Non-AIDS-defining Illnesses and Cancers in the HAART Era Evidence continues to accumulate showing that people with HIV are at elevated risk for non-AIDS-defining illnesses, even as rates of AIDS-defining opportunistic illnesses have fallen dramatically since the advent of HAART. Two studies of non-AIDS-defining illnesses and cancers were presented at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy last month in Chicago. Non-AIDS-defining Illnesses and CD4 Count In the first study, French researchers analyzed long-term follow-up data from 1281 HIV positive participants in the Aproco-Copilote (ANRS CO8) cohort who started protease-inhibitor-based HAART regimens between 1997 and 1999 (45% of whom were starting treatment for the first time). Adequate data were available for 1231 patients, followed for a median of 7 years. About three-quarters were men, the median age was 36 years, the median CD4 cell count was 279 cells/mm3, the median HIV RNA level was 4.5 log10 copies/mL, 23% were coinfected with hepatitis C virus (HCV), and 5% were coinfected with hepatitis B virus (HBV). The investigators looked at the incidence of severe (those requiring hospitalization) or life-threatening medical conditions or deaths that were neither opportunistic illnesses nor considered related to antiretroviral drug toxicity. Results
Based
on these findings, the researchers concluded, "Non-AIDS non-HAART severe
clinical events, especially bacterial infections, may be favored by persistent
immunosuppression and virological replication." Non-AIDS-defining Cancers The second study looked at rates of non-AIDS-defining cancers, that is, all malignancies other than Kaposi's sarcoma (KS), non-Hodgkins lymphoma (NHL), and invasive cervical cancer. Several past studies have shown that while the incidence of AIDS-defining cancers has fallen overall since the advent of HAART -- mostly due to a dramatic drop in KS -- rates of other types of malignancies have held steady or risen. Research has produced conflicting data about whether HIV positive people are at higher risk for non-AIDS-defining malignancies compared with HIV negative individuals. In the present study, researchers with the Veterans Administration health system used an electronic medical records system to identify HIV positive and HIV negative veterans matched for age, race, and sex who received care during 1997 through 2004 (i.e., since the wide availability of combination HAART). A total of 33,420 HIV positive and 66,840 HIV negative patients were followed for a median of 5.1 and 6.4 years, respectively. Results
"In the HAART era, the incidence of non-AIDS-defining malignancies is significantly higher among HIV positive than HIV negative veterans, adjusting for age, race, and gender," the researchers concluded. "Some non-AIDS-defining malignancies appear to be associated with mild immunosuppression." Notably, most of the cancers seen at higher rates in people with HIV are due to infectious agents. Both Hodgkin's and non-Hodgkin's lymphoma are associated with Epstein-Barr virus (EBV). Cervical cancer and anal cancer are both caused by human papillomavirus (HPV), and many experts believe anal cancer should be considered AIDS-defining as well. Liver cancer is a potential long-term outcome of chronic hepatitis B or C. Univ.
of Texas Southwestern Med. Ctr., Dallas, TX; VA North Texas Heathcare System,
Dallas, TX; VA Pittsburgh Healthcare Ctr., Pittsburgh, PA; Michael E. DeBakey
VA Med. Ctr., Houston, TX; Yale Univ. School of Medicine, West Haven, CT. RJ Bedimo, M Dunlap, KA McGinnis, and others. Incidence of non-AIDS-defining malignancies in HIV-infected vs. non-infected veterans in the HAART era: impact of immunosuppression. 47th Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL. September 17-20, 2007. Abstract H-1721.
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