Cancer during HIV infection

Neto, Marinho Marques da Silva; Brites, Carlos; Borges, Álvaro H.

doi:10.1111/apm.13020

Cited by 12 publications

(8 citation statements)

References 73 publications

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“…The higher risk of non-AIDS events found in our study could be explained by increased inflammation and immunoactivation, that have been already identified as potential mechanisms for both atherosclerosis [ 22 ] and malignancies [ 23 ] in PLWH. Thus, our findings bring to light the presence of those phenomena specifically in individuals with low CD4/CD8 ratio [ 8 ].…”

Section: Discussionsupporting

confidence: 55%

Low CD4/CD8 ratio is associated with increased morbidity and mortality in late and non-late presenters: results from a multicentre cohort study, 2004–2018

et al. 2022

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Background To study whether the association between the CD4/CD8 ratio variation over time and the development of clinical outcomes vary in late presenters (CD4 count < 350/µL or AIDS event at enrolment) or advanced presenters (CD4 count < 200/µL or AIDS event at enrolment). Methods We included ART-naïve adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) enrolled between January 2004 up to November 2018 and with at least 6 months of follow-up. We used extended Cox proportional hazard models to estimate the hazard ratios (HRs) for the association between CD4/CD8 ratio over time and a composite endpoint of the occurrence of the first AIDS event, first serious non-AIDS event or overall mortality occurring from 6 months after enrolment. HRs in non-late, late and advanced presenters were obtained by including an interaction term between late presentation status and CD4/CD8 ratio over time. Results Of 10,018 participants, 55.6% were late presenters and 26.5% were advanced presenters. Compared with CD4/CD8 ratio > 0.4, CD4/CD8 ratio ≤ 0.4 over time was associated with an increased risk of experiencing the composite endpoint in non-late (HR 1.90; 95%CI 1.48, 2.43), late (HR 1.94; 1.46, 2.57) and advanced presenters (HR 1.72; 1.26, 2.34). Similarly, CD4/CD8 ratio ≤ 0.4 over time was associated with a higher risk of developing an AIDS event (HR 3.31; 2.23, 4.93 in non-late; HR 2.75; 1.78, 4.27 in late and HR 2.25; 1.34, 3.76 in advanced presenters) or serious non-AIDS event (HR 1.39; 0.96, 2.02 in non-late, HR 1.62; 1.10, 2.40 in late and HR 1.49; 0.97, 2.29 in advanced presenters) as well as with a higher risk of overall mortality (HR 1.49; 0.92, 2.41 in non-late, HR 1.80; 1.04, 3.11 in late and HR 1.61; 0.92, 2.83 in advanced presenters) compared to CD4/CD8 > 0.4, regardless of the late presentation status. Conclusions A low CD4/CD8 measured over time is associated with increased risk of morbidity and mortality in people living with HIV independently of their late presentation status. These data support the prognostic role of CD4/CD8 over time and can help defining a subgroup of patients who need closer monitoring to avoid comorbidities.

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Section: Discussionsupporting

confidence: 55%

Low CD4/CD8 ratio is associated with increased morbidity and mortality in late and non-late presenters: results from a multicentre cohort study, 2004–2018

et al. 2022

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“…It is reported that approximately 85% of persons diagnosed with AIDS are aged 20-49 years (1981-2000) [42]. HIV can significantly damage the immune system, rendering patients prone to cancer and infection [43,44]. On one hand, patients diagnosed with HIV have a substantially higher risk of getting some types of cancer due to the compromised immune systems, including cervical invasive carcinoma, Kaposi's sarcoma, and various forms of lymphoma [45][46][47]; on the other hand, cancer patients are prone to opportunistic infections once they contract HIV.…”

Section: Discussionmentioning

confidence: 99%

Fatal Infections Among Cancer Patients: A Population-Based Study in the United States

Zheng

Chen

et al. 2021

Infect Dis Ther

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Introduction: Cancer patients are prone to infections, but the mortality of fatal infections remains unclear. Understanding the patterns of fatal infections in patients with cancer is imperative. In this study, we report the characteristics, incidence, and predictive risk factors of fatal infections among a populationbased cancer cohort. Methods: A total of 8,471,051 patients diagnosed with cancer between 1975 and 2016 were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) program. The primary outcome was dying from fatal infections. Mortality rates and standardized mortality ratios (SMRs) adjusted for age, sex, race, and calendar year were calculated to characterize the relative risks of dying from fatal infections and to compare with the general population. Furthermore, cumulative mortality rates and the Cox regression models were applied to identify predictive risk factors of fatal infections. Results: In cancer patients, the mortality rate of fatal infections was 260.1/100,000 personyears, nearly three times that of the general population [SMR, 2.92; 95% (confidence interval) CI 2.91-2.94]. Notably, a decreasing trend in mortality rate of fatal infections was observed in recent decades. SMRs of fatal infections were highest in Kaposi sarcoma (SMR, 162.2; 95% CI 159.4-165.1), liver cancer (SMR, 30.9; 95% CI 30.0-31.8), acute lymphocytic leukemia (SMR, 19.1; 95% CI 17.0-21.4), and acute myeloid leukemia (SMR, 13.3; 95% CI 12.4-14.3). Patients aged between 20 and 39 years old exhibited a higher cumulative mortality rate in the first few years after cancer diagnosis, whereas the cumulative mortality rate of those Yongqiang Zheng, Ying Chen and Kaixu Yu are co-first authors.

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“…Yet, the mechanisms through which HIV infection increases cancer risk are not fully understood. HIV-induced immunodeficiency and co-infections with oncogenic viruses among people living with HIV (PLWH) are likely to play a key role [2,3]. Evidence for direct pro-oncogenic effects of HIV, especially in lymphomagenesis, has also emerged [4].…”

Section: Introductionmentioning

confidence: 99%

Immunodeficiency and Cancer in 3.5 Million People Living With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study

Ruffieux

Muchengeti

Egger

et al. 2021

Clinical Infectious Diseases

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Background We analysed associations between immunodeficiency and cancer incidence in a nationwide cohort of people living with the human immunodeficiency virus (HIV) in South Africa. Methods We used data from the South African HIV Cancer Match study built on HIV-related laboratory measurements from the National Health Laboratory Services and cancer records from the National Cancer Registry. We evaluated associations between time-updated CD4 cell count and cancer incidence rates using Cox proportional hazards models. We reported adjusted hazard ratios (aHR) over a grid of CD4 values and estimated the aHR per 100 CD4 cells/µl decrease. Results Of 3,532,266 people living with HIV (PLWH), 15,078 developed cancer. The most common cancers were cervical cancer (4,150 cases), Kaposi sarcoma (2,262 cases), and non-Hodgkin lymphoma (1,060 cases). The association between lower CD4 cell count and higher cancer incidence rates was strongest for conjunctival cancer (aHR per 100 CD4 cells/µl decrease: 1.46, 95% confidence interval [CI] 1.38-1.54), Kaposi sarcoma (aHR 1.23, 95% CI 1.20-1.26), and non-Hodgkin lymphoma (aHR 1.18, 95% CI 1.14-1.22). Among infection-unrelated cancers, lower CD4 cell counts were associated with higher incidence rates of oesophageal cancer (aHR 1.06, 95 CI 1.00-1.11), but not breast, lung, or prostate cancer. Conclusions Lower CD4 cell counts were associated with an increased risk of developing various infection-related cancers among PLWH. Reducing HIV-induced immunodeficiency may be a potent cancer prevention strategy among PLWH in sub-Saharan Africa, a region heavily burdened by cancers attributable to infections.

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Cancer during HIV infection

Cited by 12 publications

References 73 publications

Low CD4/CD8 ratio is associated with increased morbidity and mortality in late and non-late presenters: results from a multicentre cohort study, 2004–2018

Low CD4/CD8 ratio is associated with increased morbidity and mortality in late and non-late presenters: results from a multicentre cohort study, 2004–2018

Fatal Infections Among Cancer Patients: A Population-Based Study in the United States

Immunodeficiency and Cancer in 3.5 Million People Living With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study

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