Timing of Antiretroviral Therapy Initiation and Risk of Cancer Among Persons Living With Human Immunodeficiency Virus.

Acquired Immunodeficiency Syndrome CD4 Lymphocyte Count HIV HIV Infections / complications Humans Neoplasms / epidemiology Sarcoma, Kaposi
HIV antiretroviral therapy cancer causal inference epidemiology

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213

Informations de publication

Date de publication:
01 06 2021
Historique:
received: 26 03 2020
accepted: 20 07 2020
pubmed: 14 8 2020
medline: 3 7 2021
entrez: 14 8 2020
Statut: ppublish

Résumé

Persons living with human immunodeficiency virus (HIV; PLWH) experience a high burden of cancer. It remains unknown which cancer types are reduced in PLWH with earlier initiation of antiretroviral therapy (ART). We evaluated AIDS-free, ART-naive PLWH during 1996-2014 from 22 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. PLWH were followed from first observed CD4 of 350-500 cells/µL (baseline) until incident cancer, death, lost-to-follow-up, or December 2014. Outcomes included 6 cancer groups and 5 individual cancers that were confirmed by chart review or cancer registry linkage. We evaluated the effect of earlier (in the first 6 months after baseline) versus deferred ART initiation on cancer risk. Marginal structural models were used with inverse probability weighting to account for time-dependent confounding and informative right-censoring, with weights informed by subject's age, sex, cohort, baseline year, race/ethnicity, HIV transmission risk, smoking, viral hepatitis, CD4, and AIDS diagnoses. Protective results for earlier ART were found for any cancer (adjusted hazard ratio [HR] 0.57; 95% confidence interval [CI], .37-.86), AIDS-defining cancers (HR 0.23; 95% CI, .11-.49), any virus-related cancer (HR 0.30; 95% CI, .16-.54), Kaposi sarcoma (HR 0.25; 95% CI, .10-.61), and non-Hodgkin lymphoma (HR 0.22; 95% CI, .06-.73). By 15 years, there was also an observed reduced risk with earlier ART for virus-related NADCs (0.6% vs 2.3%; adjusted risk difference -1.6; 95% CI, -2.8, -.5). Earlier ART initiation has potential to reduce the burden of virus-related cancers in PLWH but not non-AIDS-defining cancers (NADCs) without known or suspected viral etiology.

Sections du résumé

BACKGROUND
Persons living with human immunodeficiency virus (HIV; PLWH) experience a high burden of cancer. It remains unknown which cancer types are reduced in PLWH with earlier initiation of antiretroviral therapy (ART).
METHODS
We evaluated AIDS-free, ART-naive PLWH during 1996-2014 from 22 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. PLWH were followed from first observed CD4 of 350-500 cells/µL (baseline) until incident cancer, death, lost-to-follow-up, or December 2014. Outcomes included 6 cancer groups and 5 individual cancers that were confirmed by chart review or cancer registry linkage. We evaluated the effect of earlier (in the first 6 months after baseline) versus deferred ART initiation on cancer risk. Marginal structural models were used with inverse probability weighting to account for time-dependent confounding and informative right-censoring, with weights informed by subject's age, sex, cohort, baseline year, race/ethnicity, HIV transmission risk, smoking, viral hepatitis, CD4, and AIDS diagnoses.
RESULTS
Protective results for earlier ART were found for any cancer (adjusted hazard ratio [HR] 0.57; 95% confidence interval [CI], .37-.86), AIDS-defining cancers (HR 0.23; 95% CI, .11-.49), any virus-related cancer (HR 0.30; 95% CI, .16-.54), Kaposi sarcoma (HR 0.25; 95% CI, .10-.61), and non-Hodgkin lymphoma (HR 0.22; 95% CI, .06-.73). By 15 years, there was also an observed reduced risk with earlier ART for virus-related NADCs (0.6% vs 2.3%; adjusted risk difference -1.6; 95% CI, -2.8, -.5).
CONCLUSIONS
Earlier ART initiation has potential to reduce the burden of virus-related cancers in PLWH but not non-AIDS-defining cancers (NADCs) without known or suspected viral etiology.

Identifiants

DOI: 10.1093/cid/ciaa1046 PMID: 32785640 PMC: PMC8315132
pubmed: 32785640
pii: 5876705
doi: 10.1093/cid/ciaa1046
pmc: PMC8315132
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

1900-1909

Subventions

Organisme : NIDA NIH HHS
ID : F31 DA037788
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI110527
Pays : United States
Organisme : NIAID NIH HHS
ID : K01 AI131895
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146241
Pays : United States
Organisme : NCRR NIH HHS
ID : UL1 RR024131
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027757
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146193
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050409
Pays : United States
Organisme : NCI NIH HHS
ID : N01 CP001004
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA012568
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01 AA020790
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA165937
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI068636
Pays : United States
Organisme : NIMH NIH HHS
ID : P30 MH062246
Pays : United States
Organisme : NEI NIH HHS
ID : U10 EY008057
Pays : United States
Organisme : NIDA NIH HHS
ID : U01 DA036935
Pays : United States
Organisme : NIDA NIH HHS
ID : R34 DA045592
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI038855
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050410
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146194
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069432
Pays : United States
Organisme : NCI NIH HHS
ID : N02CP55504
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG053100
Pays : United States
Organisme : NIAID NIH HHS
ID : F31 AI124794
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146202
Pays : United States
Organisme : NIAAA NIH HHS
ID : U24 AA020794
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI094189
Pays : United States
Organisme : NIMHD NIH HHS
ID : G12 MD007583
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NEI NIH HHS
ID : U10 EY008052
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146245
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01 AA013566
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146205
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002378
Pays : United States
Organisme : NIDA NIH HHS
ID : K24 DA000432
Pays : United States
Organisme : NEI NIH HHS
ID : U10 EY008067
Pays : United States
Organisme : NIAID NIH HHS
ID : K01 AI093197
Pays : United States
Organisme : NIMHD NIH HHS
ID : U54 MD007587
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027767
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146333
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146240
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI038858
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA011602
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI065298
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146242
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI045008
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068634
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI118591
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146204
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069434
Pays : United States
Organisme : CIHR
Pays : Canada
Organisme : NHLBI NIH HHS
ID : U01 HL146192
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000083
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027763
Pays : United States
Organisme : NIAAA NIH HHS
ID : R01 AA016893
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146208
Pays : United States
Organisme : NCI NIH HHS
ID : K08 CA230170
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146201
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069918
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146203
Pays : United States
Organisme : NEI NIH HHS
ID : K23 EY013707
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000004
Pays : United States
Organisme : Intramural NIH HHS
ID : Z01 CP010176
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR000421
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI036219
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI068634
Pays : United States
Organisme : NIAID NIH HHS
ID : R24 AI067039
Pays : United States

Informations de copyright

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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Auteurs

Michael J Silverberg (MJ)

Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.

Wendy Leyden (W)

Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.

Raúl U Hernández-Ramírez (RU)

Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA.

Li Qin (L)

Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.

Haiqun Lin (H)

Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA.
School of Nursing, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, USA.

Amy C Justice (AC)

Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Health Policy and Management, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA.
Research Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.

Nancy A Hessol (NA)

Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA.

Chad J Achenbach (CJ)

Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Gypsyamber D'Souza (G)

Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.

Eric A Engels (EA)

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.

Keri N Althoff (KN)

Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.

Angel M Mayor (AM)

Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico.

Timothy R Sterling (TR)

Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Mari M Kitahata (MM)

Department of Medicine, University of Washington, Seattle, Washington, USA.

Ronald J Bosch (RJ)

Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Michael S Saag (MS)

Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Charles S Rabkin (CS)

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.

Michael A Horberg (MA)

Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA.

M John Gill (MJ)

Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

Surbhi Grover (S)

Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

W Christopher Mathews (WC)

Department of Medicine, University of California San Diego, San Diego, California, USA.

Jun Li (J)

Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Heidi M Crane (HM)

Department of Medicine, University of Washington, Seattle, Washington, USA.

Stephen J Gange (SJ)

Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.

Bryan Lau (B)

Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
ORCID: 0000-0002-2355-612X

Richard D Moore (RD)

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Robert Dubrow (R)

Department of Environmental Health Sciences, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA.

Romain S Neugebauer (RS)

Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.

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Classifications MeSH

questionsmedicales.fr › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › Syndrome d'immunodéficience acquise › Timing of Antiretroviral Therapy Initiation...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiogiques du sang › Hémogramme › Numération des leucocytes › Numération des lymphocytes › Numération des lymphocytes CD4 › Timing of Antiretroviral Therapy Initiation...
questionsmedicales.fr › Virus › Virus à ARN › Retroviridae › Lentivirus › Lentivirus des primates › VIH (Virus de l'Immunodéficience Humaine) › Timing of Antiretroviral Therapy Initiation...
questionsmedicales.fr › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › Timing of Antiretroviral Therapy Initiation...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Timing of Antiretroviral Therapy Initiation...
questionsmedicales.fr › Tumeurs › Timing of Antiretroviral Therapy Initiation...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs du tissu vasculaire › Sarcome de Kaposi › Timing of Antiretroviral Therapy Initiation...