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The impact of NNRTIs compared to PIs on the development of cancer: is there a difference?
N. Crum-Cianflone1,2, K. Huppler Hullsiek1,3, A. Ganesan1, V. Marconi1, A. Weintrob1, R.V. Barthel1, B. Agan1, and the Infectious Disease Clinical Reseach Program
1Infectious Disease Clinical Research Program, Bethesda, United States, 2Naval Medical Center San Diego, San Diego, United States, 3University of Minnesota, Minneapolis, United States
Background: Although NNRTIs and PIs have been compared in terms of immunologic and virologic responses, whether one class is preferable based on their impact on the development of cancer is unknown.
Methods: We examined data collected from a multicenter, prospective Natural History Study which included 2,836 HIV-infected persons during the HAART era (1/1996-12/2006). Cox multivariate proportional hazard models were performed to evaluate PI and NNRTI use on cancer development, with time-updated indicators for HAART use (PI-based, NNRTI-based, other, or none) and adjusted for demographics, CD4 cell counts, viral loads, AIDS events, and year of HIV diagnosis. Hazard ratios (HR) are given with 95% confidence intervals (CI).
Results: The mean age of the total cohort was 33 years; 91% were male; 47% were African Americans and 42% were Caucasians. Of those ever receiving NNRTIs (n=1132) or PIs (n=1316), the mean CD4 cell count at initiation was 428 and 353 cells/mm3, respectively. During 14,205 person-years (PYs) of follow-up, participants spent 3,218 PYs on NNRTIs and 5,548 PYs on PIs. Cancer occurred among 143 persons. The mean time on NNRTIs and PIs among participants was 0.6 and 1.7 years for those who developed cancer, and 1.2 and 2.0 years for those without cancer, respectively. Compared to PI use, those receiving NNRTIs had a similar risk of cancer (HR 0.87; 95% CI 0.46, 1.64). The risk of AIDS-defining cancers (HR 0.44; 95% CI 0.10, 1.98) and non-AIDS-defining cancers (HR 1.02; 95% CI 0.49, 2.11) also did not differ by treatment group.
Conclusions: There were no differences in the risk of cancer development among those receiving NNRTIs compared to PIs. Further investigations are needed to detect potential differences using larger datasets.
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