Association of Viral Suppression With Lower AIDS-Defining and Non–AIDS-Defining Cancer Incidence in HIV-Infected Veterans

Park, Lesley S.; Tate, Janet P.; Sigel, Keith; Brown, Sheldon T.; Crothers, Kristina; Gibert, Cynthia L.; Goetz, Matthew Bidwell; Rimland, David; Rodriguez‐Barradas, Maria C.; Bedimo, Roger; Justice, Amy C.; Dubrow, Robert

doi:10.7326/m16-2094

Cited by 56 publications

(59 citation statements)

References 57 publications

(54 reference statements)

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“…Keywords: Human immunodeficiency virus, Viral suppression, Sustained viral suppression, Durable viral suppression, Men who have sex with men Background Suppression of the human immunodeficiency virus (HIV) (< 200 copies/mL) among people living with HIV (PLHIV) is associated with immune reconstruction [1] and a decreased risk of acquired immune deficiency syndrome (AIDS)-defining conditions [2] and death [3]. In addition, viral suppression prevents the transmission of HIV to others [4].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

et al. 2020

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Background: HIV viral suppression is associated with health benefits for people living with HIV and a decreased risk of HIV transmission to others. The objective was to identify demographic, psychosocial, provider and neighborhood factors associated with sustained viral suppression among gay, bisexual, and other men who have sex with men. Methods: Data from adult men who have sex with men (MSM) enrolled in the Miami-Dade County Ryan White Program (RWP) before 2017 were used. Sustained viral suppression was defined as having an HIV viral load < 200 copies/ml in all viral load tests in 2017. Three-level (individual, medical case management site, and neighborhood) cross-classified mixed-effect models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for sustained viral suppression. Results: Of 3386 MSM, 90.8% were racial/ethnic minorities, and 84.4% achieved sustained viral suppression. The odds of achieving sustained viral suppression was lower for 18-24 and 25-34 year-old MSM compared with 35-49 year-old MSM, and for non-Latino Black MSM compared with White MSM. Those not enrolled in the Affordable Care Act, and those with current AIDS symptoms and a history of AIDS had lower odds of achieving sustained viral suppression. Psychosocial factors significantly associated with lower odds of sustained viral suppression included drug/alcohol use, mental health symptoms, homelessness, and transportation to appointment needs. Individuals with an HIV physician who serves a larger volume of RWP clients had greater odds of sustained viral suppression. Neighborhood factors were not associated with sustained viral suppression.(Continued on next page)

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Section: (Continued From Previous Page)mentioning

confidence: 99%

Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

et al. 2020

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“…HCC diagnoses were determined from the VA national cancer registry by topography code C22.0 (liver) and morphology codes 8170-8180 (HCC) from the International Classification of Diseases for Oncology, Third Edition (ICD-O-3), 18 consistent with Surveillance, Epidemiology, and End Results coding algorithms. 19 The VA cancer registry records cancers diagnosed and/or treated within the VA. 7 ICD-O-3 codes validly identify cancer diagnoses, including HCC. 20 To account for lags in reporting diagnoses in the cancer registry and minimize the likelihood of missing HCC events, we supplemented HCC case finding with ICD-9 diagnoses for HCC (155.0, 155.1, and 155.2) recorded in the VA electronic medical record.…”

Section: Main Study Outcomesmentioning

confidence: 99%

“…3 Despite the rising incidence of HCC among HIV-infected individuals, the determinants of this malignancy remain largely unknown in this group. 4 Three prior studies found no association between HIV suppression and risk of HCC, [5][6][7] but these studies did not evaluate the effects of longer durations or higher levels of HIV viremia, nor did they account for cirrhosis. Moreover, previous studies among predominantly HIV/HCV-coinfected patients reported that lower absolute CD4+ cell counts increased the risk of HCC.…”

Section: Introductionmentioning

confidence: 99%

HIV RNA, CD4+ Percentage, and Risk of Hepatocellular Carcinoma by Cirrhosis Status

Torgersen

Kallan

Carbonari

et al. 2019

JNCI: Journal of the National Cancer Institute

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Background Despite increasing incidence of hepatocellular carcinoma (HCC) among HIV-infected patients, it remains unclear if HIV-related factors contribute to development of HCC. We examined if higher or prolonged HIV viremia and lower CD4+ cell percentage were associated with HCC. Methods We conducted a cohort study of HIV-infected individuals who had HIV RNA, CD4+, and CD8+ cell counts and percentages assessed in the Veterans Aging Cohort Study (1999–2015). HCC was ascertained using Veterans Health Administration cancer registries and electronic records. Cox regression was used to determine hazard ratios (HR, 95% confidence interval [CI]) of HCC associated with higher current HIV RNA, longer duration of detectable HIV viremia (≥500 copies/mL), and current CD4+ cell percentage less than 14%, adjusting for traditional HCC risk factors. Analyses were stratified by previously validated diagnoses of cirrhosis prior to start of follow-up. Results Among 35 659 HIV-infected patients, 302 (0.8%) developed HCC over 281 441 person-years (incidence rate = 107.3 per 100 000 person-years). Among patients without baseline cirrhosis, higher HIV RNA (HR = 1.25, 95% CI = 1.12 to 1.40, per 1.0 log10 copies/mL) and 12 or more months of detectable HIV (HR = 1.47, 95% CI = 1.02 to 2.11) were independently associated with higher risk of HCC. CD4+ percentage less than 14% was not associated with HCC in any model. Hepatitis C coinfection was a statistically significant predictor of HCC regardless of baseline cirrhosis status. Conclusion Among HIV-infected patients without baseline cirrhosis, higher HIV RNA and longer duration of HIV viremia increased risk of HCC, independent of traditional HCC risk factors. This is the strongest evidence to date that HIV viremia contributes to risk of HCC in this group.

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“…In a recent study, Dr. Justice and her colleagues analyzed cancer risk among HIV‐positive patients who had not yet achieved any viral suppression or who had achieved early or long‐term suppression . For AIDS‐defining cancers and non‐AIDS‐defining cancers associated with oncogenic viruses, the study revealed a similar stair‐step progression of increasing risk: HIV‐negative volunteers were at the bottom, followed by patients with long‐term viral suppression and then those early into their course of viral suppression.…”

Section: “Smoldering” Inflammation and Immune Activation?mentioning

confidence: 99%

As the HIV‐positive population ages, new dangers loom

Nelson¹

2019

Cancer Cytopathology

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Association of Viral Suppression With Lower AIDS-Defining and Non–AIDS-Defining Cancer Incidence in HIV-Infected Veterans

Abstract: National Cancer Institute and National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.

Cited by 56 publications

References 57 publications

Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

HIV RNA, CD4+ Percentage, and Risk of Hepatocellular Carcinoma by Cirrhosis Status

As the HIV‐positive population ages, new dangers loom

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