Recent papers from the Swiss HIV Cohort Study newsletter

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Cessation of cigarette smoking and cancer in HIV

An analysis by Shepherd et al from the D:A:D study showing that the overall risk of cancer in HIV positive people who stop smoking, including for some smoking-related cancers, returns to levels seen in non-smokers 1-2 years after quitting. During the first year, the risks for these outcomes were approximately 60% and 200% higher, respectively.

The risk of lung cancer however, not only remained considerably elevated during the first year after quitting (approximately 20-fold compared to never smokers), but continued to be 8-fold higher over the next five years.

These results, just published in Clinical Infectious Diseases, emphasise the huge impact on better health that stopping smoking can have for HIV positive people.

The epidemiology of adolescents living with perinatally acquired HIV

A paper by Slogrove et al from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) collaboration, published in PLoS Medicine (with free open access), describing the experiences of 38,000 HIV positive children who became positive during pregnancy, at birth or from breastfeeding.

This is an international study combining results from 12 cohort studies from 1982 – 2014 looking at characteristics after 10 years as children entered into adolescence.

In addition to describing the characteristics in each cohort, the analysis compared differences in important clinical outcomes by geographic region.

Compared to children in low- or middle-income countries, children in high-income countries started treatment at a younger age, had higher CD4%, less impaired growth and lower mortality.

Loss to follow-up during the study was lowest in South America and the Caribbean and highest in sub-Saharan Africa.

Inhibiting natural killer cells in AIDS

A large international collaboration looking at genetics and HIV, and reporting links between HLA-A expression levels and HIV control. This complex analysis by Ramsuran et al reported independent and significant associations with higher viral load in each ethnicity group and in both acute and chronic infection.

HLA-A expression levels were also independently associated with likelihood of being an HIV controller or non-controller and with CD4 counts in participants with longitudinal data.

This proposed pathway included increased NKG2A- mediated NK (and/or T cell) inhibition, and impaired elimination of HIV-infected target cells, suggesting anti-NKG2A therapy as a potential target in cure-related studies.

Comorbidities in people living with HIV

An analysis by Pelchen-Matthews et al from the EuroSIDA cohort published in the journal AIDS looking at the prevalence of serious comorbidities at two timepoints as the HIV population ages. This involved nearly 10,000 participants from 2006 and nearly 13,000 participants from 2014.

Median age was higher (48 vs 43 years), with higher rates of hypertension (60% vs 47%), diabetes (6.3% vs 5.4%), chronic kidney disease (CKD) (6.9 vs 4.1%) and cardiovascular disease (CVD) (5.9 vs 3.7%), all 2006 vs 2014 respectively.

The higher odds of CKD and CVD in the 2014 cohort was explained in the multivariate analysis by age, comorbidities and other related factors, highlighting the importance of management strategies for the ageing HIV populations in Europe.