The evolving face of HIV-infected patients with AIDS-defining and non-AIDS-defining malignancies: when immunosuppression is no longer a commonly seen feature.

Présentation au sujet: "The evolving face of HIV-infected patients with AIDS-defining and non-AIDS-defining malignancies: when immunosuppression is no longer a commonly seen feature."— Transcription de la présentation:

1 The evolving face of HIV-infected patients with AIDS-defining and non-AIDS-defining malignancies: when immunosuppression is no longer a commonly seen feature at cancer diagnosis. Sapha Barkati 1, N. Machouf 2, M.K. Charles 3, G. Genest 3, C. Fortin 1,6, B. Lemieux 4, B. Lessard 5,6, B. Trottier 2,6, D. Rouleau 1,6 1 Centre Hospitalier de l’Université de Montréal, Département de Microbiologie médicale et Infectiologie, Montréal, Québec, Canada 2 Clinique Médicale l’Actuel, Montréal, Québec, Canada 3 Université de Montréal, Montréal, Québec, Canada 4 Centre Hospitalier de l’Université de Montréal, Département d’Oncologie, Montréal, Québec, Canada 5 Clinique Médicale Quartier Latin, Montréal, Québec, Canada 6 UHRESS-CHUM, Montréal, Québec, Canada

2 Background  ↓ ADCs with ART.  NADCs now represent a much larger fraction of the overall cancers in HIV-infected patients.  We observed a change in immune status at the moment of cancer diagnosis over the years in our HIV-infected population. Methods  Retrospective study.  Medical charts review of HIV-infected patients diagnosed with cancer from 1984-2009.  Type of cancer, history of ART, CD4 cell count, viral load at cancer diagnosis recorded.  95 patients, 108 cancers.

3 0 100 200 300 400 500 600 0 2 4 6 8 1010 1212 ≤200020012002200320042005200620072008 2009 p=0.022 NHL H and N Kaposi Anus Lung Hodgkin Brain PCL CD4 cell count, number and type of cancer diagnosed in the study population over the years. 0,0 0,5 1,0 1,5 2,0 2,5 3,0 3,5 4,0 4,5 0 2 4 6 8 10 12 ≤2000200120022003200420052006200720082009 p=0.001 NHL Head and neck Kaposi Anus Lung Hodgkin Brain PCL HIV Viral load (log), number and type of cancer diagnosed in the study population over the years.

4 0 50 100 150 200 250 300 350 400 450 500 ≤ 2002 2003-2006 2007-2009 non-AIDS-defining cancers AIDS-defining cancers CD4 cell count at cancer diagnosis (cell/μl) p=0.033 p=0.018 CD4 cell count at cancer diagnosis over the study period stratified for type of cancer. Viral load at cancer diagnosis (log) 0 0,5 1 1,5 2 2,5 3 3,5 4 4,5 5 ≤ 20022003-20062007-2009 non-AIDS-defining cancers AIDS-defining cancers p=0.001 HIV Viral load (log) at cancer diagnosis over the study period stratified for type of cancer.

5 Conclusion  Cancer seems no longer a pre-morbid condition in HIV-infected patients that could eventually benefit the same anticancer treatment than the general population.  Nevertheless, cancer remains an important cause of morbidity and mortality in HIV-infected patients.  Importance of Active screening for HIV in population at risk. Primary prevention of cancer risk factors. Antiretroviral therapy use. Screening HIV-infected patients for cancer in agreement with established guidelines. A multidisciplinary team approach.

6 Acknowlegements Dre Danielle Rouleau Nimâ Machouf Marthe-K. Charles and Geneviève Genest Dr Claude Fortin Dr Bernard Lemieux Dr Bernard Lessard Dr Bernard Trottier