PMID- 21572307 OWN - NLM STAT- MEDLINE DCOM- 20110914 LR - 20211020 IS - 1473-5571 (Electronic) IS - 0269-9370 (Linking) VI - 25 IP - 11 DP - 2011 Jul 17 TI - Immune reconstitution and risk of Kaposi sarcoma and non-Hodgkin lymphoma in HIV-infected adults. PG - 1395-403 LID - 10.1097/QAD.0b013e3283489c8b [doi] AB - OBJECTIVE: Given the well documented occurrence of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients who recently started combination antiretroviral therapy (cART), we examined whether cART initiation increased the risk of Kaposi sarcoma and non-Hodgkin lymphoma (NHL) using data from the Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE) collaboration. DESIGN: A nested matched case-control study design was used to assess the effects of individual CD4 cell trajectories and exposure to cART close to the time of cancer diagnosis. METHODS: Cases were patients diagnosed with either cancer during follow-up with a minimum of two consecutive CD4 cell readings within the year preceding diagnosis. For each case, up to 10 controls, matched by sex and cohort, were selected by random sampling. Changes in CD4 cell count, calculated by simple and piecewise linear regression, and recent exposure to cART were compared within matched case-control sets using conditional logistic regression. RESULTS: Using data on 689 cases and 4588 controls, we found that an initially low and decreasing CD4 cell count during the year prior to cancer diagnosis is predictive of both Kaposi sarcoma and NHL. Most of this cancer risk is explained by the immunodeficiency characteristic of the period before cART initiation; however, an increased cancer risk was seen in patients who initiated cART in the previous 3 months (odds ratio 2.31; 95% confidence interval 1.33, 4.00). CONCLUSION: Although IRIS may transiently increase the risk of Kaposi sarcoma or NHL in HIV-infected patients, the timely initiation of cART remains the best strategy to avoid the development of these malignancies. FAU - Jaffe, Harold W AU - Jaffe HW AD - Department of Public Health, University of Oxford, UK. hwj1@cdc.gov FAU - De Stavola, Bianca L AU - De Stavola BL FAU - Carpenter, Lucy M AU - Carpenter LM FAU - Porter, Kholoud AU - Porter K FAU - Cox, David R AU - Cox DR CN - CASCADE Collaboration LA - eng GR - MC_U122886351/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - AIDS JT - AIDS (London, England) JID - 8710219 SB - IM MH - Adult MH - Antiretroviral Therapy, Highly Active/adverse effects MH - CD4 Lymphocyte Count MH - Case-Control Studies MH - Europe/epidemiology MH - Female MH - HIV-1/drug effects/*immunology MH - Humans MH - Immune Reconstitution Inflammatory Syndrome/complications/drug therapy/epidemiology/*immunology MH - Lymphoma, AIDS-Related/drug therapy/epidemiology/*immunology MH - Lymphoma, Non-Hodgkin/drug therapy/epidemiology/*immunology MH - Male MH - Middle Aged MH - Odds Ratio MH - Prognosis MH - Risk Factors MH - Sarcoma, Kaposi/drug therapy/epidemiology/*immunology MH - Young Adult FIR - Del Amo, Julia IR - Del Amo J FIR - Meyer, Laurence IR - Meyer L FIR - Bucher, Heiner C IR - Bucher HC FIR - Chene, Genevieve IR - Chene G FIR - Hamouda, Osamah IR - Hamouda O FIR - Pillay, Deenan IR - Pillay D FIR - Prins, Maria IR - Prins M FIR - Rosinska, Magda IR - Rosinska M FIR - Sabin, Caroline IR - Sabin C FIR - Touloumi, Giota IR - Touloumi G FIR - Lodi, Sara IR - Lodi S FIR - Coughlin, Kate IR - Coughlin K FIR - Walker, Sarah IR - Walker S FIR - Babiker, Abdel IR - Babiker A FIR - Bucher, Heiner C IR - Bucher HC FIR - De Luca, Andrea IR - De Luca A FIR - Fisher, Martin IR - Fisher M FIR - Muga, Roberto IR - Muga R FIR - Zangerle, Robert IR - Zangerle R FIR - Kelleher, A D IR - Kelleher AD FIR - Cooper, D A IR - Cooper DA FIR - Grey, Pat IR - Grey P FIR - Finlayson, Robert IR - Finlayson R FIR - Bloch, Mark IR - Bloch M FIR - Kelleher, Tony IR - Kelleher T FIR - Ramacciotti, Tim IR - Ramacciotti T FIR - Gelgor, Linda IR - Gelgor L FIR - Cooper, David IR - Cooper D FIR - Gill, John IR - Gill J FIR - Jorgensen, Louise B IR - Jorgensen LB FIR - Tartu, U IR - Tartu U FIR - Lutsar, Irja IR - Lutsar I FIR - Chene, Genevieve IR - Chene G FIR - Dabis, Francois IR - Dabis F FIR - Thiebaut, Rodolphe IR - Thiebaut R FIR - Masquelier, Bernard IR - Masquelier B FIR - Costagliola, Dominique IR - Costagliola D FIR - Guiguet, Marguerite IR - Guiguet M FIR - Vanhems, Philippe IR - Vanhems P FIR - Chaix, Marie-Laure IR - Chaix ML FIR - Ghosn, Jade IR - Ghosn J FIR - Meyer, Laurence IR - Meyer L FIR - Boufassa, Faroudy IR - Boufassa F FIR - Hamouda, Osamah IR - Hamouda O FIR - Kucherer, Claudia IR - Kucherer C FIR - Bartmeyer, Barbara IR - Bartmeyer B FIR - Touloumi, Giota IR - Touloumi G FIR - Pantazis, Nikos IR - Pantazis N FIR - Katsarou, Olga IR - Katsarou O FIR - Rezza, Giovanni IR - Rezza G FIR - Dorrucci, Maria IR - Dorrucci M FIR - d'Arminio Monforte, Antonella IR - d'Arminio Monforte A FIR - De Luca, Andrea IR - De Luca A FIR - Prins, Maria IR - Prins M FIR - Geskus, Ronald IR - Geskus R FIR - van der Helm, Jannie IR - van der Helm J FIR - Schuitemaker, Hanneke IR - Schuitemaker H FIR - Sannes, Mette IR - Sannes M FIR - Brubakk, Oddbjorn IR - Brubakk O FIR - Kran, Anne-Marte Bakken IR - Kran AM FIR - Rosinska, Magdalena IR - Rosinska M FIR - Muga, Roberto IR - Muga R FIR - Tor, Jordi IR - Tor J FIR - Garcia de Olalla, Patricia IR - Garcia de Olalla P FIR - Cayla, Joan IR - Cayla J FIR - del Amo, Julia IR - del Amo J FIR - Moreno, Santiago IR - Moreno S FIR - Monge, Susana IR - Monge S FIR - Del Amo, Julia IR - Del Amo J FIR - Perez-Hoyos, Santiago IR - Perez-Hoyos S FIR - Bucher, Heiner C IR - Bucher HC FIR - Rickenbach, Martin IR - Rickenbach M FIR - Francioli, Patrick IR - Francioli P FIR - Malyuta, Ruslan IR - Malyuta R FIR - Brettle, Ray IR - Brettle R FIR - Sabin, Caroline IR - Sabin C FIR - Johnson, Anne IR - Johnson A FIR - Phillips, Andrew IR - Phillips A FIR - Babiker, Abdel IR - Babiker A FIR - Delpech, Valerie IR - Delpech V FIR - Pillay, Deenan IR - Pillay D FIR - Morrison, Charles IR - Morrison C FIR - Salata, Robert IR - Salata R FIR - Mugerwa, Roy IR - Mugerwa R FIR - Chipato, Tsungai IR - Chipato T FIR - Amornkul, Pauli IR - Amornkul P EDAT- 2011/05/17 06:00 MHDA- 2011/09/15 06:00 CRDT- 2011/05/17 06:00 PHST- 2011/05/17 06:00 [entrez] PHST- 2011/05/17 06:00 [pubmed] PHST- 2011/09/15 06:00 [medline] AID - 10.1097/QAD.0b013e3283489c8b [doi] PST - ppublish SO - AIDS. 2011 Jul 17;25(11):1395-403. doi: 10.1097/QAD.0b013e3283489c8b.