Increased risk for non-AIDS-defining malignancies

New research recently published by Kesselring et al. in Clinical Infectious Diseases suggests that a low CD4 count while using combination antiretroviral therapy is associated with an increased risk for non-AIDS-defining malignancies. Anouk Kesselring, MD, MSc is currently completing her PhD study at Stichting HIV Monitoring. Below, she gives further insight into this research which has already generated quite a lot of interest.

A total of 11,459 patients from the Stichting HIV Monitoring database (also known as the Athena Cohort) were included in the analysis. The observation period started in July 1996 with the introduction on HAART in the Netherlands.

Among the participants, a total of 236 non-AIDS-defining malignancies were diagnosed, of which 102 (43%) had a possible infection-related aetiology.

Multivariate regression analysis demonstrated that longer exposure to a CD4 count below 200 cells/mm³ and to a lesser extent CD4 count below 350 cells/mm³ was associated with an increased risk for malignancy per year of exposure. The effect was mainly driven by non-AIDS-defining malignancies with possible infection-related aetiologies. The analysis was adjusted for sex, cumulative exposure to combination antiretroviral therapy, smoking, and alcohol abuse.

By contrast, the presence of detectable viraemia while using combination antiretroviral therapy was not associated with an increased risk for malignancy. Additional factors associated with malignancy included age and duration of exposure to HIV infection.

It was unexpected that only the duration of having a CD4 count below 350 cells/mm³ was associated with the risk of developing non-AIDS-defining malignancies, whereas the most recent CD4 count while using combination antiretroviral therapy was not. These findings support the current guidelines that recommend treating HIV infection before the CD4 count decreases below 350 CD4 cells/mm³.

The study did not receive commercial financial support. The authors have disclosed no relevant financial relationships.

Further information: Immunodeficiency as a risk factor for non-AIDS malignancies in HIV-1 infected patients receiving combination antiretroviral therapy. Kesselring et al. Clinical Infectious Diseases 2011;52(12):1458–1465. Abstract

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Stichting HIV Monitoring

Stichting HIV Monitoring (SHM) makes an essential contribution to healthcare for HIV-positive people in the Netherlands. Working with all recognised HIV treatment centres in the Netherlands, SHM systematically collects coded medical data from all registered HIV patients. SHM uses these data to produce centre-specific reports that allow HIV treatment centres to optimise their patient care and obtain formal certification. SHM’s data also form the basis for the yearly HIV monitoring report and are used in HIV-related research in the Netherlands and internationally. The outcome of SHM’s research provides tangible input into HIV care and prevention polices in the Netherlands.

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