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Lower CD4 Counts Boost Risk of "Non-AIDS" Cancers
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Mark Mascolini
February 27, 2007
14th Conference on Retroviruses and Opportunistic Infections
Los Angeles
Lower CD4 counts predict death not only from AIDS-defining cancers but also from non-AIDS cancers, according to results of a 23,437-person study of the 11-cohort D:A:D collaboration [1]. Non-AIDS malignancies accounted for almost two thirds of the deaths tallied in this 1999-2005 analysis.
Antonella d'Arminio Monforte (University of Milan) and D:A:D colleagues counted 112 deaths from AIDS cancers and 193 from non-AIDS cancers to yield rates of 1.05 AIDS cancer deaths per 1000 person-years versus 1.79 non-AIDS cancer deaths per 1000 person-years. AIDS cancers caused 82 deaths from non-Hodgkin lymphoma, 28 from Kaposi sarcoma, and 2 from cervical carcinoma. Among the non-AIDS cancer deaths, 20% involved the lung and 13% the gastrointestinal (GI) tract, with about one third of GI deaths from liver cancer. Other non-AIDS cancers were hematologic (7% of deaths), anal (7%), urogenital (6%), upper respiratory (3%), and others (7%).
Median age at death proved higher with non-AIDS cancers (52 years) than AIDS cancers (43 years). Whereas 80.4% of people who died from an AIDS cancer had a previous AIDS diagnosis, only 49.2% of people who died from a non-AIDS cancer already had an AIDS diagnosis. Median lowest pretreatment CD4 count stood at only 30 cells in the AIDS cancer group versus 87 in the non-AIDS cancer group. Latest CD4 count was also higher in the non-AIDS group (211 versus 75 cells), and latest viral load was lower (2.3 versus 3.8 log). While 118 people (61.1%) with a non-AIDS cancer were taking antiretrovirals when they died, only 53 people (47.3%) dying from an AIDS cancer were on antiretroviral therapy.
A multivariate analysis determined that every 2-fold higher latest CD4 count nearly halved the risk of an AIDS cancer death (risk ratio [RR] 0.53, P < 0.01). But every 2-fold higher latest CD4 count also had a big impact on death risk from non-AIDS cancers, lowering that risk almost 40% (RR 0.61, P < 0.01). Excluding or including anal cancer in the analysis had no effect on the predictive power of CD4 count for non-AIDS cancer deaths. A latest viral load above 10,000 copies did not affect risk of death from AIDS or non-AIDS cancers.
Every 5 more years of age upped the odds of death from an AIDS cancer 14%, while every added 5 years made death form a non-AIDS cancer 50% more likely. Death risk from AIDS and non-AIDS cancers fell in recent years. Compared with 1991-2001, chances of an AIDS cancer death were 16% lower in 2002, 53% lower in 2003, and 59% lower in 2004-2005. Non-AIDS cancer death risks dropped 29% in 2002 compared with 1999-2001, 45% in 2003, and 75% in 2004-2005. Compared with people who never smoked, current smokers had a 2.92 times higher risk of non-AIDS cancer death, while ex-smokers had a 2.02 times higher risk. Active hepatitis B virus infection boosted odds of a non-AIDS cancer death 82%.
D:A:D researchers believe their analysis benefits from the large population size, broad geographical sampling, and scrupulous review of causes of death. A limitation, they cautioned, is the sole focus on fatal malignancies. D'Arminio-Monforte concluded that preventing CD4-cell slides through potent antiretroviral therapy can play a crucial role in lowering the risk of fatal AIDS and non-AIDS cancers in people with HIV.
Reference
1. D'Arminio Monforte A, Abrams D, Pradier C, et al. HIV-induced immunodeficiency and risk of fatal AIDS-defining and non-AIDS-defining malignancies: results from the D:A:D study. 14th Conference on Retroviruses and Opportunistic Infections. February 25-28, 2007. Los Angeles. Abstract 84.
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