Earlier Initiation of Treatment Following HIV Acquisition Reduces Non-AIDS-defining Malignancy Risk

Area of Science:

• Clinical Medicine
• Infectious Diseases
• Oncology

Background:

• Starting antiretroviral treatment (ART) at higher CD4 cell counts is linked to a decreased risk of non-AIDS-defining malignancies (NADM).
• The impact of initiating ART within one year of HIV acquisition on NADM risk requires further investigation, particularly when considering socio-economic status (SES).

Purpose of the Study:

• To determine if initiating ART within one year of HIV acquisition reduces the risk of NADM.
• To assess the influence of socio-economic status (SES) on the relationship between early ART initiation and NADM risk.

Main Methods:

• A cohort study of 19,823 individuals diagnosed with HIV-1 between 2000-2022 was conducted.
• Participants were categorized into 'early-ART' (<365 days from diagnosis) and 'late-ART' groups.
• Hazard Ratios (HR) for NADM were calculated using Cox regression, adjusting for confounders including SES.

Main Results:

• Early ART initiators (n=1,858) were younger and had higher nadir CD4 counts compared to late ART starters (n=17,965).
• Early ART initiation was associated with a reduced risk of any NADM (HR=0.60) and infection-unrelated NADM (HR=0.60).
• The association between early ART and reduced NADM risk remained consistent after adjusting for SES.

Conclusions:

• Initiating ART within one year of HIV acquisition is associated with a significantly reduced risk of non-AIDS-defining malignancies.
• Early ART initiation is a key strategy for mitigating long-term health risks in individuals living with HIV.