 to 4.49]; early suppression: RR, 3.42 [CI, 2.95 to 3.97]; long-term suppression: RR, 3.17 [CI, 2.78 to 3.62]), and absent for NADC not caused by viruses. Limitation: Lower viral suppression thresholds, duration of long-term suppression, and effects of CD4+ and CD8+ T-cell counts were not thoroughly evaluated. Conclusion: Antiretroviral therapy resulting in long-term viral suppression may contribute to cancer prevention, to a greater degree for ADC than for NADC. Patients with long-term viral suppression still had excess cancer risk.
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U2 - 10.7326/M16-2094
DO - 10.7326/M16-2094
M3 - Article
C2 - 29893768
AN - SCOPUS:85050376453
SN - 0003-4819
VL - 169
SP - 87
EP - 96
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 2
ER -