Association of Immunosuppression and Human Immunodeficiency Virus (HIV) Viremia with Anal Cancer Risk in Persons Living with HIV in the United States and Canada
| Autor: | Raúl U. Hernández-Ramírez, Adrian Betts, Haiqun Lin, Ronald J. Bosch, Jinbing Zhang, Pragna Patel, Timothy R. Sterling, Jerry Jing, Brenna C. Hogan, Michael S. Saag, Joseph J. Eron, Angel M. Mayor, Gregory D. Kirk, Joanne Lindsay, Daniel R. Drozd, William B. Lober, Michael A. Horberg, Nancy A. Hessol, Robert F. Hunter-Mellado, Steven G. Deeks, Jennifer E. Thorne, Peter F Rebeiro, James H. Willig, Amy C. Justice, M. John Gill, Sonia Napravnik, Julia Zhu, Lisa P. Jacobson, Joseph B. Margolick, Chris Grasso, Wendy A. Leyden, Mari M. Kitahata, Megan Turner, Rosemary G. McKaig, Julio S. G. Montaner, Aimee M. Freeman, Michael J. Mugavero, Kate Buchacz, Keri N. Althoff, Chad J. Achenbach, Michael J. Silverberg, Constance A. Benson, Liz Morton, Jun Li, Benita Yip, Kelly A. Gebo, Justin McReynolds, Robert S. Hogg, Karyn Gabler, John T. Brooks, Benigno Rodriguez, Heidi M. Crane, Kathryn Anastos, Stephen E. Van Rompaey, Elizabeth Humes, Jennifer S. Lee, Abigail Kroch, Robert Dubrow, Eric A. Engels, Kate Salters, W. Christopher Mathews, Kenneth H. Mayer, Sally B. Coburn, Stephen J. Gange, David A. Fiellin, Bin You, P. Richard Harrigan, Gypsyamber D'Souza, Surbhi Grover, Romain Neugebauer, David W. Haas, Charles S. Rabkin, Ann N. Burchell, Li Qin, Anita Rachlis, William C. Mathews, Jeffrey N. Martin, Richard D. Moore, Marina B. Klein |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
Canada medicine.medical_specialty Anal Carcinoma medicine.medical_treatment HIV Infections 03 medical and health sciences 0302 clinical medicine Acquired immunodeficiency syndrome (AIDS) Internal medicine Humans Medicine Anal cancer Viremia 030212 general & internal medicine Articles and Commentaries Immunosuppression Therapy Proportional hazards model business.industry Hazard ratio HIV Immunosuppression Viral Load Anus Neoplasms medicine.disease United States Confidence interval CD4 Lymphocyte Count 3. Good health Infectious Diseases 030220 oncology & carcinogenesis Cohort business |
| Zdroj: | Clin Infect Dis |
| DOI: | 10.17615/m3c9-sr83 |
| Popis: | Background People living with human immunodeficiency virus (HIV; PLWH) have a markedly elevated anal cancer risk, largely due to loss of immunoregulatory control of oncogenic human papillomavirus infection. To better understand anal cancer development and prevention, we determined whether recent, past, cumulative, or nadir/peak CD4+ T-cell count (CD4) and/or HIV-1 RNA level (HIV RNA) best predict anal cancer risk. Methods We studied 102 777 PLWH during 1996–2014 from 21 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. Using demographics-adjusted, cohort-stratified Cox models, we assessed associations between anal cancer risk and various time-updated CD4 and HIV RNA measures, including cumulative and nadir/peak measures during prespecified moving time windows. We compared models using the Akaike information criterion. Results Cumulative and nadir/peak CD4 or HIV RNA measures from approximately 8.5 to 4.5 years in the past were generally better predictors for anal cancer risk than their corresponding more recent measures. However, the best model included CD4 nadir (ie, the lowest CD4) from approximately 8.5 years to 6 months in the past (hazard ratio [HR] for Conclusions Our results are consistent with anal cancer promotion by severe, prolonged HIV-induced immunosuppression. Nadir and cumulative CD4 may represent useful markers for identifying PLWH at higher anal cancer risk. |
| Databáze: | OpenAIRE |
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