[O13] HIGHLY ACTIVE ANTIRETROVIRAL THERAPY AND THE INCIDENCE OF NON-AIDS-DEFINING CANCERS IN PEOPLE WITH HIV INFECTION

15th Annual Conference of the British HIV Association

1-3 April 2009, Liverpool, UK

HIGHLY ACTIVE ANTIRETROVIRAL THERAPY AND THE INCIDENCE OF NON-AIDS-DEFINING CANCERS IN PEOPLE WITH HIV INFECTION

HIV Med 2009 Apr 1-3 (Suppl 1);15:8 (abstract no. O13)

T Powles¹, D Robinson², J Stebbing³, M Nelson⁴, S Mandalia⁴, H Moller², B Gazzard⁴ and M Bower⁴
¹St Bartholemew’s Hospital, London, UK, ²Thames Cancer Registry, London, UK, ³Charing Cross Hospital, London, UK, ⁴Chelsea & Westminster Hospital, London, UK

BACKGROUND: The effect of highly active antiretroviral therapy (HAART) on the on the incidence of non-AIDS defining cancers (NADCs) is unclear.

METHODS: We have investigated the occurrence of NADCs in a prospective cohort of 11,112 HIV positive individuals with 71,687 patient-years of follow-up. Standardised incidence ratios (SIRs) were calculated using general population incidence data. We investigated the effect of calendar period, HIV parameters, immunological and treatment related factors on the incidence of these cancers, using univariate and multivariate analyses.

RESULTS: The SIR for all NADCs was 1.96 (95% confidence interval [CI]: 1.66–2.29). There was no significant excess in the incidence in the pre-HAART era (1983–1995) (SIR 0.95, 95%CI: 0.58–1.47). However, the incidence rose in the early HAART period (1996–2001) and remains elevated in the most recent established HAART period (2002–2007) (SIR 2.05, 95%CI: 1.51–2.72 and SIR 2.49, 95%CI: 2.00–3.07, respectively). Multivariate analysis showed that use of HAART (HR 1.64, 95%CI: 1.13–2.39) and a nadir CD4 count below 200 mm^-3 (HR 1.67, 95%CI: 1.10–2.54) were associated with an increased risk. Only the non-nucleoside reverse transcriptase inhibitors (NNRTIs) were associated with a significantly increased risk of NADCs (HR 1.45, 95%CI: 1.01–2.08). Much of this association was attributable to an increased risk of Hodgkin’s lymphoma with NNRTIs (HR2.20, 95%CI: 1.03–4.69).

CONCLUSIONS: Since the introduction of HAART there has been a significantly increased risk of NADC, which has now stabilised. A number of factors are associated with this increased risk including, HAART use. There may be an association between the use of NNRTIs and the development of Hodgkin’s lymphoma.

2009-04-01
O13

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