Do antiretrovirals reduce the risk of non-AIDS-defining malignancies?

Abstract

There is an increasing burden of non-AIDS-defining malignancies (NADMs) in the antiretroviral therapy (ART) era. The recent literature is reviewed with respect to NADM risk, ART use, and immune function. Recent studies have increasingly focused on individual ART use, CD4 T-cell counts, and the risk of NADMs. Certain NADMs have been shown to have a reduced risk with ART use including liver, breast, colorectal, and lung cancers. NADMs associated with immunosuppression included Hodgkin's lymphoma, oral/pharynx, lung, anal, and colorectal cancers. Despite the potential protective effect of ART on some NADMs, recent studies evaluating calendar era trends have noted an increased risk of Hodgkin's lymphoma and anal cancer and no change in risk for lung cancer in the ART era. Successful ART use and improvements in immune function for HIV-infected persons may reduce the risk of certain NADMs. However, a continued high risk in the ART era for certain cancers have been observed, including Hodgkin's lymphoma and anal cancers. Future studies should monitor trends in NADMs in HIV-infected persons in the ART era, as well as changes in the prevalence of risk factors, coinfections, and screening practices in this population.