Risks of Opportunistic Infections in People Living with HIV with Cancers Treated with Chemotherapy

Introduction: We ascertained incidence of OIs in people living with HIV (PLHIV) with cancer undergoing chemotherapy with non-HIV comparators. Methods : We identified 2,106 PLHIV and 2,981 uninfected Veterans with cancer who received at least one dose of chemotherapy between 1996 and 2017 from the Veterans Aging Cohort Study. We ascertained incident OIs within six months of chemotherapy amongst zoster, cytomegalovirus, tuberculosis, Candida esophagitis, Pneumocystis jirovecii pneumonia (PCP), toxoplasmosis, Cryptococcosis, atypical Mycobacterium infection, Salmonella bacteremia, histoplasmosis, coccidioidomycosis, or progressive multifocal leukoencephalopathy. We used Poisson methods to calculate OI incidence rates by HIV status, stratifying for hematological and non-hematological tumors. We compared OI rates by HIV status, using inverse probability weights of HIV status, further adjusting for PCP prophylaxis. Results: We confirmed 106 OIs in 101 persons. Adjusted OI incidence rate ratios (IRR) indicated higher risk in PLHIV for all cancers (IRR 4·8; 95% confidence interval [CI]: 2·8-8·2), hematological cancers (IRR 8·2; 95% CI 2·4-27·3), and non-hematological cancers (IRR 3·9; 95% CI: 2·1-7·2). IRRs were not significantly higher in those with CD4>200 cells/mm 3 and viral load < 500 copies/mL (IRR 1·8; 95% CI: 0·9-3·2). All PCP cases (n=11) occurred in PLHIV, with two microbiologically unconfirmed cases among 1,467 PLHIV with non-hematological cancers, no PCP prophylaxis and CD4 counts >200/mm 3 . Conclusions : Veterans with HIV undergoing chemotherapy had higher rates of OIs than uninfected Veterans, particularly those with hematological cancers, but not in PLHIV with HIV controlled disease. Our study does not support systematic PCP prophylaxis in solid tumors in PLHIV with HIV controlled disease. In conclusion, our study showed increased risk of incident OIs in the 6 months following chemotherapy in PLHIV with hematological and non-hematological malignancies compared to uninfected veterans. A statistically significant increased risk did not persist in PLHIV with CD4 counts > 200/mm 3 and controlled viremia. Most OIs reported were esophagitis candida and herpes zoster. Our study does not support systematic PCP prophylaxis in solid tumors in PLHIV with CD4 > 200 cells/mm 3 and controlled viremia.