Park LS, et al. - Whether viral suppression was associated with decreased cancer risk was determined in this prospective cohort study. The findings from the present study suggested that antiretroviral therapy resulting in long-term viral suppression could contribute to cancer prevention, to a greater degree for AIDS-defining cancer (ADC) than for non–AIDS-defining cancer (NADC). It was observed that patients with long-term viral suppression still had an excess cancer risk.

Methods

• This prospective cohort study was conducted on Department of Veterans Affairs.
• Study participants were HIV-positive veterans (n = 42,441) and demographically matched uninfected veterans (n = 104,712) from 1999 to 2015.
• They assessed standardized cancer incidence rates and Poisson regression rate ratios (RRs; HIV-positive vs uninfected persons) by viral suppression status (unsuppressed: person-time with HIV RNA levels ≥500 copies/mL; early suppression: initial 2 years with HIV RNA levels <500 copies/mL; long-term suppression: person-time after early suppression with HIV RNA levels <500 copies/mL).

Results

• According to the findings obtained, cancer incidence for HIV-positive vs uninfected persons was highest for unsuppressed persons (RR, 2.35 [95% CI, 2.19 to 2.51]), lower among persons with early suppression (RR, 1.99 [CI, 1.87 to 2.12]), and lowest among persons with long-term suppression (RR, 1.52 [CI, 1.44 to 1.61]).
• It was observed that this trend was strongest for ADC (unsuppressed: RR, 22.73 [CI, 19.01 to 27.19]; early suppression: RR, 9.48 [CI, 7.78 to 11.55]; long-term suppression: RR, 2.22 [CI, 1.69 to 2.93]), much weaker for NADC caused by viruses (unsuppressed: RR, 3.82 [CI, 3.24 to 4.49]; early suppression: RR, 3.42 [CI, 2.95 to 3.97]; long-term suppression: RR, 3.17 [CI, 2.78 to 3.62]), and absent for NADC not caused by viruses.