Among HIV-positive people, the risk of dying from a non-AIDS-related cancer is significantly greater than the risk of dying from an AIDS-related cancer, according to new data reported on Tuesday at the 14th Conference on Retroviruses and Opportunistic Infections (CROI). According to the international team of researchers reporting new results from an ongoing 23,000-plus patient study, the incidence of fatal non-AIDS-related cancers is expected to increase as the HIV-positive population ages, hence the need for greater preventive care.

Started in 1999, the international D:A:D (Data Collection on Adverse Events of Antiretroviral Drugs) study is being conducted to track the long-term effects of antiretroviral therapy among 23,441 HIV-positive patients on three continents.  D:A:D is, perhaps, best known for its data showing a slightly increased risk of cardiovascular disease and heart attacks among HIV-positive patients on antiretroviral therapy.

At the time of data preparation for CROI, 1,246 patients had died while participating in the study. Among the deaths were 193 due to non-AIDS-related cancers and 112 due to AIDS-related cancers. This difference was statistically significant.

The four most frequent non-AIDS cancer-related deaths in the study were lung cancer (62 deaths); cancer of the gastrointestinal tract, including liver cancer (41 deaths); blood-related cancers, such as leukemia and Hodgkin’s disease (20 deaths); and anal cancer (20 deaths).    

The most common AIDS-related cancer deaths were non-Hodgkin’s lymphoma (82 deaths) and Kaposi’s sarcoma (28 deaths).  Cervical cancer – the risk of this malignancy is believed to be higher in HIV-positive patients – was associated with two deaths.  

The average CD4 counts at the time of death were 75 among those with AIDS-related cancers and 211 among those with non-AIDS-related cancers.  Approximately 56% of the patients dying of non-AIDS-related cancers had viral loads below 400 – meaning that a high percentage were responding well to antiretroviral therapy – at the time of death, compared to 40% among those dying of AIDS related cancers.

As for factors associated with death from non-AIDS-related cancers, older age, current smoking (association with lung cancer only), and active hepatitis B virus (HBV) infection (association with liver cancer only) were shown to increase the risk.  

Considering that HIV-positive patients are living longer due to the use of antiretroviral therapy, the D:A:D researchers believe that death rates due to non-AIDS-related cancers will likely continue to overshadow death rates associated with “classic” AIDS-related cancers. In turn, they conclude, “prevention of development of advanced immunodeficiency and continued focus on reducing known risk factors – including smoking cessation and treatment of chronic HBV infection – appear to be key strategies to prevent fatalities caused my cancers in HIV-infected populations.”

Source:

D’Arminio Monforte A, Abrams D, Pradier C, et al. HIV-induced immunodeficiency and risk of fatal AIDS-defining and non-AIDS defining malignancies: results from the D:A:D study [Abstract 84]. 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, 2007.