HAART Is Equally Protective against First AIDS-defining Cancers and Other First AIDS-defining Events

The advent of highly active antiretroviral therapy (HAART) led to a dramatic reduction in AIDS-related illnesses, but there has been little research comparing declines in AIDS-defining cancers (Kaposi's sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer) compared with other conditions such as opportunistic infections.

The aim of the current study, published in the July 8, 2008 advance online edition of the Journal of Acquired Immune Deficiency Syndromes was to evaluate the effect of HAART on the prevention of AIDS-defining cancers relative to other AIDS-defining events (e.g., Pneumocystis pneumonia (PCP), cytomegalovirus retinitis, cryptosporidiosis, toxoplasmosis, HIV wasting syndrome, and others [see Table below]).

This prospective cohort study included 2121 HIV positive male seroconverters (median age 28 years, 51% non-Hispanic whites) in the Tri-Service AIDS Clinical Consortium (n = 1694) and the Multicenter AIDS Cohort Study (n = 427).

Poisson regression models, with calendar periods representing changes in antiretroviral therapy, were extended to analyze first incident AIDS-defining cancers and other first AIDS-defining events as competing risks.

Results

• 81 AIDS-defining cancers (64 cases of Kaposi sarcoma; 17 cases of non-Hodgkin lymphoma) and 343 other AIDS events occurred during 14,483 person-years of observation during 1990-2006.

• The rate ratio of AIDS-defining cancers during the HAART calendar period was 0.26 compared with the monotherapy/combination therapy calendar period, after adjusting for age, race, cohort, and duration on infection.

• The rate ratio of other AIDS-defining events was similar, at 0.28.

• The association of HAART with decreased AIDS incidence seemed to be equal for AIDS-defining cancers and other AIDS-defining events.

Based on these findings, the study authors concluded, In [HIV]-infected men, HAART seems equally protective against first AIDS-defining cancers and other first AIDS-defining events."

Table: AIDS-defining Events

AIDS dementia complex
Candidiasis, esophageal
Candidiasis, pulmonary
Cryptococcosis
Cryptosporidiosis
Cytomegalovirus (excluding retinitis)
Cytomegalovirus retinitis
Herpes simplex ulceration
Herpes simplex, not skin
HIV wasting syndrome
Kaposi's sarcoma
Malignant lymphoma
Mycobacterium avium, extrapulmonary
Mycobacterium, other, extrapulmonary
Pneumocystis carinii (jiroveci) pneumonia
Progressive multifocal leukoencephalopathy (PML)
Salmonella septicaemia
Toxoplasmosis
Tuberculosis, extrapulmonary

Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Tri-Service AIDS Clinical Consortium, Uniformed Services University of the Health Sciences, Bethesda, MD; Northwestern University Feinberg School of Medicine, Chicago, IL; National Naval Medical Center, Bethesda, MD; Wilford Hall United States Air Force Medical Center, San Antonio, TX; David Geffen School of Medicine at University of California, Los Angeles, CA; University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Walter Reed Army Medical Center, Washington, DC; Naval Medical Center San Diego, San Diego, CA.

7/18/08

Reference

MS Shiels, SR Cole, S Wegner, and others. Effect of HAART on Incident Cancer and Noncancer AIDS Events among Male HIV Seroconverters. Journal of Acquired Immune Deficiency Syndromes. July 8, 2008 [Epub ahead of print].

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