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Document 2381
DOCN M94A2381
TI Malignant outcomes from a cross-study analysis of patients participating
in a community-based clinical trials program. Community Programs for
Clinical Research on AIDS (CPCRA), NIAID, NIH.
DT 9412
AU Abrams DI; Wentworth DR; Neaton JD; Sherer R; Deyton L; San Francisco
General Hospital, CA 94110.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):317 (abstract no. PC0199). Unique
Identifier : AIDSLINE ICA10/94370194
AB PURPOSE: To identify predictors of malignancies in a large cohort of
patients enrolled in studies sponsored by the Terry Beirn Community
Programs for Clinical Research on AIDS (CPCRA) and to describe the
survival experience of those who develop AIDS-related malignancies.
METHODS: Cross-study data collected using standardized procedures by 17
centers were the basis for this investigation. Between September 1990
and September 1993, 3,705 patients with a baseline CD4+ T lymphocyte
count (CD4) < 500 cells/mm3 were enrolled in one or more of 11 studies
sponsored by the CPCRA. Predictors of mucocutaneous Kaposi's sarcoma
(MKS), visceral KS (VKS), and lymphoma were investigated using
proportional hazards regression. Cumulative incidence and mortality
following one of these events was estimated using the Kaplan-Meier
method. RESULTS: 15% of the 3,705 patients studied were women; 34% were
black and 13% were Latino. Approximately 29% had a history of injecting
drug use (IDU). Most men (75%) reported homosexual activity. Average
CD4+ was 153 cells/mm3. A history of MKS was found in 196 patients
(5.3%) at entry; 15 (0.4%) had a history of VKS; 16 (0.4%) had a history
of lymphoma. Each of these malignancies occurred rarely in the 565 women
under followup. Two women developed MKS during the followup, none VKS,
and 3 lymphoma. Cervical malignancies were also rare (2 women). In
contrast, among the 2950 men followed, one year incidence was 4.5% for
MKS, 1.4% for VKS, and 1.6% for lymphoma. Among men incidence varied
significantly by CD4 count (p < 0.001). For those with baseline CD4+ <
50 cells/mm3 one year cumulative incidence was 8.3% for MKS, 3.4% for
VKS, and 3.9% for lymphoma. For those with baseline CD4 count 50-99,
corresponding percents were 6.8, 2.2, and 1.9%. Above 100 cells/mm3, VKS
and lymphoma occurred in less than 1% of patients. For MKS, one year
incidence was 4.7% for those with baseline CD4 count 100-199, 1.4% for
those with CD4 200-299, and less than 1% for those with 300+ cells/mm3.
Homosexual activity was also associated with an increased risk for MKS
(RR = 4.5, p = 0.001) and VKS (RR = 5.3, p = 0.12). Age, IDU and race
were not associated with MKS, VKS or lymphoma after adjustment for CD4
count. Mortality following the development of these malignancies was
high-at one year it was 40.3% for MKS, 68.4% for VKS, and 84.1% for
lymphoma. CONCLUSIONS: Risk of AIDS-related malignancies increase with
declining CD4 count; malignancies occur rarely in women and at similar
rates among ethnic groups. Prognosis following malignant disease is
poor.
DE Acquired Immunodeficiency Syndrome/*COMPLICATIONS/IMMUNOLOGY Cervix
Neoplasms/COMPLICATIONS Female Human Leukocyte Count Lymphoma,
AIDS-Related/*EPIDEMIOLOGY Male Risk Factors Sarcoma,
Kaposi's/*EPIDEMIOLOGY/ETIOLOGY Sex Behavior Substance Abuse,
Intravenous/COMPLICATIONS T4 Lymphocytes MEETING ABSTRACT MULTICENTER
STUDY
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).