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Review
. 2017 Jan;12(1):12-19.
doi: 10.1097/COH.0000000000000334.

Combination antiretroviral therapy and cancer risk

Álvaro H Borges  1
Affiliations
Review

Combination antiretroviral therapy and cancer risk

Álvaro H Borges. Curr Opin HIV AIDS. 2017 Jan.

Abstract

Purpose of review: To review the newest research about the effects of combination antiretroviral therapy (cART) on cancer risk.

Recent findings: HIV+ persons are at increased risk of cancer. As this risk is higher for malignancies driven by viral and bacterial coinfections, classifying malignancies into infection-related and infection-unrelated has been an emerging trend. Cohorts have detected major reductions in the incidence of Kaposi sarcoma and non-Hodgkin lymphoma (NHL) following cART initiation among immunosuppressed HIV+ persons. However, recent randomized data indicate that cART reduces risk of Kaposi sarcoma and NHL also during early HIV infection before overt immunosuppression occurs. Long-term effects of cART exposure on cancer risk are not well defined; according to basic and epidemiological research, there might be specific associations of each cART class with distinct patterns of cancer risk.

Summary: The relationship between cART exposure and cancer risk is complex and nuanced. It is an intriguing fact that, whether initiated during severe immunosuppression or not, cART reduces risk of Kaposi sarcoma and NHL. Further research should identify mediators of the benefit of immediate cART initiation in reducing cancer risk, understand the relationship between long-term cART exposure and cancer incidence and assess whether adjuvant anti-inflammatory therapies can reduce cancer risk during treated HIV infection.

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Figures

Figure 1
Figure 1. Effect of immediate vs deferred cART initiation on non-AIDS-defining cancer: randomized controlled trials among treatment-naïve HIV+ persons
In SMART, only data from the subset of treatment naïve participants at study entry is included [85]. Cancer outcomes were not reported in CIPRA HT [86]. Arms with and without isoniazid preventive therapy (IPT) were combined in TEMPRANO [••78]. Abbreviations: CIPRA HT 001: Comprehensive International Program of Research on AIDS; HPTN: HIV Prevention Trials Network; SMART: The Strategies for Management of Antiretroviral Therapy Study; START: Strategic Timing of AntiRetroviral Treatment Study; TEMPRANO: Early Antiretroviral Treatment and/or Early Isoniazid Prophylaxis Against Tuberculosis in HIV-infected Adults.
See this image and copyright information in PMC

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