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1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.

BACKGROUND: PLWHIV and cancer have an increased risk of mortality. Previous studies show that a 100 cells/mm(3) drop in CD4+ T cells following chemotherapy increases the risk of mortality by up to 30%. In Mexico almost 40% of patients have a late diagnosis. The aim of this study is to measure the mo...

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Autores principales: Olmedo-Reneaum, Alejandro, VOLKOW-FERNÁNDEZ, P A T R I C I A, MARTÍNEZ-RIVERA, N A N C Y, MENDOZA-PALACIOS, M A R ÍA J O S É, ISLAS-MUÑOZ, B E D A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678980/
http://dx.doi.org/10.1093/ofid/ofad500.1324
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author Olmedo-Reneaum, Alejandro
VOLKOW-FERNÁNDEZ, P A T R I C I A
MARTÍNEZ-RIVERA, N A N C Y
MENDOZA-PALACIOS, M A R ÍA J O S É
ISLAS-MUÑOZ, B E D A
author_facet Olmedo-Reneaum, Alejandro
VOLKOW-FERNÁNDEZ, P A T R I C I A
MARTÍNEZ-RIVERA, N A N C Y
MENDOZA-PALACIOS, M A R ÍA J O S É
ISLAS-MUÑOZ, B E D A
author_sort Olmedo-Reneaum, Alejandro
collection PubMed
description BACKGROUND: PLWHIV and cancer have an increased risk of mortality. Previous studies show that a 100 cells/mm(3) drop in CD4+ T cells following chemotherapy increases the risk of mortality by up to 30%. In Mexico almost 40% of patients have a late diagnosis. The aim of this study is to measure the mortality association between the CD4+ T cell count nadir in PLWHIV and cancer. METHODS: We conducted a retrospective study involving PLWHIV and cancer ≥18 yo treated at the cancer and AIDS clinic of the Instituto Nacional de Cancerología in México City from January 01, 2005, to December 31, 2015, that received chemotherapy, immunotherapy, radiotherapy and/or oncologic surgery. The baseline CD4+ T cell count, nadir during treatment, first CD4+ T cell count after treatment, one year and five years after the end of oncologic treatment were evaluated. A logistic regression (LR) model was performed considering CD4+ T cell count at baseline, nadir during oncologic treatment and the association with all-cause mortality. Institutional Review Board (IRB) of INCan approved the study (Ref/INCAN/CI/0049/2022). RESULTS: A total of 445 patients were included, median of nadir CD4+ T cell count was 122 cells/µL (IQR 48-232), 147 (32.89%) had baseline CD4+ T cell ≤100 cells/µL. Kaposi Sarcoma (46%) and non-Hodgkin lymphoma (27%) were the most frequent diagnosis. One-year mortality occurred in 72 patients (16%), from them, the cause of death was cancer in 54 (75%). Descriptive analysis by mean difference showed significant difference in CD4+ T cell count between patients who died vs. those who survived 117.7 vs 175.4 (p=0.01). In the LR model, a significant association was found between stage IV of cancer and higher mortality at 1 year (OR 2.39; CI 1.27- 4.52) and at 5 years (OR 2.21; CI 1.21-4.02). At five years, mortality was higher in patients with a second AIDS defining event (OR 2.17; CI 1.12-4.17). At one year after completed cancer treatment having a CD4+ T cell nadir >200 cells/ µL was associated with lower mortality (OR 0.29; CI 0.08 – 0.92). CONCLUSION: This study found that having other AIDS defining events and advanced neoplastic disease was associated with higher mortality; while having a nadir ≥200 cd4+ cells/ml showed lower mortality after one year of treatment. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-106789802023-11-27 1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period. Olmedo-Reneaum, Alejandro VOLKOW-FERNÁNDEZ, P A T R I C I A MARTÍNEZ-RIVERA, N A N C Y MENDOZA-PALACIOS, M A R ÍA J O S É ISLAS-MUÑOZ, B E D A Open Forum Infect Dis Abstract BACKGROUND: PLWHIV and cancer have an increased risk of mortality. Previous studies show that a 100 cells/mm(3) drop in CD4+ T cells following chemotherapy increases the risk of mortality by up to 30%. In Mexico almost 40% of patients have a late diagnosis. The aim of this study is to measure the mortality association between the CD4+ T cell count nadir in PLWHIV and cancer. METHODS: We conducted a retrospective study involving PLWHIV and cancer ≥18 yo treated at the cancer and AIDS clinic of the Instituto Nacional de Cancerología in México City from January 01, 2005, to December 31, 2015, that received chemotherapy, immunotherapy, radiotherapy and/or oncologic surgery. The baseline CD4+ T cell count, nadir during treatment, first CD4+ T cell count after treatment, one year and five years after the end of oncologic treatment were evaluated. A logistic regression (LR) model was performed considering CD4+ T cell count at baseline, nadir during oncologic treatment and the association with all-cause mortality. Institutional Review Board (IRB) of INCan approved the study (Ref/INCAN/CI/0049/2022). RESULTS: A total of 445 patients were included, median of nadir CD4+ T cell count was 122 cells/µL (IQR 48-232), 147 (32.89%) had baseline CD4+ T cell ≤100 cells/µL. Kaposi Sarcoma (46%) and non-Hodgkin lymphoma (27%) were the most frequent diagnosis. One-year mortality occurred in 72 patients (16%), from them, the cause of death was cancer in 54 (75%). Descriptive analysis by mean difference showed significant difference in CD4+ T cell count between patients who died vs. those who survived 117.7 vs 175.4 (p=0.01). In the LR model, a significant association was found between stage IV of cancer and higher mortality at 1 year (OR 2.39; CI 1.27- 4.52) and at 5 years (OR 2.21; CI 1.21-4.02). At five years, mortality was higher in patients with a second AIDS defining event (OR 2.17; CI 1.12-4.17). At one year after completed cancer treatment having a CD4+ T cell nadir >200 cells/ µL was associated with lower mortality (OR 0.29; CI 0.08 – 0.92). CONCLUSION: This study found that having other AIDS defining events and advanced neoplastic disease was associated with higher mortality; while having a nadir ≥200 cd4+ cells/ml showed lower mortality after one year of treatment. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2023-11-27 /pmc/articles/PMC10678980/ http://dx.doi.org/10.1093/ofid/ofad500.1324 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Olmedo-Reneaum, Alejandro
VOLKOW-FERNÁNDEZ, P A T R I C I A
MARTÍNEZ-RIVERA, N A N C Y
MENDOZA-PALACIOS, M A R ÍA J O S É
ISLAS-MUÑOZ, B E D A
1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.
title 1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.
title_full 1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.
title_fullStr 1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.
title_full_unstemmed 1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.
title_short 1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.
title_sort 1489. cd4+ t cell count and associated mortality in plwhiv and cancer at an oncologic center in mexico over a 10-year period.
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678980/
http://dx.doi.org/10.1093/ofid/ofad500.1324
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