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Background ↓ ADCs with ART.

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.

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Background ↓ ADCs with ART.

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  1. The evolving face of HIV-infected patients with AIDS-defining andnon-AIDS-defining malignancies: when immunosuppression is nolonger a commonly seen feature at cancer diagnosis. Sapha Barkati1, N. Machouf2, M.K. Charles3, G. Genest3, C. Fortin1,6, B. Lemieux4, B. Lessard5,6, B. Trottier2,6, D. Rouleau1,6 1 Centre Hospitalier de l’Université de Montréal, Département de Microbiologie médicale et Infectiologie, Montréal, Québec, Canada 2Clinique Médicale l’Actuel, Montréal, Québec, Canada 3Université de Montréal, Montréal, Québec, Canada 4Centre Hospitalier de l’Université de Montréal, Département d’Oncologie, Montréal, Québec, Canada 5Clinique Médicale Quartier Latin, Montréal, Québec, Canada 6UHRESS-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. CD4 cell count, number and type of cancer diagnosed in the study population over the years. 4,5 600 4,0 12 p=0.022 12 NHL 500 3,5 H and N 10 Kaposi 10 NHL 3,0 Anus 400 p=0.001 Head and neck Lung 8 8 Kaposi Hodgkin 2,5 Anus Brain 300 HIV Viral load (log), number and type of cancer diagnosed in the study population over the years. Lung PCL 2,0 6 6 Hodgkin Brain 200 1,5 PCL 4 4 1,0 100 2 2 0,5 0 0 0,0 0 ≤2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 ≤2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

  4. 500 p=0.018 450 400 350 p=0.033 300 CD4 cell count at cancer diagnosis (cell/μl) 250 200 150 non-AIDS-defining cancers 100 AIDS-defining cancers 50 0 ≤ 2002 2007-2009 2003-2006 HIV Viral load (log) at cancer diagnosis over the study period stratified for type of cancer. 5 4,5 4 3,5 3 p=0.001 Viral load at cancer diagnosis (log) 2,5 p=0.001 2 1,5 non-AIDS-defining cancers 1 AIDS-defining cancers 0,5 0 ≤ 2002 2003-2006 2007-2009 CD4 cell count 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. • Antiretroviraltherapy use. • Screening HIV-infected patients for cancer in agreement with established guidelines. • A multidisciplinary team approach.

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

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