HIV: long-term viral suppression attenuates cancer risk

  • Ann Intern Med

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Long-term viral suppression (continuous suppression

Why this matters

  • Patient outreach to encourage HIV testing, initiation of early, sustained antiretroviral therapy (ART) may contribute to prevention/risk reduction for all cancers, ADC.

Key results

  • 42,441 HIV+ participants, 3821 with 4169 cancer cases.
  • 62% achieved long-term viral suppression.
  • All cancer: RR, 2.35 (95% CI, 2.19-2.51), 1.99 (95% CI, 1.87-2.12), 1.52 (95% CI, 1.44-1.61) in un-, early-, long-term suppressed, respectively, vs uninfected.
  • ADC: RR, 22.73 (95% CI, 19.01-27.19), 9.48 (95% CI, 7.78-11.53), 2.22 (95% CI, 1.69-2.93) in un-, early, long-term suppressed, respectively, vs uninfected. 
  • Long-term suppression associated with 94% reduction in excess ADC risk.
  • Virus non-ADC: RR, 3.82 (95% CI, 3.24-4.49), 3.42 (95% CI, 2.95-3.97), 3.17 (95% CI, 2.78-3.62) in un-, early, long-term suppressed, respectively, vs uninfected.
  • Nonvirus non-ADC: no trend observed in RR in HIV+ vs uninfected.

Study design

  • Prospective cohort study evaluating association between long-term viral suppression (i.e., sustained periods of low HIV RNA)/cancer risk in HIV+ veterans.
  • Funding: National Cancer Institute, NIH.

Limitations

  • Viral depression defined by high threshold (i.e., 500 copies/mL).
  • Viral suppression status history unmeasured.
  • Selection bias.
  • Underpowered, nongeneralizable.

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