Markers of Inflammation and Immune Dysfunction and Non-AIDS Cancer Risk in Adults With HIV

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INTRODUCTION: We evaluated the association between pre-ART immune dysfunction and inflammation markers and the risk of non-AIDS cancer (NAC) in people with HIV (PWH) after starting ART. METHODS: In a case-cohort study nested within CoRIS, a cohort of ART-naïve PWH, who started ART during 2004-2020, we included 113 NAC cases and a random subcohort of 512 individuals without prior cancers and with at least one pre-ART blood sample. We assessed immune dysfunction (CD4+ and CD8+ cell count, CD4/CD8 ratio) and inflammation markers (interleukin-6 [IL-6], high-sensitivity C-reactive protein, D-Dimer, and soluble CD14). We estimated hazard ratios (HRs) for the association between markers quartiles and NAC risk using Prentice-weighted Cox models separately for each marker and including all markers simultaneously. RESULTS: Among 614 participants (87.1% men; median age 37.3 years; 23.8% with CD4+ ≥ 500 cells/µL), we observed that NAC risk was not associated with immune dysfunction markers, and it was positively associated with IL-6 and D-dimer. Adjusted HRs for IL-6 ranged from 1.77 (95%CI 0.75, 4.16) to 2.73 (1.09, 6.86), while HRs for D-dimer were 3.93 (1.75, 8.84) for the third and 2.94 (1.26, 6.86) for the fourth compared to the first quartile. When all markers were included, only D-dimer confirmed its association with NAC. CONCLUSIONS: Pre-ART inflammation and altered coagulation, but not immune dysfunction markers, were associated with risk of NAC. Limitations include the low number of cancer cases, precluding cancer-specific analyses, and lack of information on relevant confounders, like oncogenic coinfections. Further research is needed to validate these findings.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.