CD4+ cell count trends after common cancers in people with HIV: a multicohort collaboration.

OBJECTIVE

Whilst cancer is increasingly common in people with HIV, insight into immunological outcomes after cancer diagnosis (CaD) is limited. European guidelines recommend opportunistic infection prophylaxis (OIP) at CD4+ cell count of less than 200 cells/μl, and during chemotherapy/radiotherapy regardless of CD4+ cell count. We assessed CD4+ cell count trends and predictors of post-CaD immunosuppression across common cancers.

DESIGN

Participants from D:A:D and RESPOND with Kaposi's sarcoma, non-Hodgkin lymphoma (NHL), lung, anal or prostate cancer and at least two CD4+ cell count measurements at 6-12 months post-CaD were included.

METHODS

CD4+ cell count measurements were evaluated at 6-monthly intervals. Logistic regression models with generalized estimating equations assessed predictors of CD4+ cell count of less than 200 up to 3 years post-CaD.

RESULTS

Among 1670 individuals (9597 person-years of follow-up, median 5.3 years), 89% were men, median age was 51 years [interquartile range (IQR) 42-60] and CD4+ cell count of 400 cells/μl (288-590) at CaD. The highest proportion of participants with CD4+ cell count of less than 200 cells/μl was at time of CaD for Kaposi's sarcoma (36%), at 6 months post-CaD for NHL and anal cancer (40 and 30%), at 12 months post-CaD for lung (17%) and 18 months post-CaD for prostate cancer (7%). Higher CD4+ cell count at CaD was associated with lower odds of CD4+ cell count of less than 200 post-CaD [200-350: 0.12 (95% confidence interval 0.08-0.16); 350-500: 0.05 (0.03-0.07); >500: 0.02 (0.02-0.04), vs. <200]. Other predictors included disseminated disease, anal cancer, injection drug use as HIV acquisition mode and male gender/sex; age and calendar time were not predictive.

CONCLUSION

As post-CaD immunosuppression trends varied by several factors including cancer type, and CD4+ cell count at CaD, individualized use of opportunistic infection prophylaxis may be considered when regular CD4+ cell count monitoring is available.