Scientific Publications Database
Article Title: The Effect of MSM and CD4+Count on the Development of Cancer AIDS (AIDS-defining Cancer) and Non-cancer AIDS in the HAART EraAuthors: Mondal, Prosanta; Lim, Hyun J.; Kroch, Abigail; Rachlis, Beth; Burchell, Ann; Gough, Kevin; Cohen, Jeffrey; Cooper, Curtis; Kilby, Don; Crouzat, Fred; Loutfy, Mona; Rachlis, Anita; Andany, Nisha; Mittmann, Nicole; Salit, Irving; Silverman, Michael; Sandre, Roger; Lindsay, Joanne; Betts, Adrian; Bowman, Les; Conway, Tracey; McCallum, Mark; McTavish, John; Price, Colleen; Thein, Rosie; Kendall, Claire; Bertozzi, Breklyn; Rueda, Sergio; Adam, Barry; Brennan, David; Hart, Trevor; O'Brien, Kelly
Journal: CURRENT HIV RESEARCH Volume 16 Issue 4
Date of Publication:2018
Abstract:
Background: The HIV epidemic is increasing among Men who have Sex with Men (MSM) and the risk for AIDS defining cancer (ADC) is higher among them.Objective: To examine the effect of MSM and CD4+ count on time to cancer AIDS (ADC) and noncancer AIDS in competing risks setting in the HAART era.Method: Using Ontario HIV Treatment Network Cohort Study data, HIV-positive adults diagnosed between January 1997 and October 2012 having baseline CD4+ counts <= 500 cells/mm(3) were evaluated. Two survival outcomes, cancer AIDS and non-cancer AIDS, were treated as competing risks. Kaplan-Meier analysis, Cox cause-specific hazards (CSH) model and joint modeling of longitudinal and survival outcomes were used.Results: Among the 822 participants, 657 (79.9%) were males; 686 (83.5%) received anti-retroviral (ARV) ever. Regarding risk category, the majority (58.5%) were men who have Sex with men (MSM). Mean age was 37.4 years (SD = 10.3). In the multivariate Cox CSH models, MSM were not associated with cancer AIDS but with non-cancer AIDS [HR = 2.92; P = 0.055, HR = 0.54; P = 0.0009, respectively]. However, in joint models of longitudinal and survival outcomes, MSM were associated with cancer AIDS but not with non-cancer AIDS [HR = 3.86; P = 0.013, HR = 0.73; P = 0.10]. CD4+ count, age, ARV ever were associated with both events in the joint models.Conclusion: This study demonstrates the importance of considering competing risks, and time-dependent biomarker in the survival model. MSM have higher hazard for cancer AIDS. CD4+ count is associated with both survival outcomes.