15th Conference on Retroviruses and Opportunistic Infections Boston, Massachusetts - February 3-6, 2008

Conf Retrovir Opportunistic Infect 2008 Feb 3-6;15: (abstract no. 15)

M Bruyand^1,2, R Thiebaut^1,2,3,4, S Lawson-Ayayi^1,2, P Joly^3,4, A Sasco⁵, J L Pellegrin^2,4,6, D Neau^2,4,6, P Morlat^1,2,4,6, G Chene^1,2,4, Fabrice Bonnet^1,2,4,6, and Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA)
¹INSERM U593 and CIC-EC7, Bordeaux, France; ²Ctr Hosp Univ Bordeaux, France; ³INSERM U875, Bordeaux, France; ⁴Univ Victor Segalen, Bordeaux, France; ⁵INSERM U897, Bordeaux, France; and ⁶Ctr Hosp Univ Bordeaux, France

BACKGROUND: HIV-infected patients have a high risk of AIDS- and non-AIDS-defining cancers. Besides traditional determinants, a specific role of HIV, immunodepression, and ART cannot be excluded. We aimed at studying the association between the risk of AIDS- and non-AIDS-defining cancers and either immuno-virological characteristics, or treatment history of HIV-infected patients.

METHODS: Patients from the ANRS CO3 Aquitaine Cohort were included in the analyses if the duration of follow-up was >3 months, if they had at least 2 follow-up visits available during the study period (1998 to 2006) and if 1 HIV RNA viral load was collected within the first follow-up visit. Duration of exposure was calculated as the time duration with CD4 count or HIVRNA level above or below different thresholds. Multivariate modelling was based on extended Cox proportional hazards models for time-dependent covariates and delayed entry (at time of first available HIV RNA measurement).

RESULTS: Among the 4194 patients included, 251 cancers (109 AIDS-defining and 142 non-AIDS-defining) were reported. Regarding AIDS-defining cancers, a higher incidence was independently associated with a longer duration of HIV RNA >500 copies/mL: relative risk (RR)=1.20 per year of exposure (95% confidence interval [CI] 1.10 to 1.31, p <10^–3) and a longer duration of CD4 count <200/mm³: RR=1.35 by year of exposure (CI 1.20 to 1.53, p<10^–3). A lower incidence was associated with duration of exposure to combination ART (cART): RR=0.82 per year (CI 0.74 to 0.91, p<10^–3). Regarding non-AIDS-defining cancers, a higher incidence was independently associated with a longer duration of CD4 count <200/mm³: RR=1.16 per year of exposure (CI 1.03 to 1.30, p=0.01) or a longer duration of CD4 count <500/mm³: RR=1.11 per year of exposure (CI 1.01 to 1.22, p=0.02), and a lower incidence with female gender: RR=0.58 (CI 0.37 to 0.92, p=0.02). HIV RNA and cART were not associated with the risk of non-AIDS-defining cancers.

CONCLUSIONS: A longer exposure to uncontrolled HIV RNA was associated with a higher risk of AIDS-defining cancers, independently of CD4 count. Moreover, prolonged immunosuppression was associated with a higher risk of cancers of both types, regardless of the CD4 count threshold considered. ART should aim at reaching and maintaining the CD4 count >500/mm³ to prevent the occurrence of all cancers, in addition to other prevention policies.

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2008-02-03
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