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Abstract
The impact of nelfinavir on cancer development among HIV-infected persons
N. Crum-Cianflone1, K. Huppler Hullsiek2, A. Ganesan3, A. Weintrob4, V. Marconi5, S. Fraser6, M. Roediger2, V. Barthel7, B. Agan5, S. Wegner8, Infectious Disease Clinical Research Program/TriService AIDS Clinical Consortium at the Uniformed Services University of the Health Sciences
Background: Data has suggested that protease inhibitors (PIs) such as nelfinavir mesylate (NFV) may inhibit the activation of Akt, a protein implicated in cancer development. However, the true impact of NFV and other PIs on inhibiting cancer development in humans remains unknown. We evaluated a large HIV cohort to study the association of NFV and cancer incidence.
Methods: Subjects with 15,196 person-years (PYs) of follow-up as part of a prospective HIV Natural History Study were evaluated for cancer. Cancers were classified as AIDS-defining (ADC) or non-AIDS-defining (NADC). Proportions were compared using Chi-square tests. Univariate Cox regression models with a time-updated indicator for receipt of NFV were used to evaluate the potential association of NFV and cancer. Hazard ratios (HR) and rates (per 1000 PY) are given with 95% CI. Analyses were repeated for receipt of indinavir (IDV).
Results: 826 (33%) of 2,499 patients received NFV; there were 108 cancer events (39 ADCs and 69 NADCs). Of those with cancer, 41% had received NFV compared to 34% without cancer (p=0.08). There were no significant differences in cancer rates between those who received and those who did not receive NFV: 8.2 (5.8, 10.6) vs. 6.5 (4.9, 8.1) for all cancers; 2.9 (1.5, 4.4) vs. 2.3 (1.4, 3.3) for ADCs; and 5.2 (3.2, 7.1) vs. 4.2 (2.9, 5.4) for NADCs. Using Cox regression models, NFV was not associated with protection against cancer: HR=1.3 (95% CI 0.6 - 2.8). The receipt of IDV (n=828 patients) was also not associated with lower cancer rates.
Conclusions: Despite reports that NFV may inhibit cancer development, we found no relationship between NFV use and overall cancer rates among HIV-infected persons. Further studies using large registries and clinical trials are needed to provide additional data on the potential impact of nelfinavir on cancer development among HIV-infected persons.
AIDS 2008 - XVII International AIDS Conference
Abstract no.
THPE0232
Suggested Citation
"N.Crum-Cianflone, et al.
The impact of nelfinavir on cancer development among HIV-infected persons.
:
AIDS 2008 - XVII International AIDS Conference:
Abstract no.
THPE0232"
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