To critically appraise recent published literature about factors associated with cancer risk likely to be influenced by combination antiretroviral therapy (cART) in HIV-infected individuals, and the potential of earlier cART initiation to reduce this risk.
Factors leading to increased risk of non-AIDS-defining malignancies (NADMs) in particular remain poorly understood. Immunodeficiency appears to be key, whereas evidence is emerging that a direct pro-oncogenic effect of HIV, activated inflammatory and coagulation pathways, and cART toxicity may also contribute. By reducing HIV replication, improving immune function, and limiting chronic inflammation, cART initiation at higher CD4+ cell counts may, therefore, reduce NADM risk. However, cART only partly normalizes enhanced inflammation and coagulation seen during HIV infection and conflicting laboratory and epidemiological data have been reported as to whether (and how) cART affects NADM risk. Furthermore, secondary analyses of randomized controlled trials comparing early versus delayed cART initiation were inconclusive.
Continuous epidemiological surveillance is warranted to monitor trends in cancer incidence among HIV-infected individuals and to better understand the impact of earlier cART on NADM risk. The role of adjuvant anti-inflammatory or antithrombotic therapies to reduce cancer risk deserves further investigation.
aDepartment of Infectious Diseases, Rigshospitalet & Copenhagen HIV Programme, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
bDepartment of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut
cDivision of Research, Kaiser Permanente, Oakland, California, USA
Correspondence to Álvaro H. Borges, Copenhagen HIV Programme. The Panum Institute/Building 21.1, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Tel: +45 35 45 57 65; fax: +45 35 45 57 58; e-mail: firstname.lastname@example.org.