Role of Uncontrolled HIV RNA Level and Immunodeficiency in the Occurrence of Malignancy in HIV‐Infected Patients during the Combination Antiretroviral Therapy Era: Agence Nationale de Recherche sur le Sida (ANRS) CO3 Aquitaine Cohort

Abstract

Uncontrolled plasma HIV RNA level was independently associated with a higher likelihood of developing AIDS-defining malignancies, whereas immunosuppression was associated with a higher risk of developing any type of malignancies. Antiretroviral treatment should aim at reaching and maintaining a CD4(+) count >500 cells/mm(3) to prevent the occurrence of malignancy, this should be integrated to malignancy-prevention policies.

Rate and Predictors of Non-AIDS Events in a Cohort of HIV-Infected Patients with a CD4 T Cell Count Above 500 Cells/mm3

“…t has been extensively indicated that HIV-infected patients have an increase in so-called non-AIDS events, [1][2][3][4] especially cardiovascular 5 and neurocognitive events 6,7 and neoplasms [8][9][10][11][12] not traditionally associated with HIV infection. These could cause patients to have a shorter life expectancy as compared to people not infected by HIV.…”

“…18,19 cART could also prevent new non-AIDS events since it has been reported that patients with higher level of CD4 T cell and controlled viral replication have lower rates of death and non-AIDS events. 1,3,7,8,11,20,21 In fact, it has been reported in the SMART study 22 that patients who discontinued cART had a higher risk of non-AIDS events and death than patients who continued with medication. It is also known that patients who started cART with a high level of CD4 T cell count had a lower risk of death than patients who delay the initiation of medication.…”

The 2010 South African guidelines for the management of HIV and AIDS: A review

“…Late ART initiation is linked to the risk of AIDS-and non-AIDSdefining malignancy, 10 drug resistance 9 and increased risk of failure to reconstitute the immune system. 11 Patients starting ART at CD4 ≥350 cells/µl are more likely to achieve normal CD4 counts within 4 years of starting treatment.…”

“…Baseline VL is related to risk of drug resistance and death, progression of disease, occurrence of opportunistic diseases (particularly cancers), and response to therapy. 10 When the starting-point of a journey is unknown, progress is difficult to map. After taking ART for 6 months, the VL will be either detectable or undetectable.…”

Immunological Nonresponse to Antiretroviral Drugs in HIV Infection

“…Other studies have also demonstrated that CD4 counts are related to overall mortality and incidence of non-AIDS cancers, even in subjects with CD4 lymphocytes >350/µl [12,13].…”