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

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.

• Authors: David C Boettiger, Caroline A Sabin, Andrew Grulich, Lene Ryom, Fabrice Bonnet, Peter Reiss, Antonella d'arminio Monforte, Ole Kirk, Andrew Phillips, Mark Bower, Gerd Fätkenheuer, Jens D Lundgren, Matthew Law, Data collection on Adverse events of Anti-HIV Drugs (D:A:D) study group
• Journal: AIDS (London, England) (AIDS) Vol. 30 Issue 10 Pg. 1629-37 (06 19 2016) ISSN: 1473-5571 [Electronic] England
• PMID: 26854812 (Publication Type: Journal Article, Observational Study, Research Support, U.S. Gov't, P.H.S., Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Carcinogens
• HIV Protease Inhibitors
• Nelfinavir

Topics

• Adult
• Carcinogens (administration & dosage)
• Cohort Studies
• Drug Contamination
• Female
• HIV Infections (complications, drug therapy)
• HIV Protease Inhibitors (administration & dosage)
• Humans
• Incidence
• Male
• Middle Aged
• Nelfinavir (administration & dosage)
• Neoplasms (chemically induced, epidemiology)
• Risk Assessment