title: Immuno-virological and clinical impacts of treating cancer in patients living with HIV.
abstract: BACKGROUND
  Patients living with HIV (PLHIV) are increasingly being affected by cancer. However, data evaluating the long-term impact of cancer treatment on HIV course are sparse.
  
  
  METHODS
  To determine whether anticancer treatments detrimentally impact HIV course, we conducted a retrospective cohort study in seven hospitals in France. Adult PLHIV treated for haematological or solid malignancies were included and compared (1:1) with suitably matched (cancer-free) controls. The primary outcome was the risk of a ≥ 25% reduction in the absolute CD4+ count during follow-up. The risks for virological failure (i.e. a confirmed plasma viral load >50 copies/mL), incidental AIDS-related illnesses and death over time were also assessed. Multivariate Cox proportional-hazards regression analyses were used to identify the outcome predictors.
  
  
  RESULTS
  One-hundred-and-ten patients with cancer and 110 controls were followed for a median of 4.4 years. In a Cox model, the CD4+ depletion was strongly predicted by external radiotherapy (ERT) exposure (HR = 5.1, 95% CI, 3.0-8.6, P < 0.0001) but not by chemotherapy. For patients exposed to ERT, the magnitude of the CD4+ depletion peaked 6 months after their cancer diagnosis (mean CD4+ drop at this time =  -283 ± 370 cells/mm(3)). Overall, the cancer patients were also more likely to experience virological failure than the controls (HR = 1.7, 95% CI, 1.1-2.7, P = 0.03). Finally, the incidence of AIDS-related illnesses was similar for both groups.
  
  
  CONCLUSIONS
  In PLHIV, cancer treatment increased the risk for prolonged CD4+ depletion and virological failure but had no impact on AIDS-related events when appropriate prophylaxes were implemented.
authors.affiliation: Service de Maladies Infectieuses, CHU La Milétrie, Poitiers, France COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France.
authors.forename: Gwenaël
authors.initials: G
authors.lastname: Le Moal
authors.affiliation: COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France Service de Maladies Infectieuses, CHR d'Orléans-La Source, Orléans, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Prazuck
authors.affiliation: COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France Service de Maladies Infectieuses, CHG, La Rochelle, France.
authors.forename: Mariam
authors.initials: M
authors.lastname: Saberan-Roncato
authors.affiliation: COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France Service de Pneumologie, CH Jacques Cœur, Bourges, France.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Julien
authors.affiliation: COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France Service de Médecine Interne, CHG, Saintonge, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Pasdeloup
authors.affiliation: COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France Pôle Médecine Interne et Réanimation, CHG, Niort, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Descamps
authors.affiliation: COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France Service de Pneumologie, CH Louis Pasteur, Chartres, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Lestelle
authors.affiliation: COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France Service de Médecine Interne, CHR Porte Madeleine, Orléans, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Arsac
authors.affiliation: Service d'Onco-Radiothérapie, CHR d'Orléans-La Source, Orléans, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Champeaux-Orange
authors.affiliation: COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France Service de Maladies Infectieuses, CHR d'Orléans-La Source, Orléans, France.
authors.forename: Lydia
authors.initials: L
authors.lastname: Bouaraba
authors.affiliation: COREVIH Centre Poitou-Charentes, CHU Bretonneau, Tours, France Service de Maladies Infectieuses, CHR d'Orléans-La Source, Orléans, France laurent.hocqueloux@chr-orleans.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Hocqueloux
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005602:France; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; ART; CD4+ depletion; virological failure