Is nelfinavir exposure associated with cancer incidence in HIV-positive individuals?

D.C. Boettiger, C.A. Sabin, A. Grulich, L. Ryom, F. Bonnet, P. Reiss, A.D. Monforte, O. Kirk, A. Phillips, M. Bower, G. Fätkenheuer, J.D. Lundgren, M. Law, Ferran Torres

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6 Citations (Scopus)

Abstract

Objective: Nelfinavir exhibits potent anticancer properties against a range of tumours. However, in 2006/2007, nelfinavir supplies were accidently contaminated with a carcinogen. This analysis investigated the association between nelfinavir use and cancer risk in HIV-positive persons. Design: Observational cohort study. Methods: D:A:D study data was analysed using Poisson regression models to examine associations between cancer incidence and cumulative nelfinavir exposure, current nelfinavir exposure, and exposure to nelfinavir between 1 July 2006-30 June 2007. Results: A total of 42 006 individuals (50% white, 73% male) contributed 303 005 person-years of follow-up between 1 January 2004 and 1 February 2014. At study enrolment, median age was 40 [interquartile range (IQR) 33-46] years and 8305 individuals had a history of nelfinavir use [median duration 1.7 (IQR 0.7-3.4) years]. During follow-up, nelfinavir was used by 2476 individuals for a median of 1.7 (IQR 0.7-3.8) years; 1063 were exposed to nelfinavir between 1 July 2006 and 30 June 2007. Overall, 2279 cancers were diagnosed at a rate of 0.75 [95% confidence interval (95% CI) 0.72-0.78] per 100 person-years. Neither greater cumulative exposure to nelfinavir [adjusted risk ratio (aRR) 0.93 for every additional 5 years, 95% CI 0.82-1.06, P = 0.26] nor current use of nelfinavir (aRR 0.98 vs other protease inhibitor use, 95% CI 0.68-1.41, P = 0.92) were associated with cancer risk. The adjusted risk of cancer for participants exposed to nelfinavir between 1 July 2006 and 30 June 2007 compared to those receiving other treatment over this period was 1.07 (95% CI 0.78-1.46, P = 0.68). Conclusion: Nelfinavir use was not associated with a lower cancer incidence than other protease inhibitor regimens. As of February 2014, exposure to the 2006/2007 contamination of nelfinavir does not appear to be associated with increased cancer incidence. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Original languageEnglish
Pages (from-to)1629-1637
Number of pages9
JournalAIDS (London, England)
Volume30
Issue number10
DOIs
Publication statusPublished - Jun 2016

Keywords

  • cancer
  • ethyl mesylate
  • HIV
  • Kaposi's sarcoma
  • nelfinavir
  • carcinogen
  • Human immunodeficiency virus proteinase inhibitor
  • adult
  • antiviral therapy
  • anus cancer
  • Article
  • bladder cancer
  • bone cancer
  • brain cancer
  • breast cancer
  • cancer incidence
  • cancer risk
  • cohort analysis
  • colon cancer
  • connective tissue tumor
  • drug exposure
  • esophagus cancer
  • female
  • follow up
  • gallbladder cancer
  • human
  • Human immunodeficiency virus infected patient
  • Human immunodeficiency virus infection
  • Kaposi sarcoma
  • kidney cancer
  • leukemia
  • lip cancer
  • lung cancer
  • major clinical study
  • male
  • malignant neoplastic disease
  • melanoma
  • multiple myeloma
  • nonhodgkin lymphoma
  • observational study
  • pancreas cancer
  • priority journal
  • prospective study
  • prostate cancer
  • rectum cancer
  • testis cancer
  • uterus cancer
  • virus load
  • chemically induced
  • complication
  • drug contamination
  • incidence
  • middle aged
  • neoplasm
  • risk assessment
  • Adult
  • Carcinogens
  • Cohort Studies
  • Drug Contamination
  • Female
  • HIV Infections
  • HIV Protease Inhibitors
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Nelfinavir
  • Neoplasms
  • Risk Assessment

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