| Authors |
Chammartin, Frederique ; Mocroft, Amanda ; Egle, Alexander ; Zangerle, Robert ; Smith, Colette ; Mussini, Cristina ; Wit, Ferdinand ; Vehreschild, Joerg Janne ; d'Arminio Monforte, Antonella ; Castagna, Antonella ; Bailly, Laurent ; Bogner, Johannes ; de Wit, Stephane ; Matulionytė, Raimonda ; Law, Matthew ; Svedhem, Veronica ; Tallada, Joan ; Garges, Harmony P ; Marongiu, Andrea ; Borges, Alvaro H ; Jaschinski, Nadine ; Neesgaard, Bastian ; Ryom, Lene ; Bucher, Heiner C |
| Abstract [eng] |
Background. Human immunodeficiency virus (HIV) infection leads to chronic immune activation/inflammation that can persist in virally suppressed persons on fully active antiretroviral therapy (ART) and increase risk of malignancies. The prognostic role of low CD4:CD8 ratio and elevated CD8 cell counts on the risk of cancer remains unclear. Methods. We investigated the association of CD4:CD8 ratio on the hazard of non-AIDS defining malignancy (NADM), AIDSdefining malignancy (ADM) and most frequent group of cancers in ART-treated people with HIV (PWH) with a CD4 and CD8 cell counts and viral load measurements at baseline. We developed Cox proportional hazard models with adjustment for known confounders of cancer risk and time-dependent cumulative and lagged exposures of CD4:CD8 ratio to account for timeevolving risk factors and avoid reverse causality. Results. CD4:CD8 ratios below 0.5, compared to above 1.0, were independently associated with a 12-month time-lagged higher risk of ADM and infection-related malignancies (adjusted hazard ratio 2.61 [95% confidence interval {CI }1.10–6.19] and 2.03 [95% CI 1.24–3.33], respectively). CD4 cell counts below 350 cells/μL were associated with an increased risk of NADMs and ADMs, as did infection, smoking, and body mass index-related malignancies. Conclusions. In ART-treated PWH low CD4:CD8 ratios were associated with ADM and infection-related cancers independently from CD4 and CD8 cell counts and may alert clinicians for cancer screening and prevention of NADM. |
