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Earlier Initiation of Treatment Following HIV Acquisition Reduces Non-AIDS-defining Malignancy Risk
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CID, 05 November 2025
and Editorial
Download the PDF here
Download the PDF here
Download the PDF here
Abstract
Background
Starting antiretroviral treatment (ART) at higher CD4 cell counts is associated with reduced non-AIDS-defining malignancy (NADM) risk. We studied whether starting ART within 1 year after acquiring human immunodeficiency virus type 1 (HIV-1) reduces this risk while also adjusting for socioeconomic status.
Methods
We included individuals (≥18 years) from the Dutch national ATHENA cohort diagnosed with human immunodeficiency virus (HIV) and having started ART between 2000 and 2022 without prior NADM with ≥6 months of follow-up. "Early ART" initiators were defined as starting ART <365 days following a negative HIV test or primary HIV infection, all others as "late-ART" starters. Hazard ratios (HR) for NADM were estimated using Cox regression, adjusted for a priori selected confounders (age, sex at birth, smoking, alcohol use, calendar time, HIV transmission route, region of origin, nadir CD4 cell count, HIV-1 viral copy-years), and socioeconomic status (SES) using data from Statistics Netherlands.
Results
Compared to "late-ART" (n = 17 965) participants, "early-ART" participants (n = 1858) were younger (median 34.8 vs 39.0 years), with a higher nadir CD4 count (median 478 vs 260 cells/μL). NADM were diagnosed in 25 "early-ART" and 869 "late-ART" starters resulting in an incidence rate of 2.22/1000 person-years (PY) (95% confidence interval [CI] = 1.50-3.28) and 4.87/1000 PY (95% CI = 4.56-5.21), respectively. "Early-ART" initiation was associated with a reduced risk of any NADM (HR = 0.60 [95% CI = .40-.91]) and infection-unrelated NADM (HR = 0.60 [95% CI = .37-.98]), but not of infection-related NADM (HR = 0.58 [95% CI = .27-1.28]). Additional adjustment for SES only minimally changed the hazard ratios.
Conclusions
Starting ART within 1 year of HIV acquisition is associated with a reduced NADM risk compared to starting ART later.
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