title: Thrombocytopenia is associated with an increased risk of cancer during treated HIV disease.
abstract: OBJECTIVE
  To assess the relationship between platelet counts and risk of AIDS and non-AIDS-defining events.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  EuroSIDA patients with at least one platelet count were followed from baseline (first platelet ≥ 1 January 2005) until last visit or death. Multivariate Poisson regression was used to assess the relationship between current platelet counts and the incidence of non-AIDS-defining (pancreatitis, end-stage liver/renal disease, cancer, cardiovascular disease) and AIDS-defining events.
  
  
  RESULTS
  There were 62 898 person-years of follow-up (PYFU) among 12 279 patients, including 1168 non-AIDS-defining events [crude incidence 18.6/1000 PYFU, 95% confidence interval (CI) 17.5-19.6] and 735 AIDS-defining events (crude incidence 11.7/1000 PYFU, 95% CI 10.8-12.5). Patients with thrombocytopenia (platelet count ≤100 × 10/l) had a slightly increased incidence of AIDS-defining events [adjusted incidence rate ratio (aIRR) 1.42, 95% CI 1.07-1.86], when compared to those with platelet counts 101-200 × 10/l, whereas the incidence of non-AIDS-defining events was more than two-fold higher (aIRR 2.66, 95% CI 2.17-3.26). Among non-AIDS-defining events, the adjusted incidence of cancer (aIRR 2.20, 95% CI 1.61-3.01), but not cardiovascular disease (aIRR 0.66, 95% CI 0.32-1.34), was significantly higher in patients with thrombocytopenia. The association between thrombocytopenia and cancer remained unaltered in sensitivity analyses requiring repeated platelet counts to confirm thrombocytopenia and lagging platelets by 1 year prior to clinical events.
  
  
  CONCLUSIONS
  Patients with thrombocytopenia had increased incidence of AIDS-defining and non-AIDS-defining events, but the association with the latter, in particular cancer, was stronger. Future studies should investigate whether the pathophysiological processes underlying thrombocytopenia are associated with the development of cancer during treated HIV disease.
authors.affiliation: aCentre for Health & Infectious Diseases Research (CHIP), Department of Infectious Diseases and Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark bClinica delle Malattie Infettive, Ospedale L. Sacco, Milan, Italy cDept de Medicine Tropicale, Hopital de la Pitié-Salpêtriére, Paris, France dInstituto de Saúde Ambiental, Faculdade de Medicina de Lisboa eServiço de Doenças Infecciosas, Hospital de Santa Maria, Lisbon, Portugal fDepartment of Infectious Diseases, Wojewodzki Szpital Specjalistyczny, Bialystok, Poland gDepartment of Infectious Diseases, Södersjukhuset Venhälsan, Stockholm, Sweden hInfectious Diseases Department, Gomel State Medical University, Gomel, Belarus iDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland j1st Department of Internal Medicine, Athens General Hospital 'G. Gennimatas', Athens, Greece kDepartment of Infection and Population Health, University College London, London, UK. *Study group listed in the Acknowledgements section.
authors.forename: Álvaro H
authors.initials: ÁH
authors.lastname: Borges
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ridolfo
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.forename: Francisco
authors.initials: F
authors.lastname: Antunes
authors.forename: Anna
authors.initials: A
authors.lastname: Grzeszczuk
authors.forename: Anders
authors.initials: A
authors.lastname: Blaxhult
authors.forename: Viktar M
authors.initials: VM
authors.lastname: Mitsura
authors.forename: Manuela
authors.initials: M
authors.lastname: Doroana
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Gargalianos
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D013921:Thrombocytopenia / Q000150:complications*; D055815:Young Adult