The Impact of Highly Active Antiretroviral Therapy on Cancer Survival in the Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study

Cancer;HIV;Epidemiology

Shmuel, Shahar

Johns Hopkins University

关键词: Cancer;    HIV;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39251/SHMUEL-THESIS-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

OBJECTIVES: To characterize and compare cancer survival among HIV-infected and –uninfected individuals diagnosed with cancer in the pre-HAART (1984-1994) and the HAART (1995-2013) eras, and to describe cancer survival in the HAART era by HIV status and use of HAART.DESIGN: A prospective cohort study nested within the Multicenter AIDS Cohort (MACS) and Women’s Interagency HIV Study (WIHS). STUDY PARTICIPANTS: We studied 911 individuals from the time of cancer diagnosis until the earliest of death or the last study visit attended. Only the initial primary cancers that were diagnosed after enrollment in the MACS or WIHS were included. Second primaries and subsequent metastases were not considered in the analysis. Participants with an unknown cancer diagnosis date were excluded, as were participants with more than a 2-year gap between their last visit prior to cancer diagnosis and the diagnosis date, participants whose SEER Site ICD-0-3 cancer code was an epithelial-cell skin cancer, and those with less than 24 hours of follow-up.METHODS: Cox regression was used to calculate adjusted hazard ratios of death. The proportional hazard assumption was assessed using complementary log-log regression plots and by fitting unadjusted Cox time-dependent Relative Hazards models. RESULTS: Among MACS participants, HIV-infected individuals with cancers diagnosed in the HAART era compared to those diagnosed in the pre-HAART era had better survival, and the difference between these two groups increased with time following cancer diagnosis. There was no significant difference in survival in the HAART era comparing HIV-infected and HIV-uninfected individuals (adjusted HR: 0.70; 95% CI: 0.35 – 1.38). Survival did not differ for HIV-infected individuals diagnosed with ADMs as comparedto those diagnosed with NADMs in the HAART era, but individuals taking HAART at the visit prior to cancer diagnosis had a lower hazard of death than did those not taking HAART (p = 0.03). Interestingly, we also found that HAART use was associated with survival (adjusted HR: 0.36, 95% CI: 0.19 – 0.69) for individuals diagnosed with infection-related cancers, but not among those diagnosed with non-infection-related cancers (adjusted HR: 1.07, 95% CI: 0.67 – 1.72). CONCLUSIONS: The results of this study demonstrate that HAART use prior to diagnosis with infection-related cancers among HIV-infected individuals is associated with improved survival, but this was not the case for non-infection-related cancers. Future research should further assess the survival benefit of HAART for individual infection-related cancers to determine whether our finding is generally relevant for all cancers in this class or for just a select few.