July 23, 2009

Cancer Rates Are Lower, but Still Present at Higher CD4 Levels

Cancer of all types is more likely when a person’s CD4 counts fall below 200; however, even people with CD4 counts up to 699 had a higher risk for non-AIDS-defining cancers (NADCs) than people with CD4s over 700. These results were presented at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town.

A number of recent studies have demonstrated that cancers, particularly NADCs, are occurring in HIV-positive people at higher rates than in their HIV-negative counterparts. This is particularly true of anal cancer and cancers of the head, neck and throat. Studies thus far, however, have not broken down the CD4 ranges of people at higher risk.

To determine the relationship between CD4 level and cancer risk, Nancy Crum-Cianflone, MD, from the Infectious Disease Clinical Research Program in Bethesda, Maryland, and her colleagues examined the medical records of 4,969 people living with HIV who were treated between 1984 and 2008. The average age of the patients at HIV diagnosis was 28, and most were male. Black and Caucasian participants both made up roughly 40 percent of the group.

Cancer occurred among 513 people. Among that group, 319 had AIDS-defining cancers—such as lymphoma and Kaposi’s sarcoma—while 194 people developed NADCs. The average CD4 count at around the time of cancer diagnosis was 70 for people with AIDS-related cancers and 443 for those with NADCs.

Looking primarily at the cases of NADCs, people with CD4 cell counts less than 200 had the highest cancer risk. Those with CD4 counts between 201 and 399 were also at an almost threefold increased risk. And those with even higher CD4 levels—between 400 and 699 CD4s—also had a higher risk of an NADC than people with 700 or more.

The authors conclude that even people with higher CD4s show an increased risk of NADCs and that efforts to maintain high CD4s should be considered for people with HIV.

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