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Use of Antidepressants and Risk of Cancer in Individuals Infected With HIV

Justin Stebbing, Tom Powles, Sundhiya Mandalia, Mark Nelson, Brian Gazzard, Mark Bower

From the Imperial College School of Medicine, Departments of Oncology, Imperial Healthcare National Health Service Trust; St Bartholomew's Hospital, Department of Oncology; St Stephen's Centre, Chelsea and Westminster Hospital; Imperial College School of Medicine, Department of Oncology and HIV Medicine, Chelsea and Westminster Hospital, London, United Kingdom

Corresponding author: J. Stebbing, MA, MRCP, MRCPath, PhD, Imperial College, Imperial Healthcare NHS Trust, Charing Cross Hospital, Dept Medical Oncology, 1st Floor, E Wing, Fulham Palace Rd, London W6 8RF, UK; e-mail: j.stebbing{at}ic.ac.uk

Purpose: Preclinical and cohort studies suggest that certain antidepressants are associated with a predisposition to cancer whereas others decrease the risk. We aimed to assess whether different classes of antidepressants were associated with changes in cancer incidence in a population of HIV-1 infected individuals, based on duration of exposure.

Methods: Antidepressant exposure was measured from date of first prescription of the antidepressant until the date of last follow-up or cancer diagnosis. Univariate and multivariate analyses were performed to establish the risk of AIDS-related cancers and non–AIDS-related cancers according to whether patients were receiving selective serotonin reuptake inhibitors, tricyclic antidepressants, or other medicines for depression. We analyzed data for time exposed to antidepressants, before and during the era of highly active antiretroviral therapy (HAART).

Results: From a cohort of 10,997 patients representing 52,656 years of follow-up attending a large HIV center during the pre-HAART and HAART eras, a total of 2,004 (18%) were prescribed antidepressants representing 15,850 years exposed. A total of 1,607 (15%) individuals were diagnosed with cancer. There were no significant associations between any class of antidepressant and any type of cancer (P = .19), in either the pre-HAART or HAART era (P = .23), and use of serotonin reuptake inhibitors did not alter the risk of Burkitt lymphoma.

Conclusion: Antidepressants, irrespective of their class, do not affect cancer risk in HIV-infected individuals.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.