Integrase Strand Transfer Inhibitor Use and Cancer Incidence in a Large Cohort Setting

Lauren Greenberg*, Lene Ryom, Bastian Neesgaard, Jose M. Miró, Line Dahlerup Rasmussen, Robert Zangerle, Katharina Grabmeier-Pfistershammer, Huldrych F. Günthard, Katharina Kusejko, Colette Smith, Cristina Mussini, Marianna Menozzi, Ferdinand Wit, Marc Van Der Valk, Antonella D'Arminio Monforte, Stcrossed D.Sign©phane De Wit, Coca Necsoi, Annegret Pelchen-Matthews, Jens Lundgren, Lars PetersAntonella Castagna, Camilla Muccini, Jörg Janne Vehreschild, Christian Pradier, Andreu Bruguera Riera, Anders Sönnerborg, Kathy Petoumenos, Harmony Garges, Felipe Rogatto, Nikos Dedes, Loveleen Bansi-Matharu, Amanda Mocroft, RESPOND Study Group

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

5 Downloads (Pure)


Background: Limited data exist examining the association between incident cancer and cumulative integrase inhibitor (INSTI) exposure. Methods: Participants were followed from baseline (latest of local cohort enrollment or January 1, 2012) until the earliest of first cancer, final follow-up, or December 31, 2019. Negative binomial regression was used to assess associations between cancer incidence and time-updated cumulative INSTI exposure, lagged by 6 months. Results: Of 29 340 individuals, 74% were male, 24% were antiretroviral treatment (ART)-naive, and median baseline age was 44 years (interquartile range [IQR], 36-51). Overall, 13 950 (48%) individuals started an INSTI during follow-up. During 160 657 person-years of follow-up ([PYFU] median 6.2; IQR, 3.9-7.5), there were 1078 cancers (incidence rate [IR] 6.7/1000 PYFU; 95% confidence interval [CI], 6.3-7.1). The commonest cancers were non-Hodgkin lymphoma (n=113), lung cancer (112), Kaposi's sarcoma (106), and anal cancer (103). After adjusting for potential confounders, there was no association between cancer risk and INSTI exposure (≤6 months vs no exposure IR ratio: 1.15 [95% CI, 0.89-1.49], >6-12 months; 0.97 [95% CI, 0.71-1.32], >12-24 months; 0.84 [95% CI, 0.64-1.11], >24-36 months; 1.10 [95% CI, 0.82-1.47], >36 months; 0.90 [95% CI, 0.65-1.26] [P=.60]). In ART-naive participants, cancer incidence decreased with increasing INSTI exposure, mainly driven by a decreasing incidence of acquired immune deficiency syndrome cancers; however, there was no association between INSTI exposure and cancer for those ART-experienced (interaction P<.0001). Conclusions: Cancer incidence in each INSTI exposure group was similar, despite relatively wide CIs, providing reassuring early findings that increasing INSTI exposure is unlikely to be associated with an increased cancer risk, although longer follow-up is needed to confirm this finding.

Original languageEnglish
Article numberofac029
JournalOpen Forum Infectious Diseases
Issue number3
Number of pages11
Publication statusPublished - Mar 2022

Bibliographical note

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.


  • antiretroviral treatment
  • cancer
  • cohort
  • HIV
  • integrase inhibitors


Dive into the research topics of 'Integrase Strand Transfer Inhibitor Use and Cancer Incidence in a Large Cohort Setting'. Together they form a unique fingerprint.

Cite this