Journal
ANNALS OF INTERNAL MEDICINE
Volume 174, Issue 6, Pages 768-+Publisher
AMER COLL PHYSICIANS
DOI: 10.7326/M20-5226
Keywords
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Categories
Funding
- Danish National Research Foundation (Centre of Excellence for Health, Immunity and Infections [CHIP] and Personalized Medicine of Infectious Complications in immune deficiency [PERSIMUNE]) [DNRF126]
- Highly Active Anti-retroviral Therapy Oversight Committee, a collaborative committee with representation from academic institutions
- European Agency for the Evaluation of Medicinal Products
- U.S. Food and Drug Administration
- patient community
- AbbVie
- Bristol-Myers Squibb
- Gilead Sciences
- ViiV Healthcare
- Merck Co.
- Janssen Pharmaceuticals
- Dutch Ministry of Health, Welfare and Sport through the Center for Infectious Disease Control of the National Institute for Public Health
- Dutch Ministry of Health, Welfare and Sport through the Environment to Stichting HIV Monitoring (ATHENA [AIDS Therapy Evaluation Project Netherlands])
- Agence nationale de recherches sur le sida et les hepatites virales [7]
- Fundacion para la Investigacion y la Prevencion del SIDA en Espana [FIS 99/0887]
- National Institute of Allergy and Infectious Diseases of the National Institutes of Health [5U01AI042170-10, 5U01AI046362-03, U01-AI069907]
- European Union's Seventh Framework Programme for research, technological development, and demonstration under EUROCOORD [260694]
- Janssen RD
- Pfizer
- GlaxoSmithKline (Swiss National Science Foundation) [108787]
- Swiss National Science Foundation [148522]
- Swiss HIV Cohort Study research foundation
- Australian HIV Observational Database
- Boehringer Ingelheim
- Janssen-Cilag
- Australian government Department of Health and Ageing
- Faculty of Medicine at the University of New South Wales
- Swiss Cancer League/Swiss Cancer Research [KFS-4106-02-2017]
- Stiftung Institut fur klinische Epidemiologie
- Providence/Boston Center for AIDS Research [P30AI042853]
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Immediate initiation of antiretroviral therapy (ART) has small effects on the long-term risk for cancer in a cohort of young HIV-positive persons, with further data needed for non-AIDS-defining cancer risk.
Background: Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non-AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 x 10(9) cells/L. Consequences of delayed ART on risk for non-AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear. Objective: To estimate the long-term risk difference for cancer with the immediate ART strategy. Design: Multinational prospective cohort study. Setting: The D:A:D (Data collection on Adverse events of anti-HIV Drugs) study, which included HIV-positive persons from Europe, Australia, and the United States. Participants: 8318 HIV-positive persons with at least 1 measurement each of CD4 cell count and viral load while ART-naive (study period, 2006 to 2016). Measurements: The parametric g-formula was used, with adjustment for baseline and time-dependent confounders (CD4 cell count and viral load), to assess the 10-year risk for non-AIDS-defining and AIDS-defining cancer of immediate versus deferred (at CD4 counts <350 and <500 x 10(9) cells/L) ART initiation strategies. Results: During 64 021 person-years of follow-up, 231 cases of non-AIDS-defining cancer and 272 of AIDS-defining cancer occurred among HIV-positive persons with a median age of 36 years (interquartile range, 29 to 43 years). With immediate ART, the 10-year risk for non-AIDS-defining cancer was 2.97% (95% CI, 2.37% to 3.50%) and that for AIDS-defining cancer was 2.50% (CI, 2.37% to 3.38%). Compared with immediate ART initiation, the 10-year absolute risk differences when deferring ART to CD4 counts less than 500 x 10(9) cells/L and less than 350 x 10(9) cells/L were 0.12 percentage point (CI, -0.01 to 0.26 percentage point) and 0.29 percentage point (CI, -0.03 to 0.73 percentage point), respectively, for non-AIDS-defining cancer and 0.32 percentage point (CI, 0.21 to 0.44 percentage point) and 1.00 percentage point (CI, 0.67 to 1.44 percentage points), respectively, for AIDS-defining cancer. Limitation: Potential residual confounding due to observational study design. Conclusion: In this young cohort, effects of immediate ART on 10-year risk for cancer were small, and further supportive data are needed for non-AIDS-defining cancer.
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