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Long-term viral suppression prevents cancer among patients with HIV

Among aging patients with HIV, longer periods of viral suppression prevented AIDS-defining cancers and to a lesser extent, non–AIDS-defining cancers caused by viruses, according to research published in Annals of Internal Medicine.

Incident cancer risk still appeared higher among patients with long-term viral suppression than those without HIV, the researchers noted.

“Viral suppression is a primary marker of HIV treatment success. Persons with HIV are at increased risk for AIDS-defining cancer and several types of non–AIDS-defining cancer, some of which are caused by oncogenic viruses,” Lesley S. Park, PhD, MPH, from Stanford University School of Medicine, and colleagues wrote.

Research has not focused on how sustained viral suppression affects overall cancer risk, according to the researchers.

Park and colleagues performed a cohort study to investigate if viral suppression decreases cancer risk among veterans with HIV (n = 42,441) compared with demographically matched uninfected veterans (n = 104,712).

Data showed that 3,821 patients with HIV developed 4,169 cases of cancer, whereas 7,163 uninfected patients developed 7,879 cases of cancer.

Compared with uninfected individuals, those with unsuppressed HIV had the highest risk for cancer (RR = 2.35; 95% CI, 2.19-2.51), followed by those with early suppression (RR = 1.99; 95% CI, 1.87-2.12) and those with long-term suppression (RR = 1.52; 95% CI, 1.44-1.61). These associations appeared strongest for AIDS-defining cancers — such as Kaposi’s sarcoma, non-Hodgkin lymphoma and invasive cervical cancer — and weaker for virus non–AIDS-defining cancers, such as anal cancer, liver cancer and Hodgkin lymphoma. However, they were nonexistent for nonvirus non–AIDS-defining cancers, such as lung cancer, larynx cancer, melanoma and leukemia.

“Our findings suggest that early, sustained [antiretroviral therapy], which results in long-term viral suppression, may contribute to cancer prevention, with a marked risk reduction for [AIDS-defining cancers], a much more modest reduction for virus [non–AIDS-defining cancers], and possible reductions for certain types of nonvirus [non-AIDS-defining cancer],” Park and colleagues concluded. “However, excess cancer risk remained among patients with long-term suppression.”

“Future research should extend our sensitivity analyses to examine in more detail viral suppression thresholds less than 500 copies/mL, whether cancer risk continues to decrease with longer durations of long-term suppression, and the role of CD4+ cell count and CD4+–CD8+ cell count ratio,” they wrote. – by Alaina Tedesco

Disclosure: Park reports receiving grants from the National Cancer Institute, National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Mental Health. Please see the study for all other authors’ relevant financial disclosures.