Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 19;8(8):ofab389.
doi: 10.1093/ofid/ofab389. eCollection 2021 Aug.

Risks of Opportunistic Infections in People With Human Immunodeficiency Virus With Cancers Treated With Chemotherapy

Alain Makinson  1 , Lesley S Park  2 , Kimberly Stone  3 , Janet Tate  4 , Maria C Rodriguez-Barradas  5 , Sheldon T Brown  6 , Roxanne Wadia  4 , Kristina Crothers  7 , Roger Bedimo  8 , Matthew Bidwell Goetz  9 , Fatma Shebl  10 , Jacques Reynes  1 , Vincent Le Moing  1 , Keith M Sigel  3
Affiliations

Risks of Opportunistic Infections in People With Human Immunodeficiency Virus With Cancers Treated With Chemotherapy

Alain Makinson et al. Open Forum Infect Dis. .

Abstract

Background: We ascertained incidence of opportunistic infections (OIs) in people with human immunodeficiency virus (PWH) with cancer undergoing chemotherapy with non-human immunodeficiency virus (HIV) comparators.

Methods: We identified 2106 PWH and 2981 uninfected Veterans with cancer who received at least 1 dose of chemotherapy between 1996 and 2017 from the Veterans Aging Cohort Study. We ascertained incident OIs within 6 months of chemotherapy amongst zoster, cytomegalovirus, tuberculosis, Candida esophagitis, Pneumocystis jirovecii pneumonia (PCP), toxoplasmosis, Cryptococcosis, atypical Mycobacterium infection, Salmonella bacteremia, histoplasmosis, coccidioidomycosis, or progressive multifocal leukoencephalopathy. We used Poisson methods to calculate OI incidence rates by HIV status, stratifying for hematological and nonhematological tumors. We compared OI rates by HIV status, using inverse probability weights of HIV status, further adjusting for PCP prophylaxis.

Results: We confirmed 106 OIs in 101 persons. Adjusted OI incidence rate ratios (IRRs) indicated higher risk in PWH for all cancers (IRR, 4.8; 95% confidence interval [CI], 2.8-8.2), hematological cancers (IRR, 8.2; 95% CI, 2.4-27.3), and nonhematological cancers (IRR, 3.9; 95% CI, 2.1-7.2). Incidence rate ratios were not significantly higher in those with CD4 >200 cells/mm3 and viral load <500 copies/mL (IRR, 1.8; 95% CI, 0.9-3.2). All PCP cases (n = 11) occurred in PWH, with 2 microbiologically unconfirmed cases among 1467 PWH with nonhematological cancers, no PCP prophylaxis, and CD4 counts >200/mm3.

Conclusions: Veterans with HIV undergoing chemotherapy had higher rates of OIs than uninfected Veterans, particularly those with hematological cancers, but not in PWH with HIV controlled disease. Our study does not support systematic PCP prophylaxis in solid tumors in PWH with HIV controlled disease.

Keywords: Cancer; Pneumocystis jirovecii pneumonia; chemotherapy; opportunistic infections; prophylaxis.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Incidence of opportunistic infections (OIs) after cancer chemotherapy by human immunodeficiency virus (HIV) status during 4 time periods: 1996–2000, 2001–2006, 2007–2012, and 2013–2017. Incidence was highest for people with HIV (PWH) in 2001–2006 and then declined. Adjusted incidence rate ratios (inverse probability weighted and adjusted for Pneumocystis jirovecii pneumonia prophylaxis use) for OIs for PWH versus uninfected also shown (red triangles) and was highest in 2001–2006, with a decline for subsequent periods (see main text for further details).
Figure 2.
Figure 2.
Trends in age (2a), median CD4 count (2b), proportion of hematological cancers and proportion with human immunodeficiency virus (HIV) control (HIV <500 copies/mL) (2c) during study time periods at cancer diagnosis for Veterans with HIV during study time periods.
See this image and copyright information in PMC

References

    1. Kowalska JD, Reekie J, Mocroft A, et al. ; EuroSIDA study group. Long-term exposure to combination antiretroviral therapy and risk of death from specific causes: no evidence for any previously unidentified increased risk due to antiretroviral therapy. AIDS 2012; 26:315–23. - PubMed
    1. Smith CJ, Ryom L, Weber R, et al. ; D:A:D Study Group. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet 2014; 384:241–8. - PubMed
    1. Smit M, Brinkman K, Geerlings S, et al. ; ATHENA observational cohort. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis 2015; 15:810–8. - PMC - PubMed
    1. Hleyhel M, Belot A, Bouvier AM, et al. ; French Hospital Database on HIV–ANRS CO4 Cohort. Risk of AIDS-defining cancers among HIV-1-infected patients in France between 1992 and 2009: results from the FHDH-ANRS CO4 cohort. Clin Infect Dis 2013; 57:1638–47. - PubMed
    1. Hleyhel M, Hleyhel M, Bouvier AM, et al. ; Cancer Risk Group of the French Hospital Database on HIV (FHDH-ANRS CO4). Risk of non-AIDS-defining cancers among HIV-1-infected individuals in France between 1997 and 2009: results from a French cohort. AIDS 2014; 28:2109–18. - PubMed

LinkOut - more resources