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                <title level="j">Clinical Infectious Diseases</title>
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                <term xml:lang="en">HIV</term>
                <term xml:lang="en">malignancy</term>
                <term xml:lang="en">risk</term>
                <term xml:lang="en">immunodeficiency</term>
                <term xml:lang="en">CD4+ count</term>
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              <classCode scheme="mesh">Adult</classCode>
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              <p>BACKGROUND: Human immunodeficiency virus (HIV)-infected patients are at higher risk of malignancies. In addition to traditional determinants, a specific deleterious effect of HIV and immunodeficiency is speculated. We aimed at studying the association between immunological and virological characteristics of HIV-infected patients in care and the risk of acquired immunodeficiency syndrome (AIDS)-defining and non-AIDS-defining malignancies. METHODS: Patients consecutively enrolled in the hospital-based Agence Nationale de Recherche sur le Sida (ANRS) CO3 Aquitaine Cohort were included if the duration of follow-up was &gt;3 months during the period 1998-2006. Multivariate modeling used an extended Cox proportional hazards model for time-dependent covariates and delayed entry. RESULTS: The 4194 patients included in the study developed 251 first malignancies during 22,389 person-years. A higher incidence of AIDS-defining malignancies (107 cases) was independently associated with (1) both longer and current exposures to a plasma HIV RNA level &gt;500 copies/mL (hazard ratio [HR], 1.27 per year [P&lt;.001] and 3.30 [P&lt;.001], respectively) and (2) both longer and current exposure to a CD4(+) cell count &lt;200 cells/mm(3) (HR, 1.36 per year [P&lt;.001] and 6.33 [P&lt;.001], respectively). A higher incidence of non-AIDS-defining malignancies (144 cases) was independently associated with longer and current exposure to a CD4(+) cell count &lt;500 cells/mm(3) (HR, 1.13 per year [P=.01] and 2.07 [P&lt;.001], respectively) and male sex (HR, 1.69; P=.02) but not with plasma HIV RNA level (P=.49 and P=.10 for cumulative and current exposures, respectively). CONCLUSIONS: Uncontrolled plasma HIV RNA level was independently associated with a higher likelihood of developing AIDS-defining malignancies, whereas immunosuppression was associated with a higher risk of developing any type of malignancies. Antiretroviral treatment should aim at reaching and maintaining a CD4(+) count &gt;500 cells/mm(3) to prevent the occurrence of malignancy, this should be integrated to malignancy-prevention policies.</p>
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              <addrLine>12 rue Dubernat 33400 Talence</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.chu-bordeaux.fr/</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-301274" status="VALID">
          <orgName>Groupe hospitalier Saint-André</orgName>
          <desc>
            <address>
              <country key="FR"/>
            </address>
          </desc>
        </org>
      </listOrg>
    </back>
  </text>
</TEI>