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Cancers & HIV at IAS Summary Report
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Cumulative & Current Viral Replication & Low CD4 Increases NHL Risk: Immune deficiency, uncontrolled HIV replication and non-Hodgkin's lymphoma, ANRS CO3 Aquitaine Cohort, 1998-2006. - (07/28/09)
These results show that both current and cumulative exposure to uncontrolled plasma HIV RNA viral load were independently associated with a higher hazard of NHL, suggesting that the control of plasma HIV RNA is a key factor to prevent NHL occurrence. Cumulative and current exposure to CD4 <350 were associated with a higher hazard of NHL, underlining that following a prescription of HAART, the risk of NHL may decrease when the CD4 cell count rise above 350.
What CD4 Cell Count Levels are Associated With a Reduced Risk of Cancer? 'When To Begin HAART' - (07/29/09)
From Jules: Regarding the question of 'when to begin HAART', risk for non-AIDS cancers are 2-fold higher (100% higher) when CD4s are below 700 and 3.7 fold higher when CD4 is 200-349 in the pre-HAART era in this study and also 2-fold higher for AIDS-defining risk when CD4s are <500 in the pre-HAART era (see tables 5a and 5d). This suggests that in the HAART era currently starting HAART at 700 CD4s reduces non-AIDS cancer risk and starting at 500 CD4 count reduces AIDS cancer risk. In other words, these data suggest to start HAART at 700 CD4 to optimally reduce cancer risk. This is something I said 10 years ago and I'm sure others raised this concern also when discussing this in the context of when to begin HAART: that risk for cancers are reduced if you keep the CD4 count higher and start HAART before the CD4 declines below the normal level which is I think generally considered to be 500-700 at the low end of the spectrum.
Varying Risk of AIDS and Non-AIDS Cancers in Diverse CD4 Brackets - written by Mark Mascolini - (07/29/09)
A CD4 count under 500 raised the risk of AIDS-defining cancers in a large US naval medical center study [1]. CD4 counts under 700 made non-AIDS cancers more likely in these people, but those correlations held true only for skin cancers in the pre-HAART era. The trend toward a higher AIDS cancer risk at a CD4 count above 350 reflects the experience of many clinicians who see these cancers in people with a CD4 count higher than the current threshold for starting antiretroviral therapy.
Anal Cancer Rates Keep Climbing in US HIV Group Despite HAART - written by Mark Mascolini - (07/29/09)
Despite wide use of highly active antiretroviral therapy (HAART) since 1996, anal cancer rates in an HIV-infected US military population keep rising [1]. People who already had an AIDS diagnosis in this group ran more than a tripled risk of anal cancer. The age-adjusted rate climbed steadily in the HAART period, from 13.4 cases per 100,000 person-years in 1996-2000, to 51.1 cases in 2001-2005, and to 127.6 cases in 2006-2008.
More Time With Low CD4 Count Boosts Non-AIDS Cancer Risk - written by Mark Mascolini - (07/29/09)
Every year spent with a CD4 count under 200 independently raised the risk of a non-AIDS cancer diagnosis in the Dutch ATHENA cohort [1]. More time spent with 200 to 350 CD4s also boosted the non-AIDS cancer risk, but that correlation stopped short of statistical significance. Non-AIDS cancers with an infectious origin drove the association between a low CD4 count and cancer risk, a finding supporting thinking that longer time with a compromised immune system makes cancer more likely.
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