People with HIV who maintain or regain an adequate CD4 T-cell count on antiretroviral treatment are less likely to develop cancer, according to a recent study. Cancer is a growing concern as the HIV population ages. It is well known that people with advanced immune deficiency have an elevated risk for AIDS-defining malignancies, but even less severe impairment can reduce the immune system’s ability to fight cancer.

 

Win Min Han, MD, PhD, of the University of New South Wales, and colleagues assessed the impact of CD4 cell recovery on cancer incidence among more than 48,000 adults in Europe and Australia who had viral suppression on antiretrovirals for at least two years. A total of 1,933 participants (3.9%) were newly diagnosed with cancer over a median six years of follow-up. These included 258 AIDS-defining cancers and 1,675 non-AIDS malignancies. About a third were infection-related, such as anal cancer caused by human papillomavirus or liver cancer caused by hepatitis B or C. The most common types were lung cancer, anal cancer, prostate cancer, non-Hodgkin lymphoma and breast cancer. A higher recent CD4 count and larger CD4 cell gains after starting antiretrovirals were associated with reduced cancer risk, regardless of how low the count had fallen before starting treatment. This effect was especially strong for infection-related cancers.

 

These findings confirm that starting antiretroviral treatment early, before immune function declines, leads to better outcomes. “This highlights the critical importance of diagnosing HIV at the earliest opportunity, promptly initiating antiretroviral therapy to ensure optimal immune recovery and sustained cancer risk reduction and ensuring people with poor immune recovery despite effective antiretroviral therapy undergo appropriate cancer screening strategies,” the study authors wrote.