Non-AIDS cancer risk drops considerably when ART is initiated within a year of HIV acquisition

People living with HIV are roughly 40% less likely to develop a non-AIDS-defining malignancy if they start antiretroviral therapy within one year of acquiring HIV, according to new results from a large study conducted in the Netherlands. While we’ve long understood the long-term health benefits of relatively prompt ART initiation, this study makes the scale of that impact even more clear.

Highlighted Study Population and Methods

This study utilized data from the Dutch national ATHENA observational HIV cohort. The analysis focused on adults with HIV-1 who initiated antiretroviral therapy (ART) between 2000 and 2022. Inclusion criteria included no history of non-AIDS-defining malignancy (NADM) prior to the study and at least six months of follow-up data available.

Two groups were defined based on the timing of antiretroviral therapy initiation:

• Early ART initiators: Individuals who began ART within 365 days of a negative HIV test or primary HIV infection (n = 1,858).

• Late ART starters: Individuals who began ART 365 days or more after HIV infection (n = 17,965).

At baseline, early ART initiators tended to be younger, with a median age of 34.8 years compared to 39 years for late starters. Additionally, early initiators had higher nadir CD4 counts, with a median of 478 cells/µL versus 260 cells/µL among late starters.

This analysis examined the impact of antiretroviral therapy initiation timing on incident non-AIDS-defining malignancies. The main outcome was the incidence of NADM, which was further categorized as infection-related (e.g., due to human papillomavirus) or infection-unrelated.

Cox proportional hazards regression was used to estimate hazard ratios for incident NADM. The models adjusted for multiple factors, including age, sex at birth, smoking status, alcohol use, calendar time, HIV transmission route, region of origin, nadir CD4 count, cumulative HIV-1 viral copy-years, and socioeconomic status (SES), with SES data obtained from Statistics Netherlands.

Key Findings

NADM incidence rates:

• Early ART group: 2.22 per 1,000 person-years (95% CI: 1.50–3.28)

• Late ART group: 4.87 per 1,000 person-years (95% CI: 4.56–5.21)

Risk reduction with early ART:

• Any NADM: adjusted hazard ratio (HR) = 0.60 (95% CI: 0.40–0.91)

• Infection-unrelated NADM: HR = 0.60 (95% CI: 0.37–0.98)

• Infection-related NADM: HR = 0.58 (95% CI: 0.27–1.28; not statistically significant)

• BMI-related NADM: HR = 1.45 (95% CI: 0.73–2.89; not statistically significant)

• Smoking-related NADM: HR = 0.76 (95% CI: 0.41–1.41; not statistically significant)

Socioeconomic status (SES) analysis: Minimal impact on hazard ratios.

Read an expert analysis from Benjamin Young, M.D., Ph.D. at TheBodyPro.