Monday, October 12, 2009
MONDAY, Oct. 12 (HealthDay News) -- Immunodeficiency greatly increases the risk of seven AIDS-defining and non-AIDS-defining cancers in HIV-infected patients, and combination treatment that increases CD4 counts can reduce this risk, according to a study published online Oct. 8 in The Lancet Oncology.
Marguerite Guiguet, Ph.D., from INSERM and Universite Pierre et Marie Curie in Paris, and colleagues examined the impact of immunodeficiency, HIV viral load, and combination antiretroviral therapy on the risk of cancer in 52,278 HIV-positive patients in a French hospital database with a median follow-up of 4.9 years.
The researchers found that immunodeficiency (current CD4 count <500 cells per µL) was most predictive of both AIDS-defining (Kaposi's sarcoma, non-Hodgkin lymphoma, cervical cancer) and non-AIDS-defining (Hodgkin's lymphoma, lung cancer, liver cancer) cancers with the exception of anal cancer. The risk of Kaposi's sarcoma and non-Hodgkin lymphoma increased to a lesser extent with high viral load (HIV RNA >100,000 copies per mL), but was reduced by 70 percent by combination therapy. Combination therapy reduced the risk of cervical cancer by 50 percent. The risk of anal cancer increased with the length of time that CD4 counts were <200 cells per µL and viral load was high.
"Our results suggest that combination antiretroviral therapy would be most beneficial if it restores or maintains the CD4 count above 500 cells per µL, thereby indicating an earlier diagnosis of HIV infection and an earlier treatment initiation," Guiguet and colleagues conclude. "Access to cervical-cancer screening programs should be regularly offered to all HIV-positive women, and cancer-specific screening programs, such as for lung cancer and for anal cancer, need to be assessed in HIV-infected patients."
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