Introduction
Research suggests cumulative measurement of HIV exposure is associated with mortality, AIDS, and AIDS-defining malignancies. However, the relationship between cumulative HIV and non-AIDS-defining malignancies (NADMs) remains unclear. The aim of this study was to evaluate the effect of different HIV measures on NADM hazard among HIV-infected male veterans.
Methods
We performed a retrospective cohort study utilizing Veterans Affairs HIV Clinical Case Registry data from 1985-2010. We analyzed the relationship between HIV exposure (recent HIV RNA, % undetectable HIV RNA, and HIV copy-years viremia) and NADM. To evaluate the effect of HIV, we calculated hazard ratios for three common virally-associated NADM (i.e., hepatocarcinoma (HCC), Hodgkin lymphoma (HL), squamous cell carcinoma of the anus (SCCA)) in multivariable Cox regression models.
Results
Among 31,576 HIV-infected male veterans, 383 HCC, 211 HL, and 373 SCCA cases were identified. In multivariable regression models, cross-sectional HIV measurement was not associated with NADM. However, compared to <20% undetectable HIV, individuals with ≥80% had decreased HL (aHR=0.62; 95%CI=0.37-1.02) and SCCA (aHR=0.64; 95%CI=0.44-0.93). Conversely, each log-10 increase in HIV copy-years was associated with elevated HL (aHR=1.22; 95%CI=1.06-1.40) and SCCA (aHR=1.36; 95%CI=1.21-1.52). Model fit was best with HIV copy-years. Cumulative HIV was not associated with HCC.
Conclusion
Cumulative HIV was associated with certain virally-associated NADM (i.e., HL, SCCA), independent of measured covariates. Findings underline the importance of early treatment initiation and durable medication adherence to reduce cumulative HIV burden. Future research should prioritize how to best apply cumulative HIV measures in screening for these cancers.