Combination antiretroviral therapy may prove most beneficial by maintaining higher CD4 counts

Issue: December 2009

Restoring or maintaining CD4 counts greater than 500 cells per mcL through combination antiretroviral therapy may indicate earlier diagnosis and treatment of HIV infection, allowing treatment to begin sooner.

Researchers investigated the incidence rates of seven specific cancers in 52,278 patients with HIV according to the extent of immunodeficiency, viral load and combination ART. Patients from the French Hospital Database on HIV were followed up from 1998 to 2006.

Kaposi’s sarcoma was diagnosed in 565 patients; non-Hodgkin’s lymphoma in 511; Hodgkin’s lymphoma in 149; lung cancer in 207; liver cancer in 119; anal cancer in 74 and cervical cancer in 69.

Aside from anal cancer, current CD4 count was the most predictive risk factor for all malignancies.

For Kaposi’s sarcoma, when compared with CD4 counts greater than 500 cells per mcL, the rate ratios ranged from 1.9 for CD4 counts from 350 cells per mcL to 499 cells per mcL to 25.2 for counts less than 50 cells per mcL.

For NHL, the rates ranged from 1.3 cells per mcL to 14.8 cells per mcL; for Hodgkin’s lymphoma, 1.2 cells per mcL to 5.4 cells per mcL. For lung cancer, the range was from 2.2 cells per mcL to 8.5 cells per mcL and from 2.0 cells per mcL to 7.6 cells per mcL for liver cancer (P<.0001 for all).

Compared with patients with controlled viral load, current plasma HIV RNA greater than 100,000 copies per mL was linked to increased risk for Kaposi’s sarcoma and NHL. Combination ART was independently associated with decreases in incidence.

For patients assigned to combination ART, the risk ratio for cervical cancer was 0.5. The risk for anal cancer increased with time when CD4 count was less than 200 cells per mcL and viral load was greater than 100,000 copies per mL, according to the researchers.

Guiguet M. Lancet Oncol. 2009;doi:10.1016/S1470-2045(09)70282-7.