Factors associated with non-AIDS-defining cancers and non HCV-liver related cancers in HIV/HCV-coinfected patients- ANRS-CO13 HEPAVIH cohort

Abstract

Compared to the general population, HIV-infected patients are at higher risk of developing non-AIDS-defining cancers. Chronic HCV infection has also been associated with a higher risk than that of the general population of developing cancers other than hepatocarcinoma. Evaluation of the impact of HCV-related factors on non-AIDS-defining and non HCV-liver (NANL) related cancers among HIV/HCV co-infected patients are scarce. The aim of this study was to identify the impact of HIV/HCV clinical characteristics on NANL related cancers in a large cohort of HIV/HCV-coinfected patients followed from 2005 to 2017. Cox proportional hazards models with delayed entry were used to estimate factors associated with NANL related cancer. Among 1391 patients followed for a median of 5 years, 60 patients developed NANL related cancers, yielding an incidence rate of 8.9 per 1000 person-years (95% CI, [6.6–11.1]). By final multivariable analysis, after adjustment for sex, tobacco or alcohol consumption, baseline CD4 cell count and HCV sustained viral response (SVR), age and a longer duration since HIV diagnosis were independently associated with a higher risk of NANL related cancer (aHR for each additional year 1.10, 95% CI 1.06–1.14, p<0.0001 and 1.06, 95% CI 1.01–1.11, p = 0.02, respectively). Duration of HCV infection, cirrhosis, HCV viral load, genotype and SVR were not associated with the occurrence of NANL related cancer. Among HIV/HCV-coinfected patients, age and the duration of HIV infection were the only characteristics found to be associated with the occurrence of NANL related cancer. In contrast, no association was observed with any HCV-related variables.

Increased mortality in HIV/HCV-coinfected compared to HCV-monoinfected patients in the DAA era due to non-liver-related death

“…From the 18 non-liver-related deaths observed in HIV/HCV co-infected participants, only 1 was related to HIV. Several studies in HIV populations highlight a high risk of non-AIDS defining cancers 25,26 . The higher risk of non-AIDS death in HIV infected patients can be explained by chronic inflammation and immune system dysregulation due to the HIV infection 25,[27][28][29] , but also to high-risk behaviours such as tobacco smoking and alcohol consumption 30,31 .…”

The Trends and Risk Factors of AIDS-Defining Cancers and Non-AIDS-Defining Cancers in Adults Living with and without HIV: A Narrative Review

“…The most common risk factors associated with the occurrence of any cancer, NADCs, and the related cancer mortality were advancing age [ 46 , 52 , 54 , 57 , 59 , 61 , 63 , 67 , 72 ] and longer duration with HIV infection [ 11 , 52 , 54 , 56 , 64 , 72 ]. A US-based study conducted over a 15-year period has shown that increases in the rates of NADCs were mainly driven by growth and aging of PLHIV [ 29 ].…”

Contribution of Behavioral Health Factors to Non-AIDS-Related Comorbidities: an Updated Review

“…Non-AIDS-defining Cancers.-In the general population, unhealthy alcohol consumption is causally associated with cancers of the liver, mouth, throat, esophagus, breast, colon and rectum [74]. Recent studies (Table 1) of cancer risk factors among PWH [44,75,76] were not designed to assess the association between alcohol and cancer. Therefore, important phenomena were not captured including quantity, frequency, and duration of alcohol consumption; nor were potentially sick quitters separated from current abstainers.…”