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

David C Boettiger, Caroline A. Sabin, Andrew E. 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, Pasquale Narciso, Mauro Zaccarelli, Andrea Antinori, Anna Loredana Gallo, Emanuele Nicastri, Rosa Antonietta AcinapuraRaffaella Libertone

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1629-37
Number of pages9
JournalAIDS (London, England)
Issue number10
Publication statusPublished - Jun 19 2016


  • Journal Article


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