Risk of Cancer in People With HIV Experiencing Varying Degrees of Immune Recovery With Sustained Virological Suppression on Antiretroviral Treatment for More Than 2 Years: An International, Multicenter, Observational Cohort

Year: 2025

Type: article

Abstract: BACKGROUND: The impact of long-term virological suppression (VS) and CD4 count recovery on non-AIDS-defining cancers (NADCs) is unclear. We determined whether poor immune recovery was associated with incident cancer risk in people with human immunodeficiency virus (HIV) with VS. METHODS: Participants from the Data-Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) and International Cohort Consortium of Infectious Disease (RESPOND) collaborations in Europe and Australia who achieved ≥2 years of VS on antiretroviral therapy (ART) between December 1999 and December 2022 were included. Follow-up was from baseline (date of VS for 2 years) until the earliest of a first cancer event, virological failure, final follow-up, or administrative censoring date. Multivariable Poisson regression was used to assess associations between cancer incidence (overall, AIDS-defining cancer, NADC, infection-related cancer, infection-unrelated cancer) and time-updated CD4 count stratified by pre-ART nadir CD4 counts. RESULTS: Overall, 48 343 people with VS were included (median [interquartile range] baseline age, 43 years [37-50]; CD4 count, 540 cells/µL [380-730]; nadir CD4 count, 245 cells/µL [121-394]; 74% male). There were 1933 incident cancers (median follow-up, 6.2 years [2.9-9.5]; incidence rate [IR], 6.43; 95% confidence interval [CI]: 6.15-6.73/1000 person-years). Higher time-updated CD4 count was associated with a reduced risk of overall cancer (adjusted incidence rate ratio for time-updated CD4 count 350-499 cells/µL: 0.45 [95% CI: 0.39-0.51]; 500-749 cells/µL: 0.30 [95% CI: 0.27-0.34]; and ≥750 cells/µL: 0.26 [95% CI: 0.23-0.30] vs <350 cells/µL; P < .0001). There was a significant reduction in all cancer risk by higher time-updated CD4 count, regardless of nadir CD4 count, with higher pre-ART nadir CD4 count exhibiting lower risk. CONCLUSIONS: Despite VS on ART for more than 2 years, people with poorer immune recovery experienced a significantly higher incidence of cancer. This highlights the importance of early HIV diagnosis and ART initiation, and appropriate cancer screening strategies for those with poor immune recovery.

Source: Clinical Infectious Diseases

DOI: 10.1093/cid/ciaf248

Institutions: UNSW Sydney, Kirby Institute, University of Copenhagen, Hvidovre Hospital, Rigshospitalet, University College London, Centre Hospitalier Universitaire Vaudois, Paracelsus Medical University, Hôpital Necker-Enfants Malades, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Stichting HIV Monitoring, Amsterdam University Medical Centers, Amsterdam institute for Immunology and Infectious Diseases, University of Amsterdam, University of Modena and Reggio Emilia, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, Vita-Salute San Raffaele University, Instituto de Salud Carlos III, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Centro de Investigación Biomédica en Red Enfermedades Infecciosas, Universitat de Barcelona, Inserm, Centre Hospitalier Universitaire de Bordeaux, Bordeaux Population Health, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Vilnius University, Vilnius University Hospital Santariskiu Klinikos, University of Basel, University Hospital of Basel, Gilead Sciences (United States), Merck & Co., Inc., Rahway, NJ, USA (United States), The Alfred Hospital, Monash University

Language: English

Topic: Viral-associated cancers and disorders

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,763

Funders: National Science Foundation, amfAR, The Foundation for AIDS Research, Bristol-Myers Squibb, Pfizer, GlaxoSmithKline, Styrelsen för Internationellt Utvecklingssamarbete, Gilead Sciences, ViiV Healthcare, Australian Government, Moderna, European Commission, National Research Foundation, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Danmarks Grundforskningsfond, University of New South Wales, Universiteit van Amsterdam, Ministerie van Volksgezondheid, Welzijn en Sport, Agence Nationale de Recherches sur le Sida et les Hépatites Virales, Fundación Para La Innovación Y La Prospectiva En Salud En España, Stichting HIV Monitoring, National Institutes of Health, Pan American Health Organization, Medical Research Council, National Health and Medical Research Council, National Institute of Allergy and Infectious Diseases, Janssen Pharmaceuticals, Cilag

OpenAlex ID: W4410419155