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  Reported by Jules Levin
IDWeek Oct 26-30
New Orleans 2016
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High Proportions With AIDS/Non-AIDS Cancers Remain Unsuppressed
  IDWeek 2016, October 26-30, 2016, New Orleans
Mark Mascolini
HIV suppression improved in the 24 months after cancer diagnosis in 412 patients at the University of Maryland [1]. But high proportions of HIV patients with cancer--especially those with an AIDS cancer--still had a detectable viral load at the end of follow-up.
Because few studies have analyzed virologic and CD4 outcomes in people with HIV after cancer diagnosis, University of Maryland researchers conducted this retrospective analysis of all HIV patients diagnosed with cancer from 2000 through 2011. They defined HIV suppression as a viral load at or below 400 copies, and they modeled mean CD4 count after cancer diagnosis with multivariable linear mixed models for repeated measures.
The researchers identified 412 cancer diagnoses, 122 (30%) involving an AIDS cancer and 290 a non-AIDS cancer. The most frequent non-AIDS cancers were lung cancer (59 cases), prostate cancer (46), head and neck cancer (35), liver cancer (23), and Hodgkin lymphoma (17).
People with non-AIDS cancers were older than those with AIDS cancers (median 54 versus 43 years, P < 0.0001), and they were more likely to have HCV infection (52% versus 36%, P = 0.002). Median time from HIV diagnosis to cancer diagnosis was significantly longer in the non-AIDS group (11 versus 5 years, P < 0.0001). Compared with the AIDS cancer group, people with non-AIDS cancer had a higher median CD4 count at cancer diagnosis (314 versus 137, P < 0.0001) and a lower viral load (median 62 versus 30,710 copies, P < 0.0001). A significantly higher proportion of AIDS cancer patients were not taking antiretrovirals at the time of cancer diagnosis (54% versus 25%, P< 0.0001).
In an analysis adjusted for sex, baseline CD4 count, antiretroviral therapy (ART) at cancer diagnosis, and HCV or HBV coinfection, people with a non-AIDS cancer had a significantly higher CD4 count than those with an AIDS cancer diagnosis 6 and 12 months after cancer diagnosis and a nonsignificantly higher CD4 count 18 and 24 months after diagnosis. Median CD4 count generally rose over time in both groups.
Among people with a non-AIDS cancer, the proportion with an HIV load at or below 400 copies rose from about 60% at cancer diagnosis to about 80% 18 and 24 months after diagnosis. Among people with an AIDS cancer, proportions with an HIV load at or below 400 copies rose from about 25% at diagnosis to almost 60% 18 and 24 months after diagnosis. The non-AIDS group had a higher proportion with a sub-400 viral load at every point through 24 months after cancer diagnosis.
In an adjusted analysis, people with a non-AIDS cancer had twice the odds of viral suppression 12 months after cancer diagnosis as those with an AIDS cancer (adjusted odds ratio [aOR] 2.19, 95% confidence interval [CI] 1.04 to 4.62, P = 0.04). Odds of HIV suppression remained higher in the non-AIDS cancer group 24 months after diagnosis, but the association was no longer statistically significant (aOR 2.17, 95% CI 0.92 to 5.16). Twelve months after cancer diagnosis, men had twice higher odds of HIV suppression than women (aOR 2.21, 95% CI 0.99 to 4.92, P = 0.05). Factors that did not independently predict viral suppression in this analysis were race, HIV transmission mode, HCV or HBV infection, and type of ART.
The researchers stressed that high proportions of cancer patients--especially those with an AIDS cancer--had not reached viral suppression 1 year after their cancer diagnosis (42% with an AIDS cancer, about 26% with a non-AIDS cancer). These rates, the University of Maryland team suggested, indicate that "new strategies are urgently needed for engaging and treating HIV-infected patients who are diagnosed with cancer."
1. Riedel DJ, Stafford KA, Vadlamani A, Redfield RR. Virologic and immunologic outcomes in HIV-infected patients with non-AIDS-defining and AIDS-defining cancers. IDWeek 2016, October 26-30, 2016, New Orleans. Abstract 2129.