Risks of Opportunistic Infections in People With Human Immunodeficiency Virus With Cancers Treated With Chemotherapy

Author:

Makinson Alain1,Park Lesley S2,Stone Kimberly3,Tate Janet4,Rodriguez-Barradas Maria C5,Brown Sheldon T6,Wadia Roxanne4,Crothers Kristina7,Bedimo Roger8,Goetz Matthew Bidwell9,Shebl Fatma10,Reynes Jacques1,Moing Vincent Le1,Sigel Keith M3ORCID

Affiliation:

1. University Hospital Montpellier, Institut National de Science et de Recherche Médicale U1175 and University of Montpellier, Montpellier, France

2. Stanford University School of Medicine, Stanford, California, USA

3. Icahn School of Medicine at Mt Sinai, New York, New York, USA

4. Veteran Affairs Connecticut Healthcare System, West Haven, Connecticut, USA

5. Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, Texas, USA

6. James J. Peters VA Medical Center, Bronx, New York, USA

7. VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA

8. VA North Texas Health Care Center, Dallas, Texas, USA

9. VA Greater Los Angeles Health Care System, Los Angeles, California, USA

10. Massachusetts General Hospital, Boston, Massachusetts, USA

Abstract

Abstract Background We ascertained incidence of opportunistic infections (OIs) in people with human immunodeficiency virus (PWH) with cancer undergoing chemotherapy with non-human immunodeficiency virus (HIV) comparators. Methods We identified 2106 PWH and 2981 uninfected Veterans with cancer who received at least 1 dose of chemotherapy between 1996 and 2017 from the Veterans Aging Cohort Study. We ascertained incident OIs within 6 months of chemotherapy amongst zoster, cytomegalovirus, tuberculosis, Candida esophagitis, Pneumocystis jirovecii pneumonia (PCP), toxoplasmosis, Cryptococcosis, atypical Mycobacterium infection, Salmonella bacteremia, histoplasmosis, coccidioidomycosis, or progressive multifocal leukoencephalopathy. We used Poisson methods to calculate OI incidence rates by HIV status, stratifying for hematological and nonhematological tumors. We compared OI rates by HIV status, using inverse probability weights of HIV status, further adjusting for PCP prophylaxis. Results We confirmed 106 OIs in 101 persons. Adjusted OI incidence rate ratios (IRRs) indicated higher risk in PWH for all cancers (IRR, 4.8; 95% confidence interval [CI], 2.8–8.2), hematological cancers (IRR, 8.2; 95% CI, 2.4–27.3), and nonhematological cancers (IRR, 3.9; 95% CI, 2.1–7.2). Incidence rate ratios were not significantly higher in those with CD4 >200 cells/mm3 and viral load <500 copies/mL (IRR, 1.8; 95% CI, 0.9–3.2). All PCP cases (n = 11) occurred in PWH, with 2 microbiologically unconfirmed cases among 1467 PWH with nonhematological cancers, no PCP prophylaxis, and CD4 counts >200/mm3. Conclusions Veterans with HIV undergoing chemotherapy had higher rates of OIs than uninfected Veterans, particularly those with hematological cancers, but not in PWH with HIV controlled disease. Our study does not support systematic PCP prophylaxis in solid tumors in PWH with HIV controlled disease.

Funder

Collège des Maladies Infectieuses

Merck Sharp and Dohme

National Cancer Institute

National Institute on Alcohol Abuse and Alcoholism

Veterans Aging Cohort Study

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3