| Contributors: |
Chammartin, F.; Lodi, S.; Logan, R.; Ryom, L.; Mocroft, A.; Kirk, O.; D'Arminio Monforte, A.; Reiss, P.; Phillips, A.; El-Sadr, W.; Hatleberg, C. I.; Pradier, C.; Bonnet, F.; Law, M.; De Wit, S.; Sabin, C.; Lundgren, J. D.; Bucher, H. C.; Calvo, G.; Dabis, F.; Morfeldt, L.; Weber, R.; Lind-Thomsen, A.; Salbol Brandt, R.; Hillebreght, M.; Zaheri, S.; Wit, F. W. N. M.; Scherrer, A.; Schoni-Affolter, F.; Rickenbach, M.; Tavelli, A.; Fanti, I.; Leleux, O.; Mourali, J.; Le Marec, F.; Boerg, E.; Thulin, E.; Sundstrom, A.; Bartsch, G.; Thompsen, G.; Necsoi, C.; Delforge, M.; Fontas, E.; Caissotti, C.; Dollet, K.; Mateu, S.; Torres, F.; Petoumenos, K.; Blance, A.; Huang, R.; Puhr, R.; Gronborg Laut, K.; Kristensen, D.; Kamara, D. A.; Smith, C. J.; Raben, D.; Matthews, C.; Bojesen, A.; Grevsen, A. L.; Powderly, B.; Shortman, N.; Moecklinghoff, C.; Reilly, G.; Smit, C.; Ross, M.; Fux, C. A.; Morlat, P.; Friis-Moller, N.; Kowalska, J.; Bohlius, J.; Bower, M.; Fatkenheuer, G.; Grulich, A.; Sjol, A.; Meidahl, P.; Iversen, J. S.; Hillebregt, M.; Prins, J. M.; Kuijpers, T. W.; Scherpbier, H. J.; Van Der Meer, J. T. M.; Godfried, M. H.; Van Der Poll, T.; Nellen, F. J. B.; Geerlings, S. E.; Van Vugt, M.; Pajkrt, D.; Bos, J. C.; Wiersinga, W. J.; Van Der Valk, M.; Goorhuis, A.; Hovius, J. W.; Van Eden, J.; Henderiks, A.; Van Hes, A. M. H.; Mutschelknauss, M.; Nobel, H. E.; Pijnappel, F. J. J.; Jurriaans, S.; Back, N. K. T. |
| Description: |
Background: Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non-AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 × 109 cells/L. Consequences of delayed ART on risk for non-AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear. Objective: To estimate the long-term risk difference for cancer with the immediate ART strategy. Design: Multinational prospective cohort study. Setting: The D:A:D (Data collection on Adverse events of anti-HIV Drugs) study, which included HIV-positive persons from Europe, Australia, and the United States. Participants: 8318 HIV-positive persons with at least 1 measurement each of CD4 cell count and viral load while ART-naive (study period, 2006 to 2016). Measurements: The parametric g-formula was used, with adjustment for baseline and time-dependent confounders (CD4 cell count and viral load), to assess the 10-year risk for non-AIDS-defining and AIDS-defining cancer of immediate versus deferred (at CD4 counts < 350 and < 500 × 109 cells/L) ART initiation strategies. Results: During 64 021 person-years of follow-up, 231 cases of non-AIDS-defining cancer and 272 of AIDS-defining cancer occurred among HIV-positive persons with a median age of 36 years (interquartile range, 29 to 43 years). With immediate ART, the 10-year risk for non-AIDS-defining cancer was 2.97% (95% CI, 2.37% to 3.50%) and that for AIDS-defining cancer was 2.50% (CI, 2.37% to 3.38%). Compared with immediate ART initiation, the 10-year absolute risk differences when deferring ART to CD4 counts less than 500 × 109 cells/L and less than 350 × 109 cells/L were 0.12 percentage point (CI, -0.01 to 0.26 percentage point) and 0.29 percentage point (CI, -0.03 to 0.73 percentage point), respectively, for non-AIDS-defining cancer and 0.32 percentage point (CI, 0.21 to 0.44 percentage point) and ... |