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Risk for Non-AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy : A Multinational Prospective Cohort Study

dc.rights.licenseopenen_US
dc.contributor.authorCHAMMARTIN, Frederique
dc.contributor.authorLODI, Sara
dc.contributor.authorLOGAN, Roger
dc.contributor.authorRYOM, Lene
dc.contributor.authorMOCROFT, Amanda
dc.contributor.authorKIRK, Ole
dc.contributor.authorD'ARMINIO MONFORTE, Antonella
dc.contributor.authorREISS, Peter
dc.contributor.authorPHILLIPS, Andrew
dc.contributor.authorEL-SADR, Wafaa
dc.contributor.authorHATLEBERG, Camilla I.
dc.contributor.authorPRADIER, Christian
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorBONNET, Fabrice
dc.contributor.authorLAW, Matthew
dc.contributor.authorDE WIT, Stephane
dc.contributor.authorSABIN, Caroline
dc.contributor.authorLUNDGREN, Jens D.
dc.contributor.authorBUCHER, Heiner C.
dc.date.accessioned2021-05-11T10:29:00Z
dc.date.available2021-05-11T10:29:00Z
dc.date.issued2021-03-16
dc.identifier.issn1539-3704 (Electronic) 0003-4819 (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/72139
dc.description.abstractEnBACKGROUND: Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non-AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 × 10(9) cells/L. Consequences of delayed ART on risk for non-AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear. OBJECTIVE: To estimate the long-term risk difference for cancer with the immediate ART strategy. DESIGN: Multinational prospective cohort study. SETTING: The D:A:D (Data collection on Adverse events of anti-HIV Drugs) study, which included HIV-positive persons from Europe, Australia, and the United States. PARTICIPANTS: 8318 HIV-positive persons with at least 1 measurement each of CD4 cell count and viral load while ART-naive (study period, 2006 to 2016). MEASUREMENTS: The parametric g-formula was used, with adjustment for baseline and time-dependent confounders (CD4 cell count and viral load), to assess the 10-year risk for non-AIDS-defining and AIDS-defining cancer of immediate versus deferred (at CD4 counts <350 and <500 × 10(9) cells/L) ART initiation strategies. RESULTS: During 64 021 person-years of follow-up, 231 cases of non-AIDS-defining cancer and 272 of AIDS-defining cancer occurred among HIV-positive persons with a median age of 36 years (interquartile range, 29 to 43 years). With immediate ART, the 10-year risk for non-AIDS-defining cancer was 2.97% (95% CI, 2.37% to 3.50%) and that for AIDS-defining cancer was 2.50% (CI, 2.37% to 3.38%). Compared with immediate ART initiation, the 10-year absolute risk differences when deferring ART to CD4 counts less than 500 × 10(9) cells/L and less than 350 × 10(9) cells/L were 0.12 percentage point (CI, -0.01 to 0.26 percentage point) and 0.29 percentage point (CI, -0.03 to 0.73 percentage point), respectively, for non-AIDS-defining cancer and 0.32 percentage point (CI, 0.21 to 0.44 percentage point) and 1.00 percentage point (CI, 0.67 to 1.44 percentage points), respectively, for AIDS-defining cancer. LIMITATION: Potential residual confounding due to observational study design. CONCLUSION: In this young cohort, effects of immediate ART on 10-year risk for cancer were small, and further supportive data are needed for non-AIDS-defining cancer. PRIMARY FUNDING SOURCE: Highly Active Antiretroviral Therapy Oversight Committee.
dc.language.isoENen_US
dc.subject.enDrugs
dc.subject.enInfectious diseases
dc.subject.enHIV infections
dc.subject.enAIDS
dc.subject.enHIV
dc.subject.enCohort studies
dc.subject.enViral load
dc.subject.enCancer treatment
dc.subject.enPrevention policy and public health
dc.subject.enAntiretroviral therapy
dc.title.enRisk for Non-AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy : A Multinational Prospective Cohort Study
dc.typeArticle de revueen_US
dc.identifier.doi10.7326/M20-5226en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed33721519en_US
bordeaux.journalAnnals of Internal Medicineen_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamMORPH3Eusen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03224015
hal.version1
hal.date.transferred2021-05-11T10:29:08Z
hal.exporttrue
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