title: Is nelfinavir exposure associated with cancer incidence in HIV-positive individuals?
abstract: Nelfinavir exhibits potent anticancer properties against a range of tumours. However, in 2006/2007, nelfinavir supplies were accidently contaminated with a carcinogen. This analysis investigated the association between nelfinavir use and cancer risk in HIV-positive persons.
  
  
  
  Observational cohort study.
  
  
  
  D:A:D study data was analysed using Poisson regression models to examine associations between cancer incidence and cumulative nelfinavir exposure, current nelfinavir exposure, and exposure to nelfinavir between 1 July 2006-30 June 2007.
  
  
  
  A total of 42 006 individuals (50% white, 73% male) contributed 303 005 person-years of follow-up between 1 January 2004 and 1 February 2014. At study enrolment, median age was 40 [interquartile range (IQR) 33-46] years and 8305 individuals had a history of nelfinavir use [median duration 1.7 (IQR 0.7-3.4) years]. During follow-up, nelfinavir was used by 2476 individuals for a median of 1.7 (IQR 0.7-3.8) years; 1063 were exposed to nelfinavir between 1 July 2006 and 30 June 2007. Overall, 2279 cancers were diagnosed at a rate of 0.75 [95% confidence interval (95% CI) 0.72-0.78] per 100 person-years. Neither greater cumulative exposure to nelfinavir [adjusted risk ratio (aRR) 0.93 for every additional 5 years, 95% CI 0.82-1.06, P = 0.26] nor current use of nelfinavir (aRR 0.98 vs other protease inhibitor use, 95% CI 0.68-1.41, P = 0.92) were associated with cancer risk. The adjusted risk of cancer for participants exposed to nelfinavir between 1 July 2006 and 30 June 2007 compared to those receiving other treatment over this period was 1.07 (95% CI 0.78-1.46, P = 0.68).
  
  
  
  Nelfinavir use was not associated with a lower cancer incidence than other protease inhibitor regimens. As of February 2014, exposure to the 2006/2007 contamination of nelfinavir does not appear to be associated with increased cancer incidence.
authors: aThe Kirby Institute, UNSW Australia, Sydney, AustraliabResearch Department of Infection and Population Health, UCL, London, United KingdomcCHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, DenmarkdCHU de Bordeaux and INSERM U897, Université de Bordeaux, Talence, FranceeDivision of Infectious Diseases and Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, NetherlandsfDepartment of Health Sciences, San Paolo University Hospital, Milan, ItalygNational Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, United KingdomhDepartment of Internal Medicine I, University Hospital of Cologne, Cologne, Germany.
authors: David C
authors: DC
authors: Boettiger
authors: Caroline A
authors: CA
authors: Sabin
authors: Andrew
authors: A
authors: Grulich
authors: Lene
authors: L
authors: Ryom
authors: Fabrice
authors: F
authors: Bonnet
authors: Peter
authors: P
authors: Reiss
authors: Antonella d'arminio
authors: Ad
authors: Monforte
authors: Ole
authors: O
authors: Kirk
authors: Andrew
authors: A
authors: Phillips
authors: Mark
authors: M
authors: Bower
authors: Gerd
authors: G
authors: Fätkenheuer
authors: Jens D
authors: JD
authors: Lundgren
authors: Matthew
authors: M
authors: Law
mesh_terms: D000328:Adult; D002273:Carcinogens / Q000008:administration & dosage*; D015331:Cohort Studies; D004340:Drug Contamination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019888:Nelfinavir / Q000008:administration & dosage*; D009369:Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D018570:Risk Assessment
chemical_list: D002273:Carcinogens; D017320:HIV Protease Inhibitors; D019888:Nelfinavir