Role of Uncontrolled HIV RNA Level and Immunodeficiency in the Occurrence of Malignancy in HIV-Infected Patients during the Combination Antiretroviral Therapy Era: Agence Nationale de Recherche sur le Sida (ANRS) CO3 Aquitaine Cohort
ABSTRACT Human immunodeficiency virus (HIV)-infected patients are at higher risk of malignancies. In addition to traditional determinants, a specific deleterious effect of HIV and immunodeficiency is speculated. We aimed at studying the association between immunological and virological characteristics of HIV-infected patients in care and the risk of acquired immunodeficiency syndrome (AIDS)-defining and non-AIDS-defining malignancies.
Patients consecutively enrolled in the hospital-based Agence Nationale de Recherche sur le Sida (ANRS) CO3 Aquitaine Cohort were included if the duration of follow-up was >3 months during the period 1998-2006. Multivariate modeling used an extended Cox proportional hazards model for time-dependent covariates and delayed entry.
The 4194 patients included in the study developed 251 first malignancies during 22,389 person-years. A higher incidence of AIDS-defining malignancies (107 cases) was independently associated with (1) both longer and current exposures to a plasma HIV RNA level >500 copies/mL (hazard ratio [HR], 1.27 per year [P<.001] and 3.30 [P<.001], respectively) and (2) both longer and current exposure to a CD4(+) cell count <200 cells/mm(3) (HR, 1.36 per year [P<.001] and 6.33 [P<.001], respectively). A higher incidence of non-AIDS-defining malignancies (144 cases) was independently associated with longer and current exposure to a CD4(+) cell count <500 cells/mm(3) (HR, 1.13 per year [P=.01] and 2.07 [P<.001], respectively) and male sex (HR, 1.69; P=.02) but not with plasma HIV RNA level (P=.49 and P=.10 for cumulative and current exposures, respectively).
Uncontrolled plasma HIV RNA level was independently associated with a higher likelihood of developing AIDS-defining malignancies, whereas immunosuppression was associated with a higher risk of developing any type of malignancies. Antiretroviral treatment should aim at reaching and maintaining a CD4(+) count >500 cells/mm(3) to prevent the occurrence of malignancy, this should be integrated to malignancy-prevention policies.
- SourceAvailable from: medadvocates.orgResearch initiative, treatment action: RITA 11/2009; 15.
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ABSTRACT: The Gilbert channel is a model for representing a multipath fading channel for multicarrier transmission using various parameters, such as the steady state probabilities, power ratio between each state and so on. However, a method to set parameters has not been studied. The validity of this channel model has also not been confirmed. Moreover, this channel modeling considering the effect of the non-linear amplifier has not been investigated. In this paper, we propose a more detailed Gilbert channel, including the effect of the non-linear amplifier, and a method to set parameters of the Gilbert channel. We also compare the error performance between the Gilbert channel and multipath fading channel on a convolutional coded multicarrier modulation (MCM) system. Numerical results show that our proposed channel model can approximately express the multipath fading channelElectrical and Electronic Technology, 2001. TENCON. Proceedings of IEEE Region 10 International Conference on; 02/2001
- Clinical Infectious Diseases 09/2009; 49(7):1117-8. DOI:10.1086/605595 · 9.42 Impact Factor