CD4 cell count is strongly associated with the risk of death from both AIDS-defining malignancies (ADM) and non-AIDS-defining malignancies (nADM). Non-AIDS events have become an important cause of mortality as individuals with HIV infection survive to older ages and have started to suffer from similar age-related diseases to the HIV-uninfected population.
Rate of death of nADM is higher than from ADM in all patients other than those with very low CD4 cell counts. Lung cancer is the most common fatal nADM, concordance with the high prevalence of smoking among the HIV-infected population.
Age is also a strong predictor of death from malignancies, suggesting that, at similar CD4 cell counts, older patients are at greater risk of dying from malignancy. This may be a consequence of the higher incidence of cancers in older individuals, as well as an increased likelihood of death in older individuals, irrespective of the cause. However, this may also reflect reduced immune system activity in the elderly. Interestingly, the HIV RNA level was only weakly associated with ADM mortality and was not independently associated with nADM mortality.
Non-AIDS-defining malignancies was related to combination antiretroviral (cART) exposure. The individuals taking effective cART are less likely to die from ADM and, as a result, may be more likely to die from nADM. In contrast, patients dying from ADM may be more likely to have stopped or never received cART.
(AIDS. 2008;22(16):2143-2153)
Rate of death of nADM is higher than from ADM in all patients other than those with very low CD4 cell counts. Lung cancer is the most common fatal nADM, concordance with the high prevalence of smoking among the HIV-infected population.
Age is also a strong predictor of death from malignancies, suggesting that, at similar CD4 cell counts, older patients are at greater risk of dying from malignancy. This may be a consequence of the higher incidence of cancers in older individuals, as well as an increased likelihood of death in older individuals, irrespective of the cause. However, this may also reflect reduced immune system activity in the elderly. Interestingly, the HIV RNA level was only weakly associated with ADM mortality and was not independently associated with nADM mortality.
Non-AIDS-defining malignancies was related to combination antiretroviral (cART) exposure. The individuals taking effective cART are less likely to die from ADM and, as a result, may be more likely to die from nADM. In contrast, patients dying from ADM may be more likely to have stopped or never received cART.
(AIDS. 2008;22(16):2143-2153)
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