Risk for Non-AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy : A Multinational Prospective Cohort Study
| dc.rights.license | open | en_US |
| dc.contributor.author | CHAMMARTIN, Frederique | |
| dc.contributor.author | LODI, Sara | |
| dc.contributor.author | LOGAN, Roger | |
| dc.contributor.author | RYOM, Lene | |
| dc.contributor.author | MOCROFT, Amanda | |
| dc.contributor.author | KIRK, Ole | |
| dc.contributor.author | D'ARMINIO MONFORTE, Antonella | |
| dc.contributor.author | REISS, Peter | |
| dc.contributor.author | PHILLIPS, Andrew | |
| dc.contributor.author | EL-SADR, Wafaa | |
| dc.contributor.author | HATLEBERG, Camilla I. | |
| dc.contributor.author | PRADIER, Christian | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | BONNET, Fabrice | |
| dc.contributor.author | LAW, Matthew | |
| dc.contributor.author | DE WIT, Stephane | |
| dc.contributor.author | SABIN, Caroline | |
| dc.contributor.author | LUNDGREN, Jens D. | |
| dc.contributor.author | BUCHER, Heiner C. | |
| dc.date.accessioned | 2021-05-11T10:29:00Z | |
| dc.date.available | 2021-05-11T10:29:00Z | |
| dc.date.issued | 2021-03-16 | |
| dc.identifier.issn | 1539-3704 (Electronic) 0003-4819 (Linking) | en_US |
| dc.identifier.uri | https://oskar-bordeaux.fr/handle/20.500.12278/72139 | |
| dc.description.abstractEn | BACKGROUND: 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.iso | EN | en_US |
| dc.subject.en | Drugs | |
| dc.subject.en | Infectious diseases | |
| dc.subject.en | HIV infections | |
| dc.subject.en | AIDS | |
| dc.subject.en | HIV | |
| dc.subject.en | Cohort studies | |
| dc.subject.en | Viral load | |
| dc.subject.en | Cancer treatment | |
| dc.subject.en | Prevention policy and public health | |
| dc.subject.en | Antiretroviral therapy | |
| dc.title.en | Risk for Non-AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy : A Multinational Prospective Cohort Study | |
| dc.type | Article de revue | en_US |
| dc.identifier.doi | 10.7326/M20-5226 | en_US |
| dc.subject.hal | Sciences du Vivant [q-bio]/Santé publique et épidémiologie | en_US |
| dc.identifier.pubmed | 33721519 | en_US |
| bordeaux.journal | Annals of Internal Medicine | en_US |
| bordeaux.hal.laboratories | Bordeaux Population Health Research Center (BPH) - U1219 | en_US |
| bordeaux.institution | Université de Bordeaux | en_US |
| bordeaux.institution | INSERM | en_US |
| bordeaux.team | MORPH3Eus | en_US |
| bordeaux.peerReviewed | oui | en_US |
| bordeaux.inpress | non | en_US |
| hal.identifier | hal-03224015 | |
| hal.version | 1 | |
| hal.date.transferred | 2021-05-11T10:29:08Z | |
| hal.export | true | |
| bordeaux.COinS | ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Annals%20of%20Internal%20Medicine&rft.date=2021-03-16&rft.eissn=1539-3704%20(Electronic)%200003-4819%20(Linking)&rft.issn=1539-3704%20(Electronic)%200003-4819%20(Linking)&rft.au=CHAMMARTIN,%20Frederique&LODI,%20Sara&LOGAN,%20Roger&RYOM,%20Lene&MOCROFT,%20Amanda&rft.genre=article |
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