Integrase strand transfer inhibitor use and cancer incidence in a large cohort setting. Open Forum Infectious Diseases
Greenberg et al. on behalf of the RESPOND Study Group aimed to assess whether there is an association between integrase strand transfer inhibitors (INSTI) use and the incidence of cancer, among people with HIV (PWH) in real-life settings in the International Cohort Consortium of Infectious Diseases (RESPOND).
Participants were followed from baseline (latest of local cohort enrollment or January 1, 2012) until the earliest of first cancer, final follow-up, or December 31, 2019.
Of 29’340 individuals, 74% were male, 24% were antiretroviral treatment (ART)-naive, and median baseline age was 44 years (interquartile range [IQR], 36–51). Overall, 13’950 (48%) individuals started an INSTI during follow-up. During 160’657 person-years of follow-up ([PYFU] median 6.2; IQR, 3.9–7.5), there were 1’078 cancers (incidence rate [IR] 6.7/1000 PYFU; 95% confidence interval [CI], 6.3–7.1). The commonest cancers were non-Hodgkin lymphoma (n = 113), lung cancer (112), Kaposi’s sarcoma (106), and anal cancer (103). After adjusting for potential confounders, there was no association between cancer risk and INSTI exposure (≤6 months vs no exposure IR ratio: 1.15 [95% CI, 0.89–1.49], >6–12 months; 0.97 [95% CI, 0.71–1.32], >12–24 months; 0.84 [95% CI, 0.64– 1.11], >24–36 months; 1.10 [95% CI, 0.82–1.47], >36 months; 0.90 [95% CI, 0.65–1.26] [P= .60]). In ART-naive participants, cancer incidence decreased with increasing INSTI exposure, mainly driven by a decreasing incidence of acquired immune deficiency syndrome cancers; however, there was no association between INSTI exposure and cancer for those ART-experienced (interaction P <.0001).
In conclusion, there was no association between the risk of cancer and cumulative exposure to INSTIs among ART-experienced PWH. The risk of cancer decreased with increasing exposure to INSTIs among ART-naive individuals, which was mainly driven by a decreasing incidence of AIDS-defining cancers.