Risk for non-AIDS-defining and AIDS-defining cancer of early versus delayed initiation of antiretroviral therapy: A multinational prospective cohort study
- Authors: Chammartin F.; Lodi S.; Logan R.; Ryom L.; Mocroft A.; Kirk O.; D'Arminio Monforte A.; Reiss P.; Phillips A.; El-Sadr W.; Hatleberg C.I.; Pradier C.; Bonnet F.; Law M.; De Wit S.; Sabin C.; Lundgren J.D.; Bucher H.C.; Calvo G.; Dabis F.; Morfeldt L.; Weber R.; Lind-Thomsen A.; Salbol Brandt R.; Hillebreght M.; Zaheri S.; Wit F.W.N.M.; Scherrer A.; Schoni-Affolter F.; Rickenbach M.; Tavelli A.; Fanti I.; Leleux O.; Mourali J.; Le Marec F.; Boerg E.; Thulin E.; Sundstrom A.; Bartsch G.; Thompsen G.; Necsoi C.; Delforge M.; Fontas E.; Caissotti C.; Dollet K.; Mateu S.; Torres F.; Petoumenos K.; Blance A.; Huang R.; Puhr R.; Gronborg Laut K.; Kristensen D.; Kamara D.A.; Smith C.J.; Raben D.; Matthews C.; Bojesen A.; Grevsen A.L.; Powderly B.; Shortman N.; Moecklinghoff C.; Reilly G.; Smit C.; Ross M.; Fux C.A.; Morlat P.; Friis-Moller N.; Kowalska J.; Bohlius J.; Bower M.; Fatkenheuer G.; Grulich A.; Sjol A.; Meidahl P.; Iversen J.S.; Hillebregt M.; Prins J.M.; Kuijpers T.W.; Scherpbier H.J.; Van Der Meer J.T.M.; Godfried M.H.; Van Der Poll T.; Nellen F.J.B.; Geerlings S.E.; Van Vugt M.; Pajkrt D.; Bos J.C.; Wiersinga W.J.; Van Der Valk M.; Goorhuis A.; Hovius J.W.; Van Eden J.; Henderiks A.; Van Hes A.M.H.; Mutschelknauss M.; Nobel H.E.; Pijnappel F.J.J.; Jurriaans S.; Back N.K.T.; Zaaijer H.L.; Berkhout B.; Cornelissen M.T.E.; Schinkel C.J.; Thomas X.V.; Van Den Berge M.; Stegeman A.; Baas S.; Hage De Looff L.; Versteeg D.; Pronk M.J.H.; Ammerlaan H.S.M.; de Munnik E.S.; Jansz A.R.; Tjhie J.; Wegdam M.C.A.; Deiman B.; Scharnhorst V.; Van Der Plas A.; Weijsenfeld A.M.; Van Der Ende M.E.; de Vries-Sluijs T.E.M.S.; van Gorp E.C.M.; Schurink C.A.M.; Nouwen J.L.; Verbon A.; Rijnders B.J.A.; Bax H.I.; Van Der Feltz M.; Bassant N.; Van Beek J.E.A.; Vriesde M.; Van Zonneveld L.M.; De Oude-Lubbers A.; Van Den Berg-Cameron H.J.; Bruinsma-Broekman F.B.; de Groot J.; De Zeeuw-De Man M.; Boucher C.A.B.; Koopmans M.P.G.; van Kampen J.J.A.; Pas S.D.; Driessen G.J.A.; van Rossum A.M.C.; Van Der Knaap L.C.; Visser E.; Branger J.; Rijkeboer-Mes A.; Duijf-Van De Ven C.J.H.M.; Schippers E.F.; van Nieuwkoop C.; van IJperen J.M.; Geilings J.; van der Hut G.; Franck P.F.H.; Van Eeden A.; Brokking W.; Groot M.; Elsenburg L.J.M.; Damen M.; Kwa I.S.; Groeneveld P.H.P.; Bouwhuis J.W.; Van Den Berg J.F.; Van Hulzen A.G.W.; Van Der Bliek G.L.; Bor P.C.J.; Bloembergen P.; Wolfhagen M.J.H.M.; Ruijs G.J.H.M.; Kroon F.P.; De Boer M.G.J.; Bauer M.P.; Jolink H.; Vollaard A.M.; Dorama W.; Van Holten N.; Claas E.C.J.; Wessels E.; Den Hollander J.G.; Pogany K.; Roukens A.; Kastelijns M.; Smit J.V.; Smit E.; Struik-Kalkman D.; Tearno C.; Bezemer M.; van Niekerk T.; Pontesilli O.; Lowe S.H.; Oude Lashof A.M.L.; Posthouwer D.; Ackens R.P.; Schippers J.; Vergoossen R.; Weijenberg-Maes B.; van Loo I.H.M.; Havenith T.R.A.; Leyten E.M.S.; Gelinck L.B.S.; van Hartingsveld A.; Meerkerk C.; Wildenbeest G.S.; Mutsaers J.A.E.M.; Jansen C.L.; Mulder J.W.; Vrouenraets S.M.E.; Lauw F.N.; van Broekhuizen M.C.; Paap H.; Vlasblom D.J.; Smits P.H.M.; Weijer S.; El Moussaoui R.; Bosma A.S.; van Vonderen M.G.A.; van Houte D.P.F.; Kampschreur L.M.; Dijkstra K.; Faber S.; Weel J.; Kootstra G.J.; Delsing C.E.; van der Burg-Van de Plas M.; Heins H.; Lucas E.; Kortmann W.; van Twillert G.; Cohen Stuart J.W.T.; Diederen B.M.W.; van Truijen-Oud F.A.; van der Reijden W.A.; Jansen R.; Brinkman K.; van den Berk G.E.L.; Blok W.L.; Frissen P.H.J.; Lettinga K.D.; Schouten W.E.M.; Veenstra J.; Brouwer J.C.; Geerders F.G.; Hoeksema K.; Kleene J.M.; van der Meche B.I.; Spelbrink M.; Sulman H.; Toonen A.J.M.; Wijnands S.; Kwa D.; Witte E.; Koopmans P.P.; Keuter M.; van der Ven A.J.A.M.; ter Hofstede H.J.M.; Dofferhoff A.S.M.; van Crevel R.; Albers M.; Bosch M.E.W.; Grintjes-Huisman K.J.T.; Zomer J.B.; Stelma F.F.; Rahamat-Langendoen J.; Burger D.; Richter C.; Gisolf H.E.; Hassing J.R.; ter Beest G.; van Bentum P.H.M.; Langebeek N.; Tiemessen R.; Swanink C.M.A.; van Lelyveld S.F.L.; Soetekouw R.; Hulshof
- Publication year: 2021
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/534236
Abstract
Background: Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non-AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 × 109 cells/L. Consequences of delayed ART on risk for non-AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear. Objective: To estimate the long-term risk difference for cancer with the immediate ART strategy. Design: Multinational prospective cohort study. Setting: The D:A:D (Data collection on Adverse events of anti-HIV Drugs) study, which included HIV-positive persons from Europe, Australia, and the United States. Participants: 8318 HIV-positive persons with at least 1 measurement each of CD4 cell count and viral load while ART-naive (study period, 2006 to 2016). Measurements: The parametric g-formula was used, with adjustment for baseline and time-dependent confounders (CD4 cell count and viral load), to assess the 10-year risk for non-AIDS-defining and AIDS-defining cancer of immediate versus deferred (at CD4 counts < 350 and < 500 × 109 cells/L) ART initiation strategies. Results: During 64 021 person-years of follow-up, 231 cases of non-AIDS-defining cancer and 272 of AIDS-defining cancer occurred among HIV-positive persons with a median age of 36 years (interquartile range, 29 to 43 years). With immediate ART, the 10-year risk for non-AIDS-defining cancer was 2.97% (95% CI, 2.37% to 3.50%) and that for AIDS-defining cancer was 2.50% (CI, 2.37% to 3.38%). Compared with immediate ART initiation, the 10-year absolute risk differences when deferring ART to CD4 counts less than 500 × 109 cells/L and less than 350 × 109 cells/L were 0.12 percentage point (CI, -0.01 to 0.26 percentage point) and 0.29 percentage point (CI, -0.03 to 0.73 percentage point), respectively, for non-AIDS-defining cancer and 0.32 percentage point (CI, 0.21 to 0.44 percentage point) and 1.00 percentage point (CI, 0.67 to 1.44 percentage points), respectively, for AIDS-defining cancer. Limitation: Potential residual confounding due to observational study design. Conclusion: In this young cohort, effects of immediate ART on 10-year risk for cancer were small, and further supportive data are needed for non-AIDS-defining cancer. Primary Funding Source: Highly Active Antiretroviral Therapy Oversight Committee.