HIV Specialist - March 2021 - Cover3

CLINICAL RESEARCH

UPDATE

CAROLYN CHU, MD, MSC, AAHIVS

Incoming AAHIVM Chief Medical Officer

Pahwa S, Deeks S, Zou S et al. NIH Workshop on HIV-Associated
Comorbidities, Coinfections, and Complications: Summary and
Recommendation for Future Research. J Acquir Immune Defic Syndr. 2021
Jan 1;86(1):11-18. doi: 10.1097/QAI.0000000000002528.

Hessol NA et al. Risk of smoking-related cancers among women and men
living with and without HIV. AIDS. 2021 Jan 1; 35(1): 101-114. doi: 10.1097/
QAD.0000000000002717. PMID: 33048871.

Due to the effectiveness of antiretroviral therapy (ART) most persons
with HIV (PWH) are achieving normal lifespans but not normal or
healthy aging. A higher-than-expected rate of coinfections, comorbidities and complications (CCC) which are worsened by stigma, poverty,
and isolation have been found in PWH. To address the research needs
for HIV-associated CCC, the NIH brought together 96 medical experts
and community advocates. From this group of individuals, five working
groups (WG) participated in a year-long process of assessing the " state of
the art " regarding numerous aspects of HIV care. It was the responsibility of the WGs to select three to five priority topics for presentation and
discussion. The NIH then held a two day CCC workshop (HIV ACTION)
that included over 400 participants. The format included general and
individual WG presentations and discussions. Priority lists of vital
research issues were presented by the co-chairs of each WG. The NIH
planning committee identified six key areas of research: epidemiology
and population including aging with HIV; pathogenesis and basic science
that includes immunopathogenesis; clinical research that includes
comorbidity management; implementation science; syndemics research
including HIV-infectious syndemics; and international research in lowand middle-income countries that consist of research needs and curricular training in HIV/AIDS comorbidities. Going forward, the participants
in the HIV workshop emphasized the need for " collaborative efforts of
many disciplines " to implement this ambitious research agenda needed
to improve the health and wellbeing for persons with HIV.

Non-AIDS defining cancers remain a common cause of morbidity
and mortality among persons with HIV, and high rates of established
risk factors (e.g., tobacco use, oncogenic viral co-infection) have been
described among PWH. This study examined data collected through
September 2019 from two large, well-characterized U.S. cohorts
(Women's Interagency HIV Study and Multicenter AIDS Cohort
Study) to determine whether the effect of smoking on incidence of
smoking-related cancers differed by HIV status, if sex modifies impact of risk factors for smoking-related cancers, and the sex-specific
attributable risk of smoking. A unique feature of this analysis was
availability of information for a highly-similar but HIV-seronegative
comparison group. Incidence rates, relative risks, and adjusted
population attributable fractions were calculated based on data from
4,423 WIHS and 6,789 MACS participants (representing over 139,500
person-years of follow-up). Investigators observed 214 smoking-related incident cancers among MACS participants and 192 among
WIHS participants, with the majority involving the lung/bronchus
and diagnosed in the modern ART era (defined as 2001-2018). Ageadjusted incidence rates were significantly higher among PWH
than seronegative participants, and were also higher among women
versus men. Further, adjusted interaction models demonstrated that
effects of cumulative pack-years were significantly stronger in women. Authors estimated that 31 percent of all smoking-related cancers
were attributed to smoking more than 5 pack-years in a lifetime
among PWH. 

DR. JEFFREY KIRCHNER COMMENTARY:

DR. CAROLYN CHU'S COMMENTARY:

As this is my last Clinical Research Update for the Academy, I thought it
was appropriate to highlight this article. Even though the workshop convened over one year ago this paper will be published in the January 2021
issue of AIDS. Despite the remarkable effectiveness of ART over the
past 20 years, there is still a great deal regarding chronic HIV infection
that we do not know. Until there is a cure or an effective vaccine, there
remains significant work that must be done by the HIV research and
clinical care communities and should include issues relevant to PWH in
the developed and developing world. This article from JAIDS contains
the streamlined list and a summary of WG discussions to inform investigators of current research priorities in the field of HIV medicine. 

This is one of the largest studies examining the contribution of
smoking on cancer burden among PWH, and its findings reaffirm
our understanding that HIV appears to be an independent risk factor
for smoking-related cancer development. The observation of higher
incidence rates among women with HIV compared to men with HIV
warrants further investigation. Among PWH, current motivations to
quit smoking may be very different from historical ones; pandemic-related stress has also led to increased smoking for some. Tobacco
use screening and evidence-based treatment strategies for smoking
cessation are among the most impactful health interventions HIV
providers can offer. HIV
HIV Specialist - March 2021

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