The impact of nelfinavir exposure on cancer development among a large cohort of HIV-infected patients.
BACKGROUND
Preclinical studies suggest that the antiretroviral agent, nelfinavir mesylate (NFV), may have antineoplastic properties. The relationship between NFV and cancer incidence among HIV-infected patients is unknown.


METHODS
We evaluated the impact of NFV on cancer development in a large cohort of HIV-infected persons with 108 cancer events during 13,421 person-years of follow-up. Using multivariate time-updated Cox proportional hazard models, the risk of cancer among those receiving NFV were compared to those on non-NFV antiretroviral regimens.


RESULTS
The risk of cancer among those receiving NFV was similar to those on non-NFV antiretroviral regimens (hazard ratio 1.0, 95% confidence interval 0.5, 1.7, P = 0.90). We also examined AIDS-defining and non-AIDS-defining cancers separately and found no significant associations between NFV use and cancer risk. Antiretroviral use, with or without a protease inhibitor (PI) component, was associated with a reduced risk of AIDS-defining cancers compared with no antiretroviral therapy; however, the risk of cancer was the same among those using PI or PI-sparing regimens.


CONCLUSIONS
Despite reports that NFV may have tumoricidal activity, we found no significant relationship between NFV or PI use compared with other antiretrovirals and the risk of developing cancer among a large cohort of HIV-infected persons.
Crum-Cianflone
Nancy F
NF
Infectious Disease Clinical Research Program/TriService AIDS Clinical Consortium, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. nancy.crum@med.navy.mil
Hullsiek
Katherine Huppler
KH
Marconi
Vincent
V
Weintrob
Amy
A
Ganesan
Anuradha
A
Barthel
R Vincent
RV
Fraser
Susan
S
Roediger
Mollie Poehlman
MP
Agan
Brian
B
Wegner
Scott
S
D000328:Adult; D016588:Anticarcinogenic Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D019888:Nelfinavir / Q000008:administration & dosage*; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk
D016588:Anticarcinogenic Agents; D017320:HIV Protease Inhibitors; D019888:Nelfinavir