Factors associated with non-AIDS-defining cancers and non HCV-liver related cancers in HIV/HCV-coinfected patients- ANRS-CO13 HEPAVIH cohort.

Oumar Billa,Linda Wittkop,Cécile Goujard,Estibaliz Lazaro,Claudine Duvivier,François Raffi,David Zucman,Patrick Miailhes,Laurent Alric,Julie Chas,Stéphanie Dominguez,Anne Gervais,Alissa Naqvi,Philippe Morlat,Caroline Lascoux-Combe,Olivier Bouchaud,Dominique Salmon,Karine Lacombe,Camille Gilbert,Laure Esterle,Mathieu Chalouni,Karl Barange,Christine Katlama,D Vittecoq ,Didier Néau ,Hugues Aumaître ,Isabelle Poizot‐Martin ,Éric Rosenthal ,D Garipuy ,Anne Simon,Firouzé Bani‐Sadr

doi:10.1371/journal.pone.0208657

Abstract

Compared to the general population, HIV-infected patients are at higher risk of developing non-AIDS-defining cancers. Chronic HCV infection has also been associated with a higher risk than that of the general population of developing cancers other than hepatocarcinoma. Evaluation of the impact of HCV-related factors on non-AIDS-defining and non HCV-liver (NANL) related cancers among HIV/HCV co-infected patients are scarce. The aim of this study was to identify the impact of HIV/HCV clinical characteristics on NANL related cancers in a large cohort of HIV/HCV-coinfected patients followed from 2005 to 2017. Cox proportional hazards models with delayed entry were used to estimate factors associated with NANL related cancer. Among 1391 patients followed for a median of 5 years, 60 patients developed NANL related cancers, yielding an incidence rate of 8.9 per 1000 person-years (95% CI, [6.6–11.1]). By final multivariable analysis, after adjustment for sex, tobacco or alcohol consumption, baseline CD4 cell count and HCV sustained viral response (SVR), age and a longer duration since HIV diagnosis were independently associated with a higher risk of NANL related cancer (aHR for each additional year 1.10, 95% CI 1.06–1.14, p<0.0001 and 1.06, 95% CI 1.01–1.11, p = 0.02, respectively). Duration of HCV infection, cirrhosis, HCV viral load, genotype and SVR were not associated with the occurrence of NANL related cancer. Among HIV/HCV-coinfected patients, age and the duration of HIV infection were the only characteristics found to be associated with the occurrence of NANL related cancer. In contrast, no association was observed with any HCV-related variables.

Highlights

HIV-infected patients have a higher risk of developing non-AIDS-defining cancers compared to the general population [1,2,3,4]
Additional factors may vary by cancer, such as poor immune control for oncogenic viruses such as Human papillomavirus (HPV) or Epstein Barr virus (EBV), and/or lifestyle choices, such as tobacco or alcohol use for lung or digestive cancers [2,4]
In national surveys consecutively conducted in France in 2000, 2005 and in 2010, the rate of death attributed to non-AIDS-defining cancers and non HCV-liver (NANL) related cancers significantly increased between 2000 and 2010 (11% of deaths in 2000, 17% in 2005 and 22% in 2010, p

Summary

Introduction

HIV-infected patients have a higher risk of developing non-AIDS-defining cancers compared to the general population [1,2,3,4]. Additional factors may vary by cancer, such as poor immune control for oncogenic viruses such as Human papillomavirus (HPV) or Epstein Barr virus (EBV), and/or lifestyle choices, such as tobacco or alcohol use for lung or digestive cancers [2,4]. Some epidemiological studies suggest that patients with chronic HCV infection are at higher risk than the general population of developing other cancers, such as cancers of the esophagus, pancreas, prostate, thyroid, breast or oral cavity [5,7,9,10,11]. In national surveys consecutively conducted in France in 2000, 2005 and in 2010, the rate of death attributed to non-AIDS-defining cancers and non HCV-liver (NANL) related cancers significantly increased between 2000 and 2010 (11% of deaths in 2000, 17% in 2005 and 22% in 2010, p

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Conclusion