Infections and cancer after ARV: a Portuguese cohort

Background and purpose of the study The advent of antiretroviral therapy (ARV) resulted in a significant decrease in opportunistic infections; however these diseases still represent an important cause of morbidity and mortality. ARV also changed the spectrum of cancers presented by HIV patients as a result of immune recovery and increased life expectancy. We intend to describe the variety of infections and cancers, AIDS or non‐AIDS related, identified in our patients in the new era of ARV and also identify possible risk factors related to this conditions. Methods Assessment and registry of infectious and neoplastic conditions occurring after initiation of ARV in a cohort of HIV‐infected patients who started ARV between January 2007 and December 2011. We included records of these conditions until March 2012. Epidemiological, clinical and laboratory data were analyzed and compared with a control group of HIV‐infected patients that started ARV in the same period but did not experience those comorbidities. Patients lost to follow‐up were excluded. Statistical significance of the differences encountered was evaluated with T‐student test and chi‐square; differences were considered statistically significant when p<0.05. Results 497 patients were included (71.0% were men) with a mean age of 43.4±12.5 years and average follow‐up of 30.9±16.8 months. In the analyzed period there were 112 events in 91 patients: 85 infections and 27 cancers. The most common infectious condition was tuberculosis (n=13) and the most common cancer was non‐Hodgkin's lymphoma (n=8). The interval between the introduction of ARV and the onset of these conditions was 15.1 months (min: 0.03, max: 57.40). We identified 22 deaths: 11 were result of infection and 11 from cancer. Statistically significant differences between the groups compared were identified in the following variables: risk factor for HIV infection, co‐infection with hepatitis B, clinical stage, viral load and CD4 T lymphocyte count before the beginning of ARV. Conclusions We identified a substantial number of infections and cancers in our cohort, with tuberculosis and lymphomas continuing to be particularly noteworthy. Patients who had these conditions initiated ART with more severe immunosuppression and higher viral load which reinforces the importance to establish a prompt diagnosis which enables an efficient treatment and low morbidity associated with infections and cancers, particularly those related to AIDS.