Table 4.
Cumulative and Nadir/Peak CD4 Count and Human Immunodeficiency Virus RNA Level Measures During Moving Time Windows and Anal Cancer Risk, North American AIDS Cohort Collaboration on Research and Design, 1996–2014
| Measurea | Moving Time Window | |||||
|---|---|---|---|---|---|---|
| Early | Late | Overall | ||||
| (3060 to 1620 d in the Past) | (1620 to 180 d in the Past) | (3060 to 180 d in the Past) | ||||
| Anal Cancer Cases | HR (95% CI) | Anal Cancer Cases | HR (95% CI) | Anal Cancer Cases | HR (95% CI) | |
| CD4 count average, cells/µL | ||||||
| <50 | 10 | 12.2 (6.0, 24.8) | 15 | 7.6 (4.3, 13.3) | 8 | 20.7 (9.5, 45.0) |
| 50 to <100 | 18 | 9.1 (5.1, 16.2) | 24 | 5.4 (3.4, 8.6) | 14 | 9.3 (5.0, 17.3) |
| 100 to <200 | 28 | 3.7 (2.2, 6.1) | 60 | 3.8 (2.7, 5.3) | 30 | 4.4 (2.7, 7.2) |
| 200 to <350 | 43 | 2.4 (1.5, 3.7) | 74 | 2.0 (1.5, 2.8) | 45 | 2.7 (1.7, 4.1) |
| 350 to <500 | 36 | 1.7 (1.1, 2.7) | 66 | 1.5 (1.1, 2.0) | 35 | 1.6 (1.0, 2.6) |
| ≥500 | 35 | 1.0 (ref) | 81 | 1.0 (ref) | 38 | 1.0 (ref) |
| Per 50 cells/µLb | … | 0.86 (0.83, 0.90) | … | 0.88 (0.86, 0.91) | … | 0.86 (0.83, 0.89) |
| Global P value (AIC)c | … | <.0001 (2577) | … | <.0001 (2594) | … | <.0001 (2569) |
| Proportion of time CD4 count <200 cells/µL | ||||||
| 0.00 | 73 | 1.0 (ref) | 148 | 1.0 (ref) | 61 | 1.0 (ref) |
| >0.00 to 0.25 | 29 | 2.1 (1.4, 3.3) | 44 | 1.7 (1.2, 2.5) | 36 | 1.8 (1.2, 2.7) |
| >0.25 to 0.50 | 12 | 2.1 (1.1, 3.8) | 24 | 2.3 (1.5, 3.5) | 19 | 2.7 (1.6, 4.6) |
| >0.50 to 0.75 | 10 | 2.2 (1.2, 4.3) | 26 | 3.2 (2.1, 4.8) | 18 | 3.6 (2.1, 6.2) |
| >0.75 to <1.00 | 9 | 2.1 (1.1, 4.3) | 32 | 4.1 (2.8, 6.0) | 16 | 4.0 (2.3, 7.1) |
| 1.00 | 37 | 7.9 (5.3, 11.9) | 46 | 4.7 (3.4, 6.6) | 20 | 10.3 (6.1, 17.1) |
| Per 20% of time CD4 <200 cells/µLb | … | 1.39 (1.29, 1.49) | … | 1.36 (1.28, 1.43) | … | 1.46 (1.35, 1.58) |
| Global P value (AIC)c | … | <.0001 (2572) | … | <.0001 (2591) | … | <.0001 (2575) |
| CD4 count nadir, cells/µL | ||||||
| <50 | 45 | 12.6 (6.1, 26.0) | 61 | 7.0 (4.4, 11.2) | 54 | 22.9 (7.1, 73.9) |
| 50 to <100 | 17 | 5.5 (2.4, 12.5) | 34 | 4.5 (2.7, 7.6) | 20 | 11.2 (3.3, 37.7) |
| 100 to <200 | 35 | 4.1 (1.9, 8.5) | 77 | 3.8 (2.4, 6.0) | 35 | 7.6 (2.3, 24.8) |
| 200 to <350 | 49 | 3.2 (1.6, 6.6) | 80 | 2.2 (1.4, 3.5) | 47 | 6.5 (2.0, 20.9) |
| 350 to <500 | 15 | 1.5 (0.6, 3.4) | 42 | 1.6 (1.0, 2.6) | 11 | 2.6 (0.7, 9.4) |
| ≥500 | 9 | 1.0 (ref) | 26 | 1.0 (ref) | 3 | 1.0 (ref) |
| Per 50 cells/µLb | … | 0.82 (0.78, 0.86) | … | 0.85 (0.82, 0.88) | … | 0.79 (0.75, 0.84) |
| Global P value (AIC)c | … | <.0001 (2564) | … | <.0001 (2583) | … | <.0001 (2562) |
| HIV RNA level average, copies/mL | ||||||
| ≤500 | 47 | 1.0 (ref) | 122 | 1.0 (ref) | 44 | 1.0 (ref) |
| >500 to <10 000 | 41 | 1.2 (0.8, 1.9) | 81 | 1.3 (1.0, 1.8) | 51 | 1.4 (0.9, 2.1) |
| 10 000 to <100 000 | 61 | 2.4 (1.6, 3.5) | 88 | 1.9 (1.4, 2.5) | 59 | 2.2 (1.5, 3.3) |
| ≥100 000 | 21 | 5.3 (3.1, 8.9) | 29 | 3.6 (2.4, 5.5) | 16 | 5.4 (3.0, 9.8) |
| Per log10 copies/mLb | … | 1.58 (1.36, 1.84) | … | 1.36 (1.23, 1.52) | … | 1.56 (1.33, 1.83) |
| Global P value (AIC)c | … | <.0001 (2607) | … | .0001 (2628) | … | <.0001 (2617) |
| Proportion of time HIV RNA level >500 copies/mL | ||||||
| 0.00 | 31 | 1.0 (ref) | 95 | 1.0 (ref) | 25 | 1.0 (ref) |
| >0.00 to 0.25 | 29 | 1.6 (0.9, 2.6) | 51 | 1.2 (0.8, 1.7) | 42 | 1.6 (1.0, 2.7) |
| >0.25 to 0.50 | 19 | 1.6 (0.9, 2.8) | 49 | 1.8 (1.3, 2.6) | 24 | 1.5 (0.9, 2.7) |
| >0.50 to 0.75 | 21 | 1.8 (1.0, 3.2) | 47 | 1.9 (1.3, 2.8) | 32 | 2.4 (1.4, 4.1) |
| >0.75 to <1.00 | 40 | 3.1 (1.9, 5.1) | 57 | 2.2 (1.6, 3.2) | 41 | 3.7 (2.2, 6.4) |
| 1.00 | 30 | 2.5 (1.5, 4.3) | 21 | 0.9 (0.6, 1.5) | 6 | 1.8 (0.7, 4.5) |
| Per 20% of time HIV RNA >500 copies/mLb | … | 1.21 (1.11, 1.31) | … | 1.11 (1.04, 1.18) | … | 1.25 (1.14, 1.37) |
| Global P value (AIC)c | … | .0002 (2629) | … | .0001 (2627) | … | <.0001 (2625) |
| HIV RNA level peak, copies/mL | ||||||
| ≤500 | 31 | 1.0 (ref) | 95 | 1.0 (ref) | 25 | 1.0 (ref) |
| >500 to <10 000 | 24 | 1.2 (0.7, 2.0) | 44 | 1.0 (0.7, 1.4) | 23 | 1.3 (0.7, 2.2) |
| 10 000 to <100 000 | 54 | 1.9 (1.2, 3.0) | 92 | 1.6 (1.2, 2.1) | 54 | 1.9 (1.1, 3.0) |
| ≥100 000 | 61 | 3.2 (2.1, 5.1) | 89 | 2.3 (1.7, 3.1) | 68 | 2.8 (1.7, 4.5) |
| Per log10 copies/mLb | … | 1.49 (1.30, 1.70) | … | 1.30 (1.19, 1.43) | … | 1.43 (1.25, 1.64) |
| Global P value (AIC)c | … | <.0001 (2615) | … | .0001 (2628) | … | <.0001 (2626) |
Abbreviations: AIC, Akaike information criterion; CI, confidence interval; HIV, human immunodeficiency virus; HR, hazard ratio.
aEach measure was individually included in a cohort-stratified Cox model adjusted for sex, race/ethnicity, and baseline age and calendar period. The N and number of anal cancer cases for each moving window was: early (N = 34 625; number of anal cancer cases = 170), late (60 006; 320), and overall (34 625; 170).
b P trend < .0001, except for early proportion of time HIV RNA level >500 copies/mL (Ptrend = .0010).
cGlobal P value and AIC from models among persons with follow-up >3060 days (N = 34 625; number of anal cancer cases = 170).