Effect of HAART on incident cancer and noncancer AIDS events among male HIV seroconverters

Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Room E7133, Baltimore, MD 21205, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 09/2008; 48(4):485-90. DOI: 10.1097/QAI.0b013e31817dc42b
Source: PubMed


To explore the impact of highly active antiretroviral therapy (HAART) on the prevention of AIDS-defining cancers relative to other AIDS-defining events.
Prospective cohort study using 2,121 HIV+ male seroconverters (median age: 28 years, 51% white/non-Hispanic) in the Tri-Service AIDS Clinical Consortium (n = 1694) and the Multicenter AIDS Cohort Study (n = 427).
Poisson regression models, with calendar periods to represent antiretroviral therapy, were extended to analyze first incident AIDS-defining cancers and other first AIDS-defining events as competing risks.
Eighty-one AIDS-defining cancers (64 Kaposi sarcomas; 17 non-Hodgkin lymphomas) and 343 other AIDS events occurred during 14,483 person-years in 1990-2006. The rate ratio of AIDS-defining cancers during the HAART calendar period was 0.26 (95% confidence limits: 0.15, 0.46) and of other AIDS-defining events was 0.28 (95% confidence limits: 0.21, 0.36) compared with the monotherapy/combination therapy calendar period, adjusting for age, infection duration, race, and cohort. The association of HAART with decreased AIDS incidence seemed to be equal (interaction ratio = 0.95 (95% confidence limits: 0.51, 1.74) for AIDS-defining cancers and other AIDS-defining events.
In human immunodeficiency virus-infected men, HAART seems equally protective against first AIDS-defining cancers and other first AIDS-defining events.

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    • "KSHV belongs to the genus Rhadinovirus and has a DNA sequence similar to other rhadinoviruses (Albrecht, et al., 1992). With the introduction of HAART in 1996, the incidence of AIDS-related cancers such as KS and NHL (non - Hodgkin's lymphoma) has decreased (Shiels, et al., 2008). During the 1980s and early 1990s, US population rates of KS increased 30 fold (Eltom, et al., 2002). "

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    • "Each ad hoc method addresses competing risks imperfectly, though epidemiologists have used each of these methods in past to address competing risks when estimating the effect of HAART on specific types of AIDS events [6] [7] [8]. When competing risks are independent, and method 1 is utilized, the survival experience of uncensored observations represents the unobserved survival experience of the competing risks. "
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    ABSTRACT: To compare three ad hoc methods to estimate the marginal hazard of incident cancer acquired immune deficiency syndrome (AIDS) in a highly active antiretroviral therapy (1996-2006) relative to a monotherapy/combination therapy (1990-1996) calendar period, accounting for other AIDS events and deaths as competing risks. Among 1,911 human immunodeficiency virus (HIV)-positive men from the Multicenter AIDS Cohort Study, 228 developed cancer AIDS and 745 developed competing risks in 14,202 person-years from 1990 to 2006. Method 1 censored competing risks at the time they occurred, method 2 excluded competing risks, and method 3 censored competing risks at the date of analysis. The age, race, and infection duration adjusted hazard ratios (HRs) for cancer AIDS were similar for all methods (HR approximately 0.15). We estimated bias and confidence interval coverage of each method with Monte Carlo simulation. On average, across 24 scenarios, method 1 produced less-biased estimates than methods 2 or 3. When competing risks are independent of the event of interest, only method 1 produced unbiased estimates of the marginal HR, although independence cannot be verified from the data. When competing risks are dependent, method 1 generally produced the least-biased estimates of the marginal HR for the scenarios explored; however, alternative methods may be preferred.
    Full-text · Article · Oct 2009 · Journal of clinical epidemiology
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    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.
    Preview · Article · Feb 2009 · Current opinion in HIV and AIDS
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