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Chammartin F, Mocroft A, Egle A, Zangerle R, Smith C, Mussini C, Wit F, Vehreschild JJ, d’Arminio Monforte A, Castagna A, Bailly L, Bogner J, de Wit S, Matulionyte R, Law M, Svedhem V, Tallada J, Garges HP, Marongiu A, Borges ÁH, Jaschinski N, Neesgaard B, Ryom L, Bucher HC. Measures of Longitudinal Immune Dysfunction and Risk of AIDS and Non-AIDS Defining Malignancies in Antiretroviral-Treated People With Human Immunodeficiency Virus. Clin Infect Dis 2024; 78:995-1004. [PMID: 38092042 PMCID: PMC11006099 DOI: 10.1093/cid/ciad671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection leads to chronic immune activation/inflammation that can persist in virally suppressed persons on fully active antiretroviral therapy (ART) and increase risk of malignancies. The prognostic role of low CD4:CD8 ratio and elevated CD8 cell counts on the risk of cancer remains unclear. METHODS We investigated the association of CD4:CD8 ratio on the hazard of non-AIDS defining malignancy (NADM), AIDS-defining malignancy (ADM) and most frequent group of cancers in ART-treated people with HIV (PWH) with a CD4 and CD8 cell counts and viral load measurements at baseline. We developed Cox proportional hazard models with adjustment for known confounders of cancer risk and time-dependent cumulative and lagged exposures of CD4:CD8 ratio to account for time-evolving risk factors and avoid reverse causality. RESULTS CD4:CD8 ratios below 0.5, compared to above 1.0, were independently associated with a 12-month time-lagged higher risk of ADM and infection-related malignancies (adjusted hazard ratio 2.61 [95% confidence interval {CI }1.10-6.19] and 2.03 [95% CI 1.24-3.33], respectively). CD4 cell counts below 350 cells/μL were associated with an increased risk of NADMs and ADMs, as did infection, smoking, and body mass index-related malignancies. CONCLUSIONS In ART-treated PWH low CD4:CD8 ratios were associated with ADM and infection-related cancers independently from CD4 and CD8 cell counts and may alert clinicians for cancer screening and prevention of NADM.
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Affiliation(s)
- Frédérique Chammartin
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Amanda Mocroft
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Alexander Egle
- Austrian HIV Cohort Study (AHIVCOS), Paracelsus Medical University Hospital, Salzburg, Austria
| | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Colette Smith
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, United Kingdom
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) Cohort, HIV Monitoring Foundation, Amsterdam, The Netherlands
| | | | | | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Laurent Bailly
- Nice HIV Cohort, Department of Public Health, Université Côte d’Azur—Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France
| | - Johannes Bogner
- Division of Infectious Diseases, Medizinische Klinik und Poliklinik IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stéphane de Wit
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Raimonda Matulionyte
- Vilnius University, Faculty of Medicine, Department of Infectious Diseases and Dermatovenerology; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Matthew Law
- The Australian HIV Observational Database (AHOD), Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Veronica Svedhem
- Division of Infectious Diseases, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Joan Tallada
- European AIDS Treatment Group (EATG), Brussels, Belgium
| | | | | | - Álvaro H Borges
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Nadine Jaschinski
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bastian Neesgaard
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ryom
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases 144, Hvidovre University Hospital, Copenhagen, Denmark
| | - Heiner C Bucher
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
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Álvarez H, Mocroft A, Ryom L, Neesgaard B, Edwards S, Svedhem V, Günthard HF, Zangerle R, Smith C, Castagna A, d’Arminio Monforte A, Wit F, Stecher M, Lehman C, Mussini C, Fontas E, González E, Wasmuth JC, Sönnerborg A, De Wit S, Chkhartishvili N, Stephan C, Petoumenos K, Jaschinski N, Vannappagari V, Gallant J, Young L, Volny Anne A, Greenberg L, Martín-Iguacel R, Poveda E, Llibre JM. Plasma Human Immunodeficiency Virus 1 RNA and CD4+ T-Cell Counts Are Determinants of Virological Nonsuppression Outcomes With Initial Integrase Inhibitor-Based Regimens: A Prospective RESPOND Cohort Study. Clin Infect Dis 2023; 77:593-605. [PMID: 37052343 PMCID: PMC10893964 DOI: 10.1093/cid/ciad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND There are conflicting data regarding baseline determinants of virological nonsuppression outcomes in persons with human immunodeficiency virus (HIV) starting antiretroviral treatment (ART). We evaluated the impact of different baseline variables in the RESPOND cohort. METHODS We included treatment-naive participants aged ≥18 who initiated 3-drug ART, in 2014-2020. We assessed the odds of virological suppression (VS) at weeks 48 and 96 using logistic regression. Viral blips, low-level viremia (LLV), residual viremia (RV), and virological failure (VF) rates were assessed using Cox regression. RESULTS Of 4310 eligible participants, 72% started integrase strand transfer inhibitor (INSTI)-based regimens. At 48 and 96 weeks, 91.0% and 93.3% achieved VS, respectively. At 48 weeks, Kaplan-Meier estimates of rates were 9.6% for viral blips, 2.1% for LLV, 22.2% for RV, and 2.1% for VF. Baseline HIV-1 RNA levels >100 000 copies/mL and CD4+ T-cell counts ≤200/µL were negatively associated with VS at weeks 48 (adjusted odds ratio, 0.51 [95% confidence interval, .39-.68] and .40 [.27-.58], respectively) and 96 and with significantly higher rates of blips, LLV, and RV. CD4+ T-cell counts ≤200/µL were associated with higher risk of VF (adjusted hazard ratio, 3.12 [95% confidence interval, 2.02-4.83]). Results were consistent in those starting INSTIs versus other regimens and those starting dolutegravir versus other INSTIs. CONCLUSIONS Initial high HIV-1 RNA and low CD4+ T-cell counts are associated with lower rates of VS at 48 and 96 weeks and higher rates of viral blips, LLV, and RV. Low baseline CD4+ T-cell counts are associated with higher VF rates. These associations remain with INSTI-based and specifically with dolutegravir-based regimens. These findings suggest that the impact of these baseline determinants is independent of the ART regimen initiated.
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Affiliation(s)
- Hortensia Álvarez
- Department of Internal Medicine, Infectious Diseases Unit, Complexo Hospitalario Universitario de Ferrol, Ferrol, SERGAS-A Coruña, Spain
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, Vigo, Spain
| | - Amanda Mocroft
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Lene Ryom
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark
| | | | - Simon Edwards
- Department of HIV, Mortimer Market Centre, London, United Kingdom
| | - Veronica Svedhem
- Department of Medicine, Medical Unit Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Huddinge, Sweden
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Robert Zangerle
- Austrian HIV Cohort Study, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Colette Smith
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, United Kingdom
| | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | | | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Melanie Stecher
- Division of Infectious Diseases, Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Clara Lehman
- Division of Infectious Diseases, Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Eric Fontas
- Nice HIV Cohort, Université Côte d´Azur et Centre Hospitalier Universitaire, Nice, France
| | - Eva González
- PISCIS Cohort Study, Centre Estudis Epidemologics de ITS i VIH de Catalunya, Badalona, Spain
| | | | - Anders Sönnerborg
- Swedish InfCare HIV Cohort, Karolinska University Hospital, Stockholm, Sweden
| | - Stéphane De Wit
- CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Nikoloz Chkhartishvili
- Georgian National AIDS Health Information System, Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Christoph Stephan
- Frankfurt HIV Cohort Study, University Hospital Frankfurt, Goethe-University, Infectious Diseases Unit, Frankfurt, Germany
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | | | | | - Lauren Greenberg
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | | | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)–Complexo Hospitalario Universitario de Vigo, Vigo, SERGAS-UVigo, Spain
| | - Josep M Llibre
- Infectious Diseases Division and Fight Infections Foundation, University Hospital Germans Trias i Pujol, Barcelona, Spain
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Greenberg L, Ryom L, Neesgaard B, Miró JM, Dahlerup Rasmussen L, Zangerle R, Grabmeier-Pfistershammer K, Günthard HF, Kusejko K, Smith C, Mussini C, Menozzi M, Wit F, Van Der Valk M, d’Arminio Monforte A, De Wit S, Necsoi C, Pelchen-Matthews A, Lundgren J, Peters L, Castagna A, Muccini C, Vehreschild JJ, Pradier C, Bruguera Riera A, Sönnerborg A, Petoumenos K, Garges H, Rogatto F, Dedes N, Bansi-Matharu L, Mocroft A. Integrase strand transfer inhibitor use and cancer incidence in a large cohort setting. Open Forum Infect Dis 2022; 9:ofac029. [PMID: 35198646 PMCID: PMC8860165 DOI: 10.1093/ofid/ofac029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Limited data exist examining the association between incident cancer and cumulative integrase inhibitor (INSTI) exposure. Methods Participants were followed from baseline (latest of local cohort enrollment or January 1, 2012) until the earliest of first cancer, final follow-up, or December 31, 2019. Negative binomial regression was used to assess associations between cancer incidence and time-updated cumulative INSTI exposure, lagged by 6 months. Results Of 29 340 individuals, 74% were male, 24% were antiretroviral treatment (ART)-naive, and median baseline age was 44 years (interquartile range [IQR], 36–51). Overall, 13 950 (48%) individuals started an INSTI during follow-up. During 160 657 person-years of follow-up ([PYFU] median 6.2; IQR, 3.9–7.5), there were 1078 cancers (incidence rate [IR] 6.7/1000 PYFU; 95% confidence interval [CI], 6.3–7.1). The commonest cancers were non-Hodgkin lymphoma (n = 113), lung cancer (112), Kaposi’s sarcoma (106), and anal cancer (103). After adjusting for potential confounders, there was no association between cancer risk and INSTI exposure (≤6 months vs no exposure IR ratio: 1.15 [95% CI, 0.89–1.49], >6–12 months; 0.97 [95% CI, 0.71–1.32], >12–24 months; 0.84 [95% CI, 0.64–1.11], >24–36 months; 1.10 [95% CI, 0.82–1.47], >36 months; 0.90 [95% CI, 0.65–1.26] [P = .60]). In ART-naive participants, cancer incidence decreased with increasing INSTI exposure, mainly driven by a decreasing incidence of acquired immune deficiency syndrome cancers; however, there was no association between INSTI exposure and cancer for those ART-experienced (interaction P < .0001). Conclusions Cancer incidence in each INSTI exposure group was similar, despite relatively wide CIs, providing reassuring early findings that increasing INSTI exposure is unlikely to be associated with an increased cancer risk, although longer follow-up is needed to confirm this finding.
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Affiliation(s)
- Lauren Greenberg
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
- Correspondence: Lauren Greenberg, PhD, Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, Rowland Hill Street, NW3 2PF, United Kingdom ()
| | - Lene Ryom
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jose M Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruch, Austria
| | | | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Katharina Kusejko
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Colette Smith
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | | | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Marc Van Der Valk
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), HIV Monitoring Foundation, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Stéphane De Wit
- CHU Saint-Pierre, Infectious Diseases, Saint-PIerre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Coca Necsoi
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Jens Lundgren
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peters
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Camilla Muccini
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Jörg Janne Vehreschild
- Medical Department 2, Hematology/Oncology, University Hospital of Frankfurt, Frankfurt, Germany
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d’Azur et Centre Hospitalier Universitaire, Nice, France
| | - Andreu Bruguera Riera
- PISCIS Cohort Study, Centre Estudis Epidemiologics de ITS i VIH de Catalunya, Badalona, Spain
| | - Anders Sönnerborg
- Swedish InfCare HIV Cohort, Karolinska University Hospital, Stockholm, Sweden
| | - Kathy Petoumenos
- The Australian HIV Observational Database (AHOD), UNSW, Sydney, Australia
| | - Harmony Garges
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | - Nikos Dedes
- European AIDS Treatment Group, Brussels, Belgium
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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