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CD4 Measures as Predictors of Lung Cancer Risk and Prognosis in HIV Infection.....cd4 <500 & CD4/CD8 ratio <0.4 associated with increased lung cancer risk
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..... ......"Lung cancer incidence was associated with cumulative exposure to: 24-month moving CD4 average of CD4 counts less than 500 associated with 30% increased risk for lung cancer, CD4 <200 with 70% increased risk cells/mm3; moving avg CD4/CD8 ratios less than 0.4"
Reported by Jules Levin
CROI 2015 Feb 23-26, Seattle, WA
Keith Sigel, MD, MPH1, Kristina Crothers, MD2, Kirsha Gordon3, Sheldon Brown, MD4,1, David Rimland, MD5 Maria Rodriguez-Barradas, MD6,
Cynthia Gibert MD7, Matthew Goetz, MD8, Roger Bedimo, MD9, Robert Dubrow, MD, PhD10
1Mount Sinai School of Medicine, New York, NY 2University of Washington School of Medicine, Seattle, WA 3VA Connecticut Healthcare System and Yale University Schools of Medicine and Public Health, New Haven, CT 4James J. Peters
VA Medical Center, Bronx, NY 5Atlanta VA Medical Center and Emory University School of Medicine 6Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 7Washington DC VA Medical Center, Washington,
DC, 8VA Greater Los Angeles Healthcare System, Los Angeles, CA, 9VA North Texas Health Care System, Dallas, TX, 10Yale University School of Public Health
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program abstract
CD4 Measures as Predictors of Lung Cancer Risk and Prognosis in HIV Infection
Keith Sigel1, Robert Dubrow10, Kristina Crothers2, Kirsha Gordon3, Sheldon Brown4, David Rimland5, Maria Rodriguez-Barradas6, Cynthia Gibert7, Matthew Goetz8, Roger Bedimo9
1 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States;2 Medicine, University of Washington School of Medicine, Seattle, Washington, United States;3 VA Connecticut Healthcare System and Yale University Schools of Medicine and Public Health, New Haven, Connecticut, United States;4 Medicine, James J. Peters VA Medical Center, Bronx, New York, United States;5 Medicine, Atlanta VA Medical Center, Atlanta, Georgia, United States;6 Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States;7 Medicine, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States;8 Medicine, Los Angeles VA Medical Center, Los Angeles, California, United States;9 Medicine, Veterans Affairs North Texas Health Care System, Dallas, Texas, United States;10 Epidemiology, Yale University School of Public Health, New Haven, Connecticut, United States
Abstract Body:
Background: Immunodeficiency may adversely affect both lung cancer risk and outcomes in the setting of HIV infection. Using data from a large HIV cohort, we investigated relationships between 1) recent and cumulative measures of CD4 and CD8 count and lung cancer incidence and 2) CD4 measures and lung cancer prognosis.
Methods: We followed 26,065 HIV+ subjects from the Veterans Aging Cohort Study (VACS) for a minimum of 2 years, during 1999-2010. We linked VACS with the VA Central Cancer Registry to obtain incident, pathologically confirmed lung cancer cases. Our exposures of interest were longitudinal CD4 (3 [c/mm3], 200-500 c/mm3 or >500 c/mm3), CD4/CD8 (3 or 3). We used Cox regression models to investigate the effect of time-updated CD4, CD4/CD8 ratio and CD8 measures on lung cancer risk, including values lagged 12 months, and 12- and 24-month simple moving averages. Models were adjusted for age, sex, race/ethnicity, smoking, and history of pneumonia and COPD. We then collected all non-small cell lung cancer cases from the full VACS (HIV+ and HIV- subjects from 1996-2010) and used conditional probability function regression (a competing risks method to account for higher risk of non-lung cancer death in HIV+) to compare lung cancer-specific survival in 3 groups: HIV- (n=679), HIV+ with CD4≥200 c/mm3 at cancer diagnosis (n=299) and HIV+ with CD4
Results: We identified 325 (1.2%) cases of incident lung cancer in our cohort. In adjusted models (Table 1), a 12 month lagged CD4 count 3 as well as moving averages of both CD43 and CD4 200-500 c/mm3 were significantly associated with increased lung cancer incidence. In similar adjusted models, 12-month moving averages of CD4/CD8 ratio 0.05) after adjustment.
Conclusions: In our large HIV cohort, we found that several measures of recent and cumulative exposure to immunodeficiency were associated with increased lung cancer risk. CD4 count at time of cancer diagnosis was not associated with cancer-specific survival after accounting for competing risk of non-lung cancer death.
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