1. Chemotherapy and/or radiotherapy may provoke significant declines in CD4 counts in HIV patients as compared to other treatments, which in turn are associated with increased mortality.
Evidence Rating Level: 2 (Good)
Treating cancer in patients with human immunodeficiency virus (HIV) infection can be problematic due to the immunosuppressive effects of certain cancer treatments. Pronounced periods of immunosuppression after various chemotherapy and radiotherapy regimens have been observed in HIV patients, but the impact of these periods on mortality remains unclear. In this prospective cohort study, data was collected on 196 patients with HIV who had an incident first cancer to compare the impact of cancer treatment with chemotherapy and/or radiotherapy versus surgery or other treatment on HIV RNA levels and CD4 counts. The researchers hypothesized that chemotherapy and/or radiotherapy would be associated with an increase in HIV RNA levels, a larger initial decline in CD4 count, a slower CD4 recovery, and higher mortality compared with surgery or other cancer treatments. At baseline, 68.9% of patients were male with a median age of 50 years at cancer treatment initiation (IQR 43 to 55 years), and 36.7% had no viral suppression. Most patients (60.2%) received chemotherapy and/or radiotherapy, and 11.7% were antiretroviral therapy (ART)-naïve at baseline. Researchers found that in patients with a baseline CD4 count of greater than 500 cells/ml, the initial decline in CD4 count associated with chemotherapy and/or radiotherapy (versus surgery or other treatment) was 203 cells/ml (95% CI 92 to 306), and in those with a baseline CD4 count of no greater than 350 cells/ml, the decline in CD4 count was attenuated by 158 cells/ml, resulting in a mean decline of 45 cells/ml (95% CI 31 to 276 cells/ml). Chemotherapy and/or radiotherapy was not found to be associated with increased HIV RNA levels; in fact, among those who were virally unsuppressed before cancer treatment, HIV RNA levels declined more in the chemotherapy and/or radiotherapy group than in the surgery or other treatment group (interaction estimate -0.53, 95% CI -1.09 to -0.02). Limitations of this study included the lack of data on cancer response. Overall, results from this study suggest that chemotherapy and/or radiotherapy may induce more substantial declines in CD4 counts than other therapies, which in turn may lead to increased mortality.
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