title: Immune reconstitution and risk of Kaposi sarcoma and non-Hodgkin lymphoma in HIV-infected adults.
abstract: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health, University of Oxford, UK. hwj1@cdc.gov
authors.forename: Harold W
authors.initials: HW
authors.lastname: Jaffe
authors.forename: Bianca L
authors.initials: BL
authors.lastname: De Stavola
authors.forename: Lucy M
authors.initials: LM
authors.lastname: Carpenter
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
authors.forename: David R
authors.initials: DR
authors.lastname: Cox
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D015497:HIV-1 / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D055815:Young Adult