Patterns of HIV viremia and viral suppression before diagnosis of non-AIDS-defining cancers in HIV-infected individuals.

David J Riedel,Anne F Rositch,Robert R Redfield

doi:10.1186/s13027-015-0033-x

David J Riedel, Anne F Rositch + Show 1 more

Open Access

https://doi.org/10.1186/s13027-015-0033-x

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Abstract

BackgroundThe association between HIV viremia and non-AIDS-defining cancers (NADCs) is not well characterized. Viremia may contribute directly or indirectly to cancer development and may have a differential impact on various cancer types. Our objective was to characterize patterns of HIV viremia in a retrospective, urban, clinical cohort (N = 320) of patients diagnosed with NADCs.FindingsThe most common NADC’s were lung (n = 60), prostate (n = 47), oropharyngeal (n = 32), liver (n = 29), and anal cancer (n = 20) and Hodgkin lymphoma (n = 18). In the year before cancer diagnosis, 66 % of all patients were virally suppressed. Patients with oropharyngeal (70 %) and prostate cancer (78 %) had a higher proportion of visits with suppressed viral loads. Patients diagnosed with anal cancer and Hodgkin lymphoma were infrequently virally suppressed and more frequently had viral loads ≥5 log10 copies/ml in the ten years prior to cancer diagnosis.ConclusionsIn this cohort of HIV-infected patients diagnosed with NADCs, there were important differences in the patterns and levels of viremia between the different NADCs in the ten years prior to cancer diagnosis. Patients with anal cancer and Hodgkin lymphoma had the highest proportion of high level viremia in the ten years before cancer and the lowest frequency of viral load suppression at cancer diagnosis.

Highlights

Cancer risk is markedly increased in Human immunodeficiency virus (HIV)-infected individuals compared to the general population, and it has become a frequent cause of morbidity and mortality in this population
The median age at Non-AIDS-defining cancer (NADC) diagnosis was 54 (IQR: 48-59) years, and 68 % of NADCs were in patients older than 50 years compared to 76 % of AIDS-defining cancer (ADC) in patients 50 years or younger
Patients with anal cancer (19.4 %) and Hodgkin lymphoma (17.5 %) had the highest frequency of ≥5 log10 Viral load (VL) measurements, while those with prostate (2.7 %), liver (3.6 %), lung (5.1 %), and oropharyngeal (6.9 %) cancers had the fewest. In this urban cohort of HIV-infected patients diagnosed with cancer, there were important differences in the patterns of viral suppression and levels of viremia between those with ADCs and NADCs and among the different NADCs in the ten years prior to cancer diagnosis

Summary

Introduction

Cancer risk is markedly increased in HIV-infected individuals compared to the general population, and it has become a frequent cause of morbidity and mortality in this population. The actual mechanism by which circulating virus contributes to lymphomagenesis is not yet known, and the association and oncogenic mechanisms between HIV viremia and NADCs is understudied. The purpose of this retrospective cohort study was to characterize patterns of HIV viremia and viral suppression in the ten years preceding NADC diagnosis and to compare these factors among the six most common NADCs (Hodgkin lymphoma and oropharyngeal, anal, Riedel et al Infectious Agents and Cancer (2015) 10:38 liver, lung, and prostate cancer) and to ADCs in a diverse, urban clinic population.

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