The association of HIV control and immunosuppression with risk of non-AIDS defining cancer risk among patients on antiretroviral therapy

Abstract

Background PWH are experiencing an increased prevalence of non-AIDS defining cancers (NADCs). Our study investigated the association of immunosuppression and HIV control with NADCs among PWH on antiretroviral therapy (ART) in the US. Methods Among patients across 8 clinical cohorts on ART between 1996-2016 we assessed immune function and HIV control utilizing six metrics of CD4 count or HIV-RNA viral load (VL): (1) CD4 or VL at ART initiation; (2) change in CD4 or VL following ART initiation; and (3) proportion of follow-up time at CD4>500 cells/ul or VL<50 copies/ml. Cox models were used to ascertain the association of these measures with risk of a viral NADC or non-viral NADC Results Among 29,568 patients on ART, there were 410 non-viral NADCs and 213 viral NADCs. PWH with a CD4 <200 cells/ul at ART initiation had an 80% elevated risk for developing a viral NADC. Each increase of 100 cells/ul in CD4 after ART initiation decreased risk 14%. For viral and non-viral NADCs, 10% more follow-up time spent with a CD4 >500 cells/ul was associated with decreased risk (viral, aHR: 0.82; 95% CI:0.78-0.86; non-viral, aHR: 0.88; 95% CI: 0.86-91), even after accounting for CD4 at ART initiation. When examining HIV control only, 10% more time with VL <50 copies/ml was significantly associated with decreased viral (aHR: 0.85; 95% CI: 0.82-0.89) and non-viral NADC risk (aHR: 0.88; 95% CI: 0.85-0.90). Conclusions This study demonstrates that even for PWH on ART therapy, maintaining HIV control is associated with lower risk of both viral and non-viral NADCs.