 |
|
|
| |
Survival After Cancer Diagnosis Improves in US HIV Cohort: 'Incidence (new diagnoses) of AIDS cancers dropped, as did incidence of non-AIDS infection-related cancers. But incidence of non-AIDS cancers not related to infection rose since the arrival of triple antiretroviral therapy'
|
| |
| |
18th Conference on Retroviruses and Opportunistic Infections, February 27-March 2, 2011, Boston
The HOPS investigators suggested that survival after cancer diagnosis improved over time partly because of higher CD4 counts at diagnosis. They proposed "early detection and treatment of non-infection-related non-AIDS cancers may improve survival." The HOPS team encouraged clinicians to consider screening people for cancer, regardless of age, if they have "concerning signs and symptoms" or relevant coinfections (such as viral hepatitis) or behavioral risks (such as smoking).
Mark Mascolini
Survival after cancer diagnosis improved over time among people in the HIV Outpatient Study (HOPS) cohort, according analysis of almost 8000 cohort members since 1996 [1]. Incidence (new diagnoses) of AIDS cancers dropped, as did incidence of non-AIDS infection-related cancers. But incidence of non-AIDS cancers not related to infection rose since the arrival of triple antiretroviral therapy.
HOPS is an ongoing prospective study of HIV-positive adults in 8 US cities. This cancer incidence and survival study involved 7974 people who had at least two physician visits since 1996. From 1996 through 2009, median CD4 count climbed from 263 to 508. Over the same period, median age rose from to 38.1 to 47.1
During follow-up, HOPS clinicians diagnosed 683 cancers in 607 people (7.6% of 7974). Overall incidence of AIDS-defining cancer decreased significantly over time (from 1195 per 100,000 person-years in 1996-2000 to 302 per 100,000 in 2005-2008, P < 0.001), as did incidence of infection-related non-AIDS cancers (from 540 per 100,000 person-years in 1996-2000 to 394 per 100,000 in 2005-2008, P < 0.047). In contrast, incidence of non-AIDS non-infection-related cancers rose significantly (from 540 per 100,000 person-years in 1996-2000 to 717 per 100,000 in 2005-2008, P < 0.001).
Multivariate analysis determined that age, gender, race, nadir CD4 count, and other variables independently affected the risk of AIDS cancers and non-AIDS cancers at the following relative risks (RR) (and 95% confidence intervals):
AIDS cancers
Age over 50 years lowered the risk: RR 0.45 (0.27 to 0.77), P = 0.004
Gay HIV transmission: RR 1.67 (1.31 to 2.13), P < 0.001
Nadir CD4 count under 200: RR 2.47 (1.89 to 3.23), P < 0.001
History of opportunistic infections: RR 2.59 (2.03 to 3.30), P < 0.001
Infection-related non-AIDS cancers
Age over 50 years: RR 2.00 (1.34 to 2.98), P < 0.001
Age 40 to 50 years: RR 1.62 (1.21 to 2.16), P < 0.001
Male gender: RR 1.85 (1.20 to 2.86), P = 0.005
White race: RR 1.53 (1.14 to 2.07), P = 0.005
Nadir CD4 count under 200: RR 2.30 (1.74 to 3.05), P < 0.001
Public insurance: RR 1.45 (1.08 to 1.96), P = 0.014
Prior or current tobacco use: RR 1.59 (1.20 to 2.12), P = 0.001
HBV infection: RR 2.04 (1.10 to 3.75), P = 0.023
Non-infection-related non-AIDS cancers
Age over 50 years: RR 7.96 (5.82 to 10.9), P < 0.001
Age 40 to 50 years: RR 2.45 (1.80 to 3.33), P < 0.001
White race: RR 2.40 (1.76 to 3.26), P < 0.001
Gay transmission risk lowered the risk: 0.72 (0.54 to 0.95), P = 0.018
Survival after cancer diagnosis increased significantly (P < 0.001) in the three periods analyzed, and median CD4 count at cancer diagnosis rose in those three periods: 1996-2000, median 153 CD4s; 2001-2004, median 329 CD4s; 2005-2009, 372 CD4s (P < 0.001). Over those same three periods, all-cause mortality associated with AIDS cancers dropped significantly (from 466 to 106 per 100,000 person-years, P < 0.001), mortality associated with non-infection-related non-AIDS cancers increased significantly over time (from 138 to 163 per 100,000 person-years, P < 0.001), and mortality associated with infection-related non-AIDS cancers did not change significantly (from 153 to 132 per 100,000 person-years, P = 0.27).
The following factors independently raised or lowered the risk of all-cause mortality after diagnosis of the three types of cancer at the following relative risks (RR) (and 95% confidence intervals):
AIDS cancers
Every 100-cell higher nadir CD4 count lowered the risk: RR 0.63 (0.49 to 0.81), P < 0.001
Infection-related non-AIDS cancers
Public insurance: RR 1.75 (1.04 to 2.92), P = 0.034
Non-infection-related non-AIDS cancers
Every 100-cell higher nadir CD4 count lowered the risk: RR 0.86 (0.73 to 1.00), P = 0.046
Public insurance: RR 1.98 (1.13 to 3.48), P = 0.017
Prior or current tobacco use: RR 2.97 (1.57 to 5.63), P < 0.001
The HOPS investigators suggested that survival after cancer diagnosis improved over time partly because of higher CD4 counts at diagnosis. They proposed that "early detection and treatment of non-infection-related non-AIDS cancers may improve survival."
The HOPS team encouraged clinicians to consider screening people for cancer, regardless of age, if they have "concerning signs and symptoms" or relevant coinfections (such as viral hepatitis) or behavioral risks (such as smoking).
Reference
1. Patel P, Brooks J, Armon C, et al. Survival after cancer diagnosis and factors associated with all-cause mortality among HIV+ persons with cancer: HOPS during the HAART era. 18th Conference on Retroviruses and Opportunistic Infections. February 27-March 2, 2011. Boston. Abstract 867. http://www.retroconference.org/2011/PDFs/867.pdf.
|
| |
|
|
|
|
|
