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Taborelli M, Suligoi B, Serraino D, Frova L, Grande E, Toffolutti F, Regine V, Pappagallo M, Pugliese L, Grippo F, Zucchetto A. Increased kidney disease mortality among people with AIDS versus the general population: a population-based cohort study in Italy, 2006-2018. BMJ Open 2022; 12:e064970. [PMID: 36456002 PMCID: PMC9716863 DOI: 10.1136/bmjopen-2022-064970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES This study aimed to assess whether an excess mortality related to kidney and other urinary tract diseases exists among Italian people with AIDS (PWA), as compared with the general population without AIDS (non-PWA). DESIGN Population-based, retrospective cohort study. SETTING AND PARTICIPANTS We conducted a nationwide study including 9481 Italian PWA, aged 15-74 years, reported to the National AIDS Registry between 2006 and 2018. METHODS Vital status and causes of death were retrieved by record linkage with the National Register of Causes of Death up to 2018. Excess mortality for PWA versus non-PWA was estimated through sex-standardised and age-standardised mortality ratios (SMRs) with corresponding 95% CIs. RESULTS Among 2613 deceased PWA, 262 (10.0%) reported at least one urinary tract disease at death, including 254 (9.7%) non-cancer diseases-mostly renal failures (225 cases, 8.6%)-and 9 cancers (0.3%). The overall SMR for non-cancer urinary tract diseases was 15.3 (95% CI 13.4 to 17.3) with statistically significant SMRs for acute (SMR=22.3, 95% CI 18.0 to 27.4), chronic (SMR=8.4, 95% CI 6.0 to 11.3), and unspecified renal failure (SMR=13.8, 95% CI 11.2 to 16.8). No statistically significant excess mortality was detected for urinary tract cancers (SMR=1.7, 95% CI 0.8 to 3.3). The SMRs were particularly elevated among PWA aged <50 years, injecting drug users, or those with the first HIV-positive test >6 months before AIDS diagnosis. CONCLUSIONS The excess mortality related to non-cancer kidney and other urinary tract diseases reported among PWA highlights the importance of implementing the recommendation for screening, diagnosis and management of such conditions among this population.
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Affiliation(s)
- Martina Taborelli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Luisa Frova
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Enrico Grande
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Vincenza Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy
| | - Marilena Pappagallo
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Lucia Pugliese
- Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy
| | - Francesco Grippo
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Antonella Zucchetto
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Taborelli M, Suligoi B, Toffolutti F, Frova L, Grande E, Grippo F, Pappagallo M, Pugliese L, Regine V, Serraino D, Zucchetto A. Excess liver-related mortality among people with AIDS compared to the general population: an Italian nationwide cohort study using multiple causes of death. HIV Med 2020; 21:642-649. [PMID: 32876382 DOI: 10.1111/hiv.12937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Liver diseases have become a leading cause of death among people with AIDS (PWA). This study aimed to investigate whether PWA experienced excess mortality related to liver diseases as compared to the general population (non-PWA), using a multiple cause of death (MCoD; i.e. all conditions reported on death certificates) approach. METHODS A population-based, nationwide, retrospective cohort study was conducted among Italian people, aged 15-74 years, who had been diagnosed with AIDS since 2006. Date of death and MCoD data were retrieved, up to December 2015, by individual record linkage with national mortality data. Sex- and age-standardized mortality ratios (SMRs), with 95% confidence intervals (CIs), were estimated by dividing the observed number of deaths related to a specific condition among PWA to the expected number, based on non-PWA mortality rates. RESULTS Among 7912 PWA (34 184 person-years), 2076 deaths occurred. The number of death certificates reporting liver diseases among MCoDs was 583 (28.1%), including 382 (18.4%) reporting viral hepatitis, 370 (17.8%) reporting nonviral liver diseases, and 41 (2.0%) reporting liver cancers. The corresponding SMRs were 40.4 (95% CI 37.2-43.8) for all liver diseases, 131.1 (95% CI 118.3-145.0) for viral hepatitis, 29.9 (95% CI 27.0-33.1) for nonviral liver diseases, and 11.2 (95% CI 8.1-15.3) for liver cancers. Particularly elevated SMRs emerged among PWA aged 15-49 years and those infected by injecting drug use. CONCLUSIONS The high excess liver-related mortality observed among PWA warrants preventive actions to limit the burden of viral hepatitis coinfections, alcohol abuse, and metabolic disorders, especially among younger PWA and injecting drug users.
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Affiliation(s)
- M Taborelli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - B Suligoi
- National AIDS Unit, National Health Institute, Rome, Italy
| | - F Toffolutti
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - L Frova
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - E Grande
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - F Grippo
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - M Pappagallo
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - L Pugliese
- National AIDS Unit, National Health Institute, Rome, Italy
| | - V Regine
- National AIDS Unit, National Health Institute, Rome, Italy
| | - D Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - A Zucchetto
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Lodi S, Günthard HF, Gill J, Phillips AN, Dunn D, Vu Q, Siemieniuk R, Garcia F, Logan R, Jose S, Bucher HC, Scherrer AU, Reiss P, van Sighem A, Boender TS, Porter K, Gilson R, Paraskevis D, Simeon M, Vourli G, Moreno S, Jarrin I, Sabin C, Hernán MA. Effectiveness of Transmitted Drug Resistance Testing Before Initiation of Antiretroviral Therapy in HIV-Positive Individuals. J Acquir Immune Defic Syndr 2019; 82:314-320. [PMID: 31609929 PMCID: PMC7830777 DOI: 10.1097/qai.0000000000002135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND For people living with HIV, major guidelines in high-income countries recommend testing for transmitted drug resistance (TDR) to guide the choice of first-line antiretroviral therapy (ART). However, individuals who fail a first-line regimen can now be switched to one of several effective regimens. Therefore, the virological and clinical benefit of TDR testing needs to be evaluated. METHODS We included individuals from the HIV-CAUSAL Collaboration who enrolled <6 months of HIV diagnosis between 2006 and 2015, were ART-naive, and had measured CD4 count and HIV-RNA. Follow-up started at the date when all inclusion criteria were first met (baseline). We compared 2 strategies: (1) TDR testing within 3 months of baseline versus (2) no TDR testing. We used inverse probability weighting to estimate the 5-year proportion and hazard ratios (HRs) of virological suppression (confirmed HIV-RNA <50 copies/mL), and of AIDS or death under both strategies. RESULTS Of 25,672 eligible individuals (82% males, 52% diagnosed in 2010 or later), 17,189 (67%) were tested for TDR within 3 months of baseline. Of these, 6% had intermediate- or high-level TDR to any antiretroviral drug. The estimated 5-year proportion virologically suppressed was 77% under TDR testing and 74% under no TDR testing; HR 1.06 (95% confidence interval: 1.03 to 1.19). The estimated 5-year risk of AIDS or death was 6% under both strategies; HR 1.03 (95% confidence interval: 0.95 to 1.12). CONCLUSIONS TDR prevalence was low. Although TDR testing improved virological response, we found no evidence that it reduced the incidence of AIDS or death in first 5 years after diagnosis.
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Affiliation(s)
- Sara Lodi
- Boston University School of Public Health, Boston, MA
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Zürich, Switzerland
| | - John Gill
- University of Calgary, Calgary, Alberta, Canada
- Southern Alberta Clinic, Calgary, Alberta, Canada
| | - Andrew N Phillips
- Institute for Global Health, University College London, London, United Kingdom
| | - David Dunn
- Institute for Global Health, University College London, London, United Kingdom
| | - Quang Vu
- University of Calgary, Calgary, Alberta, Canada
| | - Reed Siemieniuk
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Roger Logan
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sophie Jose
- Institute for Global Health, University College London, London, United Kingdom
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Zürich, Switzerland
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, the Netherlands
- Division of Infectious Diseases, Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | | | | | - Kholoud Porter
- Institute for Global Health, University College London, London, United Kingdom
| | - Richard Gilson
- Institute for Global Health, University College London, London, United Kingdom
| | | | | | - Georgia Vourli
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Santiago Moreno
- Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
- University of Alcalá de Henares, Madrid, Spain
| | - Inmaculada Jarrin
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Caroline Sabin
- Institute for Global Health, University College London, London, United Kingdom
| | - Miguel A Hernán
- Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard-MIT Division of Health Sciences and Technology, Boston, MA
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Lodi S, Phillips A, Lundgren J, Logan R, Sharma S, Cole SR, Babiker A, Law M, Chu H, Byrne D, Horban A, Sterne JAC, Porter K, Sabin C, Costagliola D, Abgrall S, Gill J, Touloumi G, Pacheco AG, van Sighem A, Reiss P, Bucher HC, Montoliu Giménez A, Jarrin I, Wittkop L, Meyer L, Perez-Hoyos S, Justice A, Neaton JD, Hernán MA. Effect Estimates in Randomized Trials and Observational Studies: Comparing Apples With Apples. Am J Epidemiol 2019; 188:1569-1577. [PMID: 31063192 DOI: 10.1093/aje/kwz100] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/17/2019] [Indexed: 12/25/2022] Open
Abstract
Effect estimates from randomized trials and observational studies might not be directly comparable because of differences in study design, other than randomization, and in data analysis. We propose a 3-step procedure to facilitate meaningful comparisons of effect estimates from randomized trials and observational studies: 1) harmonization of the study protocols (eligibility criteria, treatment strategies, outcome, start and end of follow-up, causal contrast) so that the studies target the same causal effect, 2) harmonization of the data analysis to estimate the causal effect, and 3) sensitivity analyses to investigate the impact of discrepancies that could not be accounted for in the harmonization process. To illustrate our approach, we compared estimates of the effect of immediate with deferred initiation of antiretroviral therapy in individuals positive for the human immunodeficiency virus from the Strategic Timing of Antiretroviral Therapy (START) randomized trial and the observational HIV-CAUSAL Collaboration.
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Affiliation(s)
- Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Andrew Phillips
- Institute for Global Health, University College London, United Kingdom
| | - Jens Lundgren
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - Roger Logan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shweta Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Abdel Babiker
- Medical Research Council, Clinical Trials Unit in University College London, London, United Kingdom
| | | | - Haitao Chu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Dana Byrne
- Division of Infectious Diseases, Department of Medicine, Cooper University Hospital, Cooper Medical School at Rowan University, New Jersey
| | - Andrzej Horban
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
| | - Jonathan A C Sterne
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Kholoud Porter
- Institute for Global Health, University College London, United Kingdom
| | - Caroline Sabin
- Institute for Global Health, University College London, United Kingdom
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Sophie Abgrall
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Paris, France
- AP-HP, Hôpital Antoine Béclère, Service de Médecine Interne, Clamart, France
| | - John Gill
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Canada
| | - Giota Touloumi
- National and Kapodistrian University of Athens, Faculty of Medicine, Dept. of Hygiene, Epidemiology and Medical Statistics, Greece
| | - Antonio G Pacheco
- Programa de Computação Científica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, the Netherlands
- Amsterdam University Medical Centres, University of Amsterdam, Department of Global Health and Division of Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Switzerland
| | - Alexandra Montoliu Giménez
- Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Badalona, Spain
| | - Inmaculada Jarrin
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Linda Wittkop
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
| | - Laurence Meyer
- CHU de Bordeaux, Pôle de santé publique, Service d'information médicale, Bordeaux, France
- Université Paris Sud, UMR 1018, le Kremlin Bicêtre, France
| | | | - Amy Justice
- Yale University School of Medicine, New Haven, Connecticut
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Miguel A Hernán
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health
- Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts
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Suligoi B, Virdone S, Taborelli M, Frova L, Grande E, Grippo F, Pappagallo M, Regine V, Pugliese L, Serraino D, Zucchetto A. Excess mortality related to circulatory system diseases and diabetes mellitus among Italian AIDS patients vs. non-AIDS population: a population-based cohort study using the multiple causes-of-death approach. BMC Infect Dis 2018; 18:428. [PMID: 30153797 PMCID: PMC6114052 DOI: 10.1186/s12879-018-3336-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/15/2018] [Indexed: 12/21/2022] Open
Abstract
Background Chronic diseases, chiefly cancers and circulatory system diseases (CSDs), have become the leading non-AIDS-related causes of death among HIV-infected people, as in the general population. After our previous report of an excess mortality for several non-AIDS-defining cancers, we now aim to assess whether people with AIDS (PWA) experience also an increased mortality for CSDs and diabetes mellitus (DM), as compared to the non-AIDS general population (non-PWA). Methods A nationwide, population-based, retrospective cohort study was conducted including 5285 Italians, aged 15−74 years, who were diagnosed with AIDS between 2006 and 2011. Multiple cause-of-death (MCoD) data, i.e. all conditions reported in death certificates, were retrieved through record-linkage with the National Register of Causes of Death up to 2011. Using MCoD data, sex- and age-standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated by dividing the observed number of PWA reporting a specific disease among MCoD to the expected number, estimated on the basis of mortality rates (based on MCoD) of non-PWA. Results Among 1229 deceased PWA, CSDs were mentioned in 201 (16.4%) certificates and DM in 46 (3.7%) certificates among the various causes of death. These values corresponded to a 13-fold higher mortality related to CSDs (95% CI 10.8–14.4) and DM (95% CI: 9.5–17.4) as compared to 952,019 deceased non-PWA. Among CSDs, statistically significant excess mortality emerged for hypertension (23 deaths, SMR = 6.3, 95% CI: 4.0–9.4), ischemic heart diseases (39 deaths, SMR = 6.1, 95% CI: 4.4–8.4), other forms of heart diseases (88 deaths, SMR = 13.4, 95% CI: 10.8–16.5), and cerebrovascular diseases (42 deaths, SMR = 13.4, 95% CI: 9.7–18.2). The SMRs were particularly elevated among PWA aged < 50 years and those infected through drug injection. Conclusions The use of MCoD data disclosed the fairly high mortality excess related to several CSDs and DM among Italian PWA as compared to non-PWA. Study findings also indicate to start preventive strategies for such diseases at a younger age among AIDS patients than in the general population and with focus on drug users.
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Affiliation(s)
- Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, via Regina Elena 299, 00161, Rome, Italy
| | - Saverio Virdone
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Martina Taborelli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Luisa Frova
- Integrated system for health, social assistance, welfare and justice, Istituto Nazionale di Statistica, viale Liegi 13, 00198, Rome, Italy
| | - Enrico Grande
- Integrated system for health, social assistance, welfare and justice, Istituto Nazionale di Statistica, viale Liegi 13, 00198, Rome, Italy
| | - Francesco Grippo
- Integrated system for health, social assistance, welfare and justice, Istituto Nazionale di Statistica, viale Liegi 13, 00198, Rome, Italy
| | - Marilena Pappagallo
- Integrated system for health, social assistance, welfare and justice, Istituto Nazionale di Statistica, viale Liegi 13, 00198, Rome, Italy
| | - Vincenza Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, via Regina Elena 299, 00161, Rome, Italy
| | - Lucia Pugliese
- Centro Operativo AIDS, Istituto Superiore di Sanità, via Regina Elena 299, 00161, Rome, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Antonella Zucchetto
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy.
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Barchielli A, Buiatti E, Galanti C, Lazzeri V. Linkage between Aids Surveillance Systeml and Population-Based Cancer Registry Data in Italy: A Pilot Study in Florence, 1985-90. TUMORI JOURNAL 2018; 81:169-72. [PMID: 7571022 DOI: 10.1177/030089169508100303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The role of the Tuscany population-based Cancer Registry (TCR) in the assessment of cancer incidence in AIDS patients, and the completeness of cancer reporting to the Italian AIDS surveillance system (RAIDS) was evaluated through a linkage between the TCR and the RAIDS in the period 1985-90. In the Province of Florence, the incidence of Kaposi's sarcoma in AIDS cases was underestimated by 24% (95% CI; 9.8%-47%; 6/25 cases) by RAIDS in comparison with the TCR. Of kaposi's sarcomas unknown to RAIDS, 2 were incident at the time of AIDS diagnosis (“truly” unreported cases) and 4 were late manifestations of AIDS. Moreover, 1 non-Hodgkin lymphoma unknown to RAIDS and 10 other malignancies (4 lung cancers) were identified through the TCR. In AIDS patients, the incidence of lung cancer was 95-fold (99% CI, 16-310) the expected one on the basis of age-sex-specific incidence rates in the general population of the same area. Altogether, about 25% of AIDS cases developed a cancer during HIV infection. In spite of the small size of the present study, the results confirm the role of population-based cancer registries in the assessment of the occurrence of malignancies in AIDS patients.
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Affiliation(s)
- A Barchielli
- Tuscany Cancer Registry/Epidemiology Unit, Center for the Study and Prevention of Cancer, Florence, Italy
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Gobert A, Veyri M, Poizot-Martin I, Lavolé A, Solas C, Paliche R, Katlama C, Costagliola D, Spano JP. [HIV and cancer : What's new in 2017?]. Bull Cancer 2018; 105:256-262. [PMID: 29548534 DOI: 10.1016/j.bulcan.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 12/20/2022]
Abstract
Since the era of combined antiretroviral therapy, life expectancy of people living with HIV has been improved and is associated with a change in causes of death. Cancer, both AIDS-defining or non-AIDS-defining cancers, has become the leading cause of death in people living with HIV associated with an increase in the incidence of some cancers compared to the general population. Epidemiology and the identification of risk factors is a crucial issue, particularly to determine the most appropriate prevention and screening strategies in this population. In the absence of dedicated clinical trials, the cancer management in these patients is based on general recommendations, with specific attention to comorbidities and drug interactions. In addition, the development of new innovative therapies such as immunotherapy with inhibitory antibodies of immune checkpoints receptor represents a hope for the patient care, both infected or not with HIV. In this context, the establishment of the national network CancerVIH makes sense, allowing the establishment of multi-disciplinary consultation meetings involving all the practitioners involved in the care of these patients with cancer, as well as the constitution of a national cohort and the promotion of dedicated trials, to improve and optimize the management for these patients.
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Affiliation(s)
- Aurélien Gobert
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, service d'oncologie médicale, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - Marianne Veyri
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, service d'oncologie médicale, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Isabelle Poizot-Martin
- Assistance publique-Hôpitaux de Marseille, CHU Sainte-Marguerite, service d'immuno-hématologie clinique, 20, avenue Viton, 13274 Marseille, France
| | - Armelle Lavolé
- Hôpital Tenon, service de pneumologie, 4, rue de la Chine, 75020 Paris, France
| | - Caroline Solas
- Assistance publique-Hôpitaux de Marseille, hôpital de la Timone, service de pharmacocinétique toxicocinétique, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Romain Paliche
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, service des maladies infectieuses et tropicales, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Christine Katlama
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, service des maladies infectieuses et tropicales, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Dominique Costagliola
- Institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), Sorbonne-universités, UPMC université Paris-06, Inserm, 75013 Paris, France
| | - Jean-Philippe Spano
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, service d'oncologie médicale, 47, boulevard de l'Hôpital, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), Sorbonne-universités, UPMC université Paris-06, Inserm, 75013 Paris, France
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Murray EJ, Robins JM, Seage GR, Lodi S, Hyle EP, Reddy KP, Freedberg KA, Hernán MA. Using Observational Data to Calibrate Simulation Models. Med Decis Making 2018; 38:212-224. [PMID: 29141153 PMCID: PMC5771959 DOI: 10.1177/0272989x17738753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individual-level simulation models are valuable tools for comparing the impact of clinical or public health interventions on population health and cost outcomes over time. However, a key challenge is ensuring that outcome estimates correctly reflect real-world impacts. Calibration to targets obtained from randomized trials may be insufficient if trials do not exist for populations, time periods, or interventions of interest. Observational data can provide a wider range of calibration targets but requires methods to adjust for treatment-confounder feedback. We propose the use of the parametric g-formula to estimate calibration targets and present a case-study to demonstrate its application. METHODS We used the parametric g-formula applied to data from the HIV-CAUSAL Collaboration to estimate calibration targets for 7-y risks of AIDS and/or death (AIDS/death), as defined by the Center for Disease Control and Prevention under 3 treatment initiation strategies. We compared these targets to projections from the Cost-effectiveness of Preventing AIDS Complications (CEPAC) model for treatment-naïve individuals presenting to care in the following year ranges: 1996 to 1999, 2000 to 2002, or 2003 onwards. RESULTS The parametric g-formula estimated a decreased risk of AIDS/death over time and with earlier treatment. The uncalibrated CEPAC model successfully reproduced targets obtained via the g-formula for baseline 1996 to 1999, but over-estimated calibration targets in contemporary populations and failed to reproduce time trends in AIDS/death risk. Calibration to g-formula targets improved CEPAC model fit for contemporary populations. CONCLUSION Individual-level simulation models are developed based on best available information about disease processes in one or more populations of interest, but these processes can change over time or between populations. The parametric g-formula provides a method for using observational data to obtain valid calibration targets and enables updating of simulation model inputs when randomized trials are not available.
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Affiliation(s)
- Eleanor J Murray
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (EJM, JMR, GRS, SL, MAH)
| | - James M Robins
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (EJM, JMR, GRS, SL, MAH)
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA (JMR, MAH)
| | - George R Seage
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (EJM, JMR, GRS, SL, MAH)
| | - Sara Lodi
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (EJM, JMR, GRS, SL, MAH)
| | - Emily P Hyle
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA (EPH, KAF)
| | - Krishna P Reddy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA (KPR)
| | - Kenneth A Freedberg
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA (EPH, KAF)
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA (KAF)
- Center for AIDS Research, Harvard University, Boston, MA, USA (KAF)
| | - Miguel A Hernán
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (EJM, JMR, GRS, SL, MAH)
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA (JMR, MAH)
- Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA (MAH)
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9
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Lodi S, Günthard HF, Dunn D, Garcia F, Logan R, Jose S, Bucher HC, Scherrer AU, Schneider MP, Egger M, Glass TR, Reiss P, van Sighem A, Boender TS, Phillips AN, Porter K, Hawkins D, Moreno S, Monge S, Paraskevis D, Simeon M, Vourli G, Sabin C, Hernán MA. Effect of immediate initiation of antiretroviral treatment on the risk of acquired HIV drug resistance. AIDS 2018; 32:327-335. [PMID: 29135583 PMCID: PMC5758415 DOI: 10.1097/qad.0000000000001692] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We estimated and compared the risk of clinically identified acquired drug resistance under immediate initiation [the currently recommended antiretroviral therapy (ART) initiation strategy], initiation with CD4 cell count less than 500 cells/μl and initiation with CD4 cell count less than 350 cells/μl. DESIGN Cohort study based on routinely collected data from the HIV-CAUSAL collaboration. METHODS For each individual, baseline was the earliest time when all eligibility criteria (ART-naive, AIDS free, and others) were met after 1999. Acquired drug resistance was defined using the Stanford classification as resistance to any antiretroviral drug that was clinically identified at least 6 months after ART initiation. We used the parametric g-formula to adjust for time-varying (CD4 cell count, HIV RNA, AIDS, ART regimen, and drug resistance testing) and baseline (calendar period, mode of acquisition, sex, age, geographical origin, ethnicity and cohort) characteristics. RESULTS In 50 981 eligible individuals, 10% had CD4 cell count more than 500 cells/μl at baseline, and 63% initiated ART during follow-up. Of 2672 tests for acquired drug resistance, 794 found resistance. The estimated 7-year risk (95% confidence interval) of acquired drug resistance was 3.2% (2.8,3.5) for immediate initiation, 3.1% (2.7,3.3) for initiation with CD4 cell count less than 500 cells/μl, and 2.8% (2.5,3.0) for initiation with CD4 cell count less than 350 cells/μl. In analyses restricted to individuals with baseline in 2005-2015, the corresponding estimates were 1.9% (1.8, 2.5), 1.9% (1.7, 2.4), and 1.8% (1.7, 2.2). CONCLUSION Our findings suggest that the risk of acquired drug resistance is very low, especially in recent calendar periods, and that immediate ART initiation only slightly increases the risk. It is unlikely that drug resistance will jeopardize the proven benefits of immediate ART initiation.
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Affiliation(s)
- Sara Lodi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | | | - Roger Logan
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel
| | - Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Marie-Paule Schneider
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, Geneva
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern
| | - Tracy R Glass
- Swiss Tropical and Public Health Institute
- University of Basel, Basel, Switzerland
| | - Peter Reiss
- Stichting HIV Monitoring
- Division of Infectious Diseases, Department of Global Health, Academic Medical Centre, University of Amsterdam
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | | | | | | | | | | | - Santiago Moreno
- IRYCIS, Ramón y Cajal Hospital
- University of Alcalá de Henares
| | - Susana Monge
- University of Alcalá de Henares
- National Centre of Epidemiology - ISCIII, Madrid, Spain
| | | | | | - Georgia Vourli
- National and Kapodistrian University of Athens Medical School, Athens
| | | | - Miguel A Hernán
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA
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Mondal P, Lim HJ. The Effect of MSM and CD4+ Count on the Development of Cancer AIDS (AIDS-defining Cancer) and Non-cancer AIDS in the HAART Era. Curr HIV Res 2018; 16:288-296. [PMID: 30520378 PMCID: PMC6416461 DOI: 10.2174/1570162x17666181205130532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/06/2018] [Accepted: 11/29/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The HIV epidemic is increasing among Men who have Sex with Men (MSM) and the risk for AIDS defining cancer (ADC) is higher among them. OBJECTIVE To examine the effect of MSM and CD4+ count on time to cancer AIDS (ADC) and noncancer AIDS in competing risks setting in the HAART era. METHOD Using Ontario HIV Treatment Network Cohort Study data, HIV-positive adults diagnosed between January 1997 and October 2012 having baseline CD4+ counts ≤ 500 cells/mm3 were evaluated. Two survival outcomes, cancer AIDS and non-cancer AIDS, were treated as competing risks. Kaplan-Meier analysis, Cox cause-specific hazards (CSH) model and joint modeling of longitudinal and survival outcomes were used. RESULTS Among the 822 participants, 657 (79.9%) were males; 686 (83.5%) received anti-retroviral (ARV) ever. Regarding risk category, the majority (58.5%) were men who have Sex with men (MSM). Mean age was 37.4 years (SD = 10.3). In the multivariate Cox CSH models, MSM were not associated with cancer AIDS but with non-cancer AIDS [HR = 2.92; P = 0.055, HR = 0.54; P = 0.0009, respectively]. However, in joint models of longitudinal and survival outcomes, MSM were associated with cancer AIDS but not with non-cancer AIDS [HR = 3.86; P = 0.013, HR = 0.73; P = 0.10]. CD4+ count, age, ARV ever were associated with both events in the joint models. CONCLUSION This study demonstrates the importance of considering competing risks, and timedependent biomarker in the survival model. MSM have higher hazard for cancer AIDS. CD4+ count is associated with both survival outcomes.
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Affiliation(s)
| | - Hyun J. Lim
- Address correspondence to this author at the 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada; Tel: 306 966 6288; Fax: 306-966-7920; E-mail:
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11
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Lodi S, Costagliola D, Sabin C, Del Amo J, Logan R, Abgrall S, Reiss P, van Sighem A, Jose S, Blanco JR, Hernando V, Bucher HC, Kovari H, Segura F, Ambrosioni J, Gogos CA, Pantazis N, Dabis F, Vandenhende MA, Meyer L, Seng R, Gill MJ, Krentz H, Phillips AN, Porter K, Grinsztejn B, Pacheco AG, Muga R, Tate J, Justice A, Hernán MA. Effect of Immediate Initiation of Antiretroviral Treatment in HIV-Positive Individuals Aged 50 Years or Older. J Acquir Immune Defic Syndr 2017; 76:311-318. [PMID: 28746165 PMCID: PMC5704899 DOI: 10.1097/qai.0000000000001498] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HIV-positive individuals. However, those guidelines are based on trials of relatively young participants. METHODS We included HIV-positive antiretroviral therapy-naive, AIDS-free individuals aged 50-70 years after 2004 in the HIV-CAUSAL Collaboration. We used the parametric g-formula to estimate the 5-year risk of all-cause and non-AIDS mortality under (1) immediate initiation at baseline and initiation at CD4 count, (2) <500 cells/mm, and (3) <350 cells/mm. Results were presented separately for the general HIV population and for a US Veterans cohort with high mortality. RESULTS The study included 9596 individuals (28% US Veterans) with median (interquantile range) age of 55 (52-60) years and CD4 count of 336 (182-513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm. The 5-year risk of non-AIDS mortality was 0.17% (95% CI: -0.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm. CONCLUSIONS Immediate initiation seems to reduce all-cause and non-AIDS mortality in patients aged 50-70 years.
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Affiliation(s)
- Sara Lodi
- 1Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; 2Sorbonne Universités, INSERM, UPMC Univ Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France; 3Institute of Global Health, University College London, London, United Kingdom; 4Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain; 5CIBERESP, Instituto de Salud Carlos III, Madrid, Spain; 6AP-HP, Hôpital Antoine Béclère, Service de Médecine Interne, Clamart, France; 7Stichting HIV Monitoring, Amsterdam, the Netherlands; 8Academic Medical Centre, Department of Global Health and Division of Infectious Diseases, University of Amsterdam, Amsterdam, the Netherlands; 9Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands; 10Hospital San Pedro-CIBIR, Logroño, Spain; 11Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland; 12Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 13Infectious Disease Department, Hospital Parc Tauli, Sabadell, Spain; 14Hospital Clinic-IDIBAPS, Barcelona, Spain; 15Division of Infectious Diseases, Patras University Hospital, Patras, Greece; 16Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece; 17Université de Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France; 18Centre INSERM U1219- Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, Bordeaux, France; 19Department of Internal Medicine, Bordeaux University Hospital, Bordeaux, France; 20Université Paris Sud, UMR 1018, le Kremlin Bicêtre, Paris, France; 21Inserm, UMR 1018, le Kremlin Bicêtre, Paris, France; 22AP-HP, Hôpital de Bicêtre, Service de Santé Publique, le Kremlin Bicêtre, Paris, France; 23Southern Alberta Clinic, Calgary, AB, Canada; 24Department of Medicine, University of Calgary, Calgary, AB, Canada; 25Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brasil; 26Programa de Computação Científica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brasil; 27Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 28Department of Internal Medicine, Yale University School of Medicine, New Haven; 29VA Connecticut Healthcare System, West Haven, CT; 30Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston; and 31Harvard-MIT Division of Health Sciences and Technology, Boston, MA
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12
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Abstract
BACKGROUND Non-AIDS-defining cancers (non-ADCs) have become the leading non-AIDS-related cause of death among people with HIV/AIDS. We aimed to quantify the excess risk of cancer-related deaths among Italian people with AIDS (PWA), as compared with people without AIDS (non-PWA). METHODS A nationwide, population-based, retrospective cohort study was carried out among 5285 Italian PWA, aged 15-74 years, diagnosed between 2006 and 2011. Date of death and multiple-cause-of-death data were retrieved up to December 2011. Excess mortality, as compared with non-PWA, was estimated using sex- and age-standardized mortality ratios (SMRs) and the corresponding 95% confidence intervals (CIs). RESULTS Among 1229 deceased PWA, 10.3% reported non-ADCs in the death certificate, including lung (3.1%), and liver (1.4%), cancers. A 7.3-fold (95% CI: 6.1 to 8.7) excess mortality was observed for all non-ADCs combined. Statistically significant SMRs emerged for specific non-ADCs, ie, anus (5 deaths, SMR = 227.6, 95% CI: 73.9 to 531.0), Hodgkin lymphoma (12 deaths, SMR = 122.0, 95% CI: 63.0 to 213.0), unspecified uterus (4 deaths, SMR = 52.5, 95% CI: 14.3 to 134.5), liver (17 deaths, SMR = 13.2, 95% CI: 7.7 to 21.1), skin melanoma (4 deaths, SMR = 10.9, 95% CI: 3.0 to 27.8), lung (38 deaths, SMR = 8.0, 95% CI: 5.7 to 11.0), head and neck (9 deaths, SMR = 7.8, 95% CI: 3.6 to 14.9), leukemia (5 deaths, SMR = 7.6, 95% CI: 2.4 to 17.7), and colon-rectum (10 deaths, SMR = 5.4, 95% CI: 2.6 to 10.0). SMRs for non-ADCs were particularly elevated among PWA infected through injecting drug use. CONCLUSION This population-based study documented extremely elevated risks of death for non-ADCs among PWA. These findings stress the need of preventive interventions for both virus-related and non-virus-related cancers among HIV-infected individuals.
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13
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Grande E, Zucchetto A, Suligoi B, Grippo F, Pappagallo M, Virdone S, Camoni L, Taborelli M, Regine V, Serraino D, Frova L. Multiple cause-of-death data among people with AIDS in Italy: a nationwide cross-sectional study. Popul Health Metr 2017; 15:19. [PMID: 28521797 PMCID: PMC5437492 DOI: 10.1186/s12963-017-0135-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 05/04/2017] [Indexed: 12/12/2022] Open
Abstract
Background Multiple cause-of-death (MCOD) data allow analyzing the contribution to mortality of conditions reported on the death certificate that are not selected as the underlying cause of death. Using MCOD data, this study aimed to fully describe the cause-specific mortality of people with AIDS (PWA) compared to people without AIDS. Methods We conducted a nationwide investigation based on death certificates of 2,515 Italian PWA and 123,224 people without AIDS who had died between 2006 and 2010. The conditions most frequently associated with PWA mortality, compared to people without AIDS, were identified using an age-standardized proportion ratio (ASPR) calculated as the ratio between the age-standardized proportion of a specific cause among PWA and the same proportion among people without AIDS. Results The most frequently reported conditions at death among PWA were infectious/parasitic diseases (52%), digestive (36%), respiratory (33%), and circulatory (32%) system diseases, and neoplasms (29%). All AIDS-defining conditions resulted highly associated (ASPR significantly greater than unity) with PWA deaths. Significant associations also emerged for leishmaniasis (ASPR = 188.0), encephalitis/myelitis/encephalomyelitis (ASPR = 14.3), dementia (ASPR = 13.1), chronic viral hepatitis (ASPR = 13.1), liver fibrosis/cirrhosis (ASPR = 4.4), pneumonia (ASPR = 4.4), anal (ASPR = 12.1) and liver (ASPR = 1.9) cancers, and Hodgkin’s disease (ASPR = 3.1). Conclusions Study findings identified the contribution of several non-AIDS-defining conditions on PWA mortality, emphasizing the need of preventive public health interventions targeting this population.
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Affiliation(s)
- Enrico Grande
- Servizio Sistema integrato salute, assistenza, previdenza e giustizia, Istituto Nazionale di Statistica, Viale Liegi 13, 00198, Rome, Italy
| | - Antonella Zucchetto
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Via Gallini 2, 33081, Aviano, PN, Italy
| | - Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Francesco Grippo
- Servizio Sistema integrato salute, assistenza, previdenza e giustizia, Istituto Nazionale di Statistica, Viale Liegi 13, 00198, Rome, Italy
| | - Marilena Pappagallo
- Servizio Sistema integrato salute, assistenza, previdenza e giustizia, Istituto Nazionale di Statistica, Viale Liegi 13, 00198, Rome, Italy
| | - Saverio Virdone
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Via Gallini 2, 33081, Aviano, PN, Italy
| | - Laura Camoni
- Centro Operativo AIDS, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Martina Taborelli
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Via Gallini 2, 33081, Aviano, PN, Italy
| | - Vincenza Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Via Gallini 2, 33081, Aviano, PN, Italy.
| | - Luisa Frova
- Servizio Sistema integrato salute, assistenza, previdenza e giustizia, Istituto Nazionale di Statistica, Viale Liegi 13, 00198, Rome, Italy
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14
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Taborelli M, Virdone S, Camoni L, Regine V, Zucchetto A, Frova L, Grande E, Boros S, Dal Maso L, De Paoli P, Serraino D, Suligoi B. The persistent problem of late HIV diagnosis in people with AIDS: a population-based study in Italy, 1999-2013. Public Health 2016; 142:39-45. [PMID: 28057195 DOI: 10.1016/j.puhe.2016.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/30/2016] [Accepted: 10/13/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite the wide accessibility to free human immunodeficiency virus (HIV) testing and combined antiretroviral therapy (cART), late HIV diagnosis remains common with severe consequences at individual and population level. This study aimed to describe trends of late HIV testing and to identify their determinants in the late cART era in Italy. STUDY DESIGN We conducted a population-based, nationwide analysis of the Italian National AIDS Registry data (AIDS - acquired immune deficiency syndrome) for the years 1999-2013. METHODS Late testers (LTs) were defined as people with AIDS (PWA) whose first HIV-positive test preceded AIDS diagnosis by 3 months or less. Odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were estimated to examine factors associated with being LTs. Joinpoint analysis was used to estimate annual percent changes (APCs) of LTs' proportion over time. RESULTS Among 20,753 adult PWA, 50.8% were LTs. Italian PWA showed a lower proportion of LTs than non-Italian PWA (46.5% vs 68.2%). Among Italian PWA, the odds of being LTs was higher in men than in women (OR = 2.62, 95% CI: 2.38-2.90); in the age groups below 35 years and over 49 years at diagnosis (OR = 1.24, 95% CI: 1.12-1.37 and OR = 1.51, 95% CI: 1.38-1.67, respectively) vs PWA aged 35-49 years; and in those infected through sexual contact as compared with injecting drug use (OR = 13.34, 95% CI: 12.06-14.76 for heterosexual contact and OR = 8.13, 95% CI: 7.30-9.06 for male-to-male sexual contact). The proportion of LTs increased over time among Italians, especially in the latest period (APC2006-2013 = 5.3, 95% CI: 3.8-6.9). The LTs' proportion resulted higher, though stable, among PWA aged ≥50 years. Conversely, an increasing trend was observed among PWA aged 18-34 years (APC = 5.3, 95% CI: 4.5-6.1). The LTs' proportion was persistently higher among PWA who acquired HIV infection through sexual contact, even if a marked increase among injecting drug users was observed after 2005 (APC = 11.4, 95% CI: 5.7-17.5). CONCLUSIONS The increasing trend of LTs' proportion in the late cART era highlights the need of new strategies tailored to groups who may not consider themselves to be at a high risk of infection. Active promotion of early testing and continuous education of infection, especially among young people, need to be implemented.
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Affiliation(s)
- M Taborelli
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy.
| | - S Virdone
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - L Camoni
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
| | - V Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
| | - A Zucchetto
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - L Frova
- Servizio Sanità, Salute ed Assistenza, Istituto Nazionale di Statistica, Rome, Italy
| | - E Grande
- Servizio Sanità, Salute ed Assistenza, Istituto Nazionale di Statistica, Rome, Italy
| | - S Boros
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
| | - L Dal Maso
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - P De Paoli
- Scientific Directorate, CRO Aviano National Cancer Institute, Aviano, Italy
| | - D Serraino
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - B Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy
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15
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Incidence and clearance of anal high-risk human papillomavirus in HIV-positive men who have sex with men: estimates and risk factors. AIDS 2016; 30:37-44. [PMID: 26355673 PMCID: PMC4674141 DOI: 10.1097/qad.0000000000000874] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text Background: To estimate incidence and clearance of high-risk human papillomavirus (HR-HPV), and their risk factors, in men who have sex with men (MSM) recently infected by HIV in Spain; 2007–2013. Methods: Multicenter cohort. HR-HPV infection was determined and genotyped with linear array. Two-state Markov models and Poisson regression were used. Results: We analysed 1570 HR-HPV measurements of 612 MSM over 13 608 person-months (p-m) of follow-up. Median (mean) number of measurements was 2 (2.6), median time interval between measurements was 1.1 years (interquartile range: 0.89–1.4). Incidence ranged from 9.0 [95% confidence interval (CI) 6.8–11.8] per 1000 p-m for HPV59 to 15.9 (11.7–21.8) per 1000 p-m for HPV51. HPV16 and HPV18 had slightly above average incidence: 11.9/1000 p-m and 12.8/1000 p-m. HPV16 showed the lowest clearance for both ‘prevalent positive’ (15.7/1000 p-m; 95% CI 12.0–20.5) and ‘incident positive’ infections (22.1/1000 p-m; 95% CI 11.8–41.1). More sexual partners increased HR-HPV incidence, although it was not statistically significant. Age had a strong effect on clearance (P-value < 0.001) due to the elevated rate in MSM under age 25; the effect of HIV-RNA viral load was more gradual, with clearance rate decreasing at higher HIV-RNA viral load (P-value 0.008). Conclusion: No large variation in incidence by HR-HPV type was seen. The most common incident types were HPV51, HPV52, HPV31, HPV18 and HPV16. No major variation in clearance by type was observed, with the exception of HPV16 which had the highest persistence and potentially, the strongest oncogenic capacity. Those aged below 25 or with low HIV-RNA- viral load had the highest clearance.
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Mor Z, Barchana M. Cancer incidence in people living with HIV/AIDS in Israel, 1981-2010. AIDS Res Hum Retroviruses 2015; 31:873-81. [PMID: 25941873 DOI: 10.1089/aid.2015.0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Antiretroviral therapy (ART) improved the survival of people living with HIV/AIDS (PLWHA) and decreased HIV-related morbidities. This study assesses the cancer incidence of all adult PLWHA in Israel by transmission routes before and after 1996. This cohort study was based on cross-matching the National HIV/AIDS and Cancer Registries of all HIV/AIDS and cancer cases reported from 1981 to 2010 with the National civil census. PLWHA were followed-up until cancer diagnosis, death, leaving Israel, or 2010, whichever occurred first. Cancer incidence was adjusted for age, and compared with the National incidence. Of all 5,154 PLWHA followed-up for 36,296 person-years, 362 (7.0%) developed cancer (997.4 cases per 100,000 person-years). Higher hazard ratios to develop cancer were demonstrated among older PLWHA, Jewish people, and intravenous drug users. Cancer incidence among PLWHA was higher in the pre-ART period than after 1997 (1,232.0 and 846.7 cases per 100,000 person-years, respectively). The incidence of AIDS-defining cancers was higher than non-AIDS-defining malignancies, and higher in the pre-ART than the post-ART period (777.0 and 467.2 cases per 100,000 person-years, respectively), while the incidence of non-AIDS-defining cancers showed the opposite trend (376.5 and 455.0 cases per 100,000 person-years, respectively). The incidence of AIDS-defining and non-AIDS-defining cancers declined between the pre-ART and the post-ART period by 2.0 to 3.4 times. PLWHA had higher rates of malignancies than the general population. In conclusion, cancer incidence among PLWHA was associated with age, and declined after ART introduction; yet it was higher than that of the general population. PLWHA may benefit from age-related cancer screening, increased adherence to ART, and reduction of environmental oncogenes.
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Affiliation(s)
- Zohar Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
- Ramla Department of Health, Ministry of Health, Ramla, Israel
| | - Micha Barchana
- School of Public Health, Haifa University, Haifa, Israel
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17
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Lodi S, Phillips A, Logan R, Olson A, Costagliola D, Abgrall S, van Sighem A, Reiss P, Miró JM, Ferrer E, Justice A, Gandhi N, Bucher HC, Furrer H, Moreno S, Monge S, Touloumi G, Pantazis N, Sterne J, Young JG, Meyer L, Seng R, Dabis F, Vandehende MA, Pérez-Hoyos S, Jarrín I, Jose S, Sabin C, Hernán MA. Comparative effectiveness of immediate antiretroviral therapy versus CD4-based initiation in HIV-positive individuals in high-income countries: observational cohort study. Lancet HIV 2015; 2:e335-43. [PMID: 26423376 PMCID: PMC4643831 DOI: 10.1016/s2352-3018(15)00108-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/16/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recommendations have differed nationally and internationally with respect to the best time to start antiretroviral therapy (ART). We compared effectiveness of three strategies for initiation of ART in high-income countries for HIV-positive individuals who do not have AIDS: immediate initiation, initiation at a CD4 count less than 500 cells per μL, and initiation at a CD4 count less than 350 cells per μL. METHODS We used data from the HIV-CAUSAL Collaboration of cohort studies in Europe and the USA. We included 55,826 individuals aged 18 years or older who were diagnosed with HIV-1 infection between January, 2000, and September, 2013, had not started ART, did not have AIDS, and had CD4 count and HIV-RNA viral load measurements within 6 months of HIV diagnosis. We estimated relative risks of death and of death or AIDS-defining illness, mean survival time, the proportion of individuals in need of ART, and the proportion of individuals with HIV-RNA viral load less than 50 copies per mL, as would have been recorded under each ART initiation strategy after 7 years of HIV diagnosis. We used the parametric g-formula to adjust for baseline and time-varying confounders. FINDINGS Median CD4 count at diagnosis of HIV infection was 376 cells per μL (IQR 222-551). Compared with immediate initiation, the estimated relative risk of death was 1·02 (95% CI 1·01-1·02) when ART was started at a CD4 count less than 500 cells per μL, and 1·06 (1·04-1·08) with initiation at a CD4 count less than 350 cells per μL. Corresponding estimates for death or AIDS-defining illness were 1·06 (1·06-1·07) and 1·20 (1·17-1·23), respectively. Compared with immediate initiation, the mean survival time at 7 years with a strategy of initiation at a CD4 count less than 500 cells per μL was 2 days shorter (95% CI 1-2) and at a CD4 count less than 350 cells per μL was 5 days shorter (4-6). 7 years after diagnosis of HIV, 100%, 98·7% (95% CI 98·6-98·7), and 92·6% (92·2-92·9) of individuals would have been in need of ART with immediate initiation, initiation at a CD4 count less than 500 cells per μL, and initiation at a CD4 count less than 350 cells per μL, respectively. Corresponding proportions of individuals with HIV-RNA viral load less than 50 copies per mL at 7 years were 87·3% (87·3-88·6), 87·4% (87·4-88·6), and 83·8% (83·6-84·9). INTERPRETATION The benefits of immediate initiation of ART, such as prolonged survival and AIDS-free survival and increased virological suppression, were small in this high-income setting with relatively low CD4 count at HIV diagnosis. The estimated beneficial effect on AIDS is less than in recently reported randomised trials. Increasing rates of HIV testing might be as important as a policy of early initiation of ART. FUNDING National Institutes of Health.
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Affiliation(s)
- Sara Lodi
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | | | - Roger Logan
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Ashley Olson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Dominique Costagliola
- Sorbonne Universités, University Pierre et Marie Curie (UPMC), UMR S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Sophie Abgrall
- Sorbonne Universités, University Pierre et Marie Curie (UPMC), UMR S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Antoine Béclère, Service de Médecine Interne, Clamart, France
| | | | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands; Academic Medical Center, Department of Global Health and Division of Infectious Diseases, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - José M Miró
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Elena Ferrer
- Bellvitge University Hospital, L'Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Amy Justice
- Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, CT, USA
| | - Neel Gandhi
- Departments of Epidemiology, Global Health, and Medicine, Emory University, Atlanta, GA, USA
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Santiago Moreno
- Ramón y Cajal Hospital, Madrid, Spain; University of Alcalá de Henares, Madrid, Spain
| | | | | | | | | | - Jessica G Young
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Laurence Meyer
- Université Paris Sud, UMR 1018, and AP-HP, Hôpital de Bicêtre, Service de Santé Publique, le Kremlin Bicêtre, France
| | - Rémonie Seng
- Université Paris Sud, UMR 1018, and AP-HP, Hôpital de Bicêtre, Service de Santé Publique, le Kremlin Bicêtre, France
| | - Francois Dabis
- INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, and Bordeaux University Hospital, Department of Internal Medicine, Bordeaux, France
| | - Marie-Anne Vandehende
- INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, and Bordeaux University Hospital, Department of Internal Medicine, Bordeaux, France
| | - Santiago Pérez-Hoyos
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Vall d'Hebron Research Institute, Barcelona, Spain
| | - Inma Jarrín
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Miguel A Hernán
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, and Harvard-Massachusetts Institute of Technology, Division of Health Sciences and Technology, Boston, MA, USA
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18
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Abstract
BACKGROUND Governments are increasingly recognizing the need to focus limited HIV resources on specific geographic areas and specific populations to have a greater impact. Nigeria, with the second largest HIV epidemic in the world, is an important example of where more localized programming has the potential to improve the efficiency of the HIV response. METHODS Using Spectrum software we modelled the Nigerian HIV epidemic using two methods: First, we created national HIV estimates using trends in urban and rural areas. Second, we created national HIV estimates using trends from each of the 37 states in Nigeria and aggregated these results. In both instances we used HIV surveillance data from antenatal clinics and household surveys and aggregated the trends to determine the national epidemic. RESULTS The state models showed divergent trends in the 37 states. Comparing the national results calculated from the two methods resulted in different conclusions. In the aggregated state files, adult HIV incidence in Nigeria was stable between 2005 and 2013 (change of -6%), whereas the urban and rural file suggested incidence was decreasing over the same time (change of -50%). This difference was also reflected in the HIV prevalence trends, although the two methods showed similar trends in AIDS-related mortality. The two models had similar adult HIV prevalence in 2013: 3.0% (2.0-4.5%) in the aggregated state files versus 3.2% (3.0-3.5%) in the urban/rural file. CONCLUSION The state-level estimates provide insight into the variations of the HIV epidemic in each state and provide useful information for programme managers. However, the reliability of the results is highly dependent on the amount and quality of data available from each sub-national area.
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Suligoi B, Zucchetto A, Grande E, Camoni L, Dal Maso L, Frova L, Virdone S, Boros S, Pappagallo M, Taborelli M, Regine V, De Paoli P, Serraino D. Risk factors for early mortality after AIDS in the cART era: A population-based cohort study in Italy. BMC Infect Dis 2015; 15:229. [PMID: 26067992 PMCID: PMC4464724 DOI: 10.1186/s12879-015-0960-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the dramatically improved survival due to combination antiretroviral therapies (cART), life expectancy of people with HIV/AIDS remains lower than that of the general population. This study aimed to estimate, at a population level, the survival experience of Italian people with AIDS (PWA) and to quantify the prognostic role of selected factors at diagnosis in the risk of early mortality (i.e., within six months from AIDS diagnosis). METHODS A population-based, retrospective-cohort study was conducted among Italian PWA diagnosed between 1999 and 2009 and recorded in the national AIDS registry. The vital status, up to December 2010, of 14,552 PWA was ascertained through a record linkage procedure with the Italian mortality database. Survival probabilities were estimated through Kaplan-Meier method. To identify risk factors for early mortality from any cause, odds ratios (ORs) and corresponding 95% confidence intervals (CIs), adjusted for major confounders, were computed using multivariate logistic regression models. RESULTS Of the 5,706 deaths registered among the 14,552 PWA included in the study, 2,757 (18.9%) occurred within six months from AIDS diagnosis. The probability of surviving six months increased from 81.2% in PWA diagnosed in 1999-2000 to 82.9% in 2009, while the 5-year survival augmented from 60.7% in PWA diagnosed in 1999-2000 to 65.4% for PWA diagnosed in 2005-2006. Elevated risks of early mortality were associated to older age (OR = 5.28; 95% CI: 4.41-6.32 for age ≥60 vs. <35 years), injecting drug use (OR = 1.71; 95% CI: 1.53-1.91 vs. heterosexual intercourse), and CD4 count <50 cells/mm(3) at AIDS diagnosis (OR = 1.87, 95% CI: 1.55-2.27 vs. ≥350). Elevated ORs for early mortality also emerged for PWA diagnosed with primary brain lymphoma (OR = 11.66, 95% CI: 7.32-18.57), or progressive multifocal leukoencephalopathy (OR = 4.21, 95% CI: 3.37-5.27). CONCLUSIONS Our study documented, among Italian PWA, the high - though slightly decreasing - frequency of early mortality in the full cART era. These findings indicate the need for enduring and ameliorating preventive actions aimed at timely HIV testing among all individuals at risk for HIV infection and/or those who present diseases known to be related with HIV infection.
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Affiliation(s)
- Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
| | - Antonella Zucchetto
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
| | - Enrico Grande
- Health and social care Section, National Institute of Statistics, Rome, Italy.
| | - Laura Camoni
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
| | - Luigino Dal Maso
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
| | - Luisa Frova
- Health and social care Section, National Institute of Statistics, Rome, Italy.
| | - Saverio Virdone
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
| | - Stefano Boros
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
| | - Marilena Pappagallo
- Health and social care Section, National Institute of Statistics, Rome, Italy.
| | - Martina Taborelli
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
| | - Vincenza Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy.
| | - Paolo De Paoli
- Scientific Directorate, CRO Aviano National Cancer Institute, Aviano, Italy.
| | - Diego Serraino
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy.
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20
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Abstract
HIV infection is related to an increased risk of cancer compared with general population, both AIDS-defining cancers (Kaposi's sarcoma, non Hodgkin's lymphoma, invasive cervical cancer) and non-AIDS-defining cancers. Although the advent of the highly active antiretroviral therapy era has decreased the Kaposi's sarcoma and non-Hodgkin's lymphoma incidences, non-AIDS-defining malignancies, such as lung cancer, hepatocarcinoma, anal cancer and skin cancers, remain a major cause of morbidity and death in the HIV-infected population. The clinical presentation is often different between the infected and non-infected populations, often with a more advanced stage at diagnosis, a more aggressive pathology, and associated morbidities like immunosuppression, leading to poorer outcomes. Numerous studies have focused on HIV-related malignancies' treatment, however specific guidelines are still missing. Practitioners have to be careful with interactions between antiretroviral and antineoplastic drugs, particularly through the cytochrome P 450. Because of this, a national multidisciplinary approach, "Cancer and HIV, " was started in 2013 thanks to the National Institute of Cancer (INCa). The aim of this review is to present a scientific update about AIDS-and non-AIDS-defining malignancies, both in their clinical aspects and regarding their specific therapeutic management.
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21
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Lodi S, Fisher M, Phillips A, De Luca A, Ghosn J, Malyuta R, Zangerle R, Moreno S, Vanhems P, Boufassa F, Guiguet M, Porter K. Symptomatic illness and low CD4 cell count at HIV seroconversion as markers of severe primary HIV infection. PLoS One 2013; 8:e78642. [PMID: 24244330 PMCID: PMC3828389 DOI: 10.1371/journal.pone.0078642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/20/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The risk/benefit of initiating ART in primary HIV infection (PHI) is unclear. The benefits are more likely to outweigh the risks in patients with severe PHI. An accepted definition of severe PHI is, however, lacking. METHODS CASCADE patients with HIV test interval <6 months were classified as severe and non-severe PHI based on whether the following traits were recorded in the first 6 months following seroconversion: severe specific pre-defined symptoms, central nervous system-implicated illness, and ≥1, ≥2 CD4<350 (and <500) cells/mm(3). For each definition, we used Kaplan-Meier curves and Cox survival models to compare time to AIDS/death, censoring at the earlier of last clinic visit or 1/1/1997, when combination antiretroviral therapy (cART) became available. RESULTS Among 1108 included patients mostly males (85%) infected through sex between men (71%), 366 were diagnosed with AIDS/died. The risk of AIDS/death was significantly higher for individuals with severe symptoms, those with ≥1 CD4<350 cells/mm(3) or ≥2 CD4 <500 cells/mm(3) in the first 6 months [aHR (95% confidence interval) 2.1 (1.4,3.2), 2.0 (1.5,2.7), and 2.3, (1.5-3.5) respectively]. Median [interquantile range] survival for patients with ≥2, ≥1 and no CD4<350 cells/mm(3) within 6 months of seroconversion was 3.9 [2.7,6.5], 5.4 [4.5,8.4] and 8.1 [4.3,10.3] years, respectively. The diagnosis of CNS-implicated symptoms was rare and did not appear to be prognostic. CONCLUSION One CD4 count <350 or two <500 cells/mm(3) within 6 months of seroconversion and/or severe illness in PHI may be useful early indicators of individuals at high risk of disease progression.
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Affiliation(s)
- Sara Lodi
- Instituto de Salud Carlos III, Madrid, Spain
| | - Martin Fisher
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom
| | | | - Andrea De Luca
- University Division of Infectious Diseases, University Hospital of Siena, Siena, Italy
| | - Jade Ghosn
- Université Paris Descartes, EA 3620, Paris, France
| | - Ruslan Malyuta
- Perinatal Prevention of AIDS Initiative, Odessa, The Ukraine
| | | | | | - Philippe Vanhems
- Edouard Herriot Hospital, Lyon, and Universite' de Lyon 1, Lyon, France
| | - Faroudy Boufassa
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of HIV and STI Team, Le Kremlin-Bicetre, France
| | | | - Kholoud Porter
- MRC Clinical Trials Unit at University College London, London, United Kingdom
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22
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Impact of late presentation on the risk of death among HIV-infected people in France (2003-2009). J Acquir Immune Defic Syndr 2013; 64:197-203. [PMID: 24047970 DOI: 10.1097/qai.0b013e31829cfbfa] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A recent consensus defines "late presentation" (LP) during the course of HIV infection as presentation with AIDS whatever the CD4 cell count or with CD4 <350 cells per cubic millimeter. Here, using this new definition, we examined the frequency and predictors of LP and its impact on mortality. METHODS In antiretroviral-naive patients enrolled in the French Hospital Database on HIV between 2003 and 2009, we studied risk factors for LP by multivariable logistic regression. The impact of LP on mortality was analyzed according to the level of immunodeficiency by using Cox multivariable models adjusted for potential confounders, with follow-up categorized into 0-6, 6-12, and 12-48 months. RESULTS There were 11,038 (53.9%) late presenters among the 20,496 patients included in the study. Compared with patients presenting for care with CD4 ≥350 cells per cubic millimeter, patients presenting with AIDS had a very high risk of death with crude hazard ratio ranging from 48.3 during the first 6 months of follow-up to 4.8 during months 12-48; the corresponding values among AIDS-free patients with CD4 ≤200 cells per cubic millimeter were 8.1 and 2.3. Importantly, patients presenting with CD4 between 200 and 350 cells per cubic millimeter also had a significantly increased risk of death beyond 6 months of follow-up (hazard ratio: 3.0 and 1.8 for months 6-12 and 12-48, respectively). Results were similar after adjustment. CONCLUSIONS LP with HIV infection is still very frequent in France and is associated with higher mortality, even among patients with only moderate immunodeficiency. Encouraging early testing and access to care is still urgently needed.
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Identification of TRIM22 single nucleotide polymorphisms associated with loss of inhibition of HIV-1 transcription and advanced HIV-1 disease. AIDS 2013; 27:2335-44. [PMID: 23921607 DOI: 10.1097/01.aids.0000432474.76873.5f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE(S) Tripartite motif-containing 22 (TRIM22) is an interferon-induced protein that inhibits HIV-1 transcription and replication in vitro. Two single nucleotide missense polymorphisms rs7935564A/G (SNP-1) and rs1063303C/G (SNP-2) characterize the coding sequence of human TRIM22 gene. We tested whether these variants affected the inhibitory effect of TRIM22 on HIV-1 replication and transcription and their potential association with HIV-1 disease. DESIGN The allelic discrimination was determined in 182 HIV-1-negative and among HIV-1-positive individuals with advanced disease progression (advanced progressors; n = 57), normal progressors (n = 76), and long-term nonprogressors (LTNPs; n = 95). METHODS Renilla luciferase activity was measured after infection of activated peripheral blood mononuclear cells (PBMCs) from an additional group of 61 blood donors with a recombinant HIV-1. HIV-1-long terminal repeat (LTR)-driven luciferase activity was tested in the presence of plasmid expressing TRIM22 variants in 293T cells. The SNP genotyping was determined by TaqMan assay. RESULTS HIV-1 replication was more efficient in PBMCs from donors with SNP-1G and SNP-2G than from those with SNP-1A and SNP-2C alleles. Consistently, TRIM22-GG enhanced, whereas TRIM22-AC restricted basal HIV-1 LTR-driven transcription. In vivo, SNP-1G homozygotes and A/G heterozygotes were more frequent in advanced progressors than in LTNPs [odds ratio (OR) = 2.072, P = 0.005] or in normal progressors (OR = 1.809, P = 0.022); in contrast, SNP-2 was not associated with any state of HIV-1 disease progression. Although SNP-2 distribution was similar among the groups, TRIM22-GG haplotype was found more frequently in advanced progressors than in LTNPs (P = 0.02). CONCLUSION TRIM22 genetic diversity affects HIV-1 replication in vitro and it is a potentially novel determinant of HIV-1 disease severity.
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Berretta M, Martellotta F, Simonelli C, Di Benedetto F, De Ruvo N, Drigo A, Bearz A, Spina M, Zanet E, Berretta S, Tirelli U. Cetuximab/Targeted Chemotherapy in an HIV-Positive Patient with Metastatic Colorectal Cancer in the HAART Era: a Case Report. J Chemother 2013; 19:343-6. [PMID: 17594933 DOI: 10.1179/joc.2007.19.3.343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Recent data have shown the efficacy of cetuximab/Folfiri regimen in patients with chemotherapy-resistant metastatic colorectal cancer. In the literature there are no data about this treatment in HIV-positive patients with metastatic colorectal cancer. At the Aviano Cancer Center, we used the cetuximab/Folfiri regimen and concomitant HAART in an HIV-positive patient with metastatic colorectal cancer. The patient experienced acceptable non-hematological toxicity, without any opportunistic infection and his HIV infection was kept under control. This case suggests that, in the HAART era, a multidisciplinary approach can be offered to HIV patients with advanced cancer when they have good performance status, resulting in efficacious control of the HIV infection.
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Affiliation(s)
- M Berretta
- Division of Medical Oncology A, National Cancer Institute, Aviano, Italy
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25
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Simmons RD, Ciancio BC, Kall MM, Rice BD, Delpech VC. Ten-year mortality trends among persons diagnosed with HIV infection in England and Wales in the era of antiretroviral therapy: AIDS remains a silent killer. HIV Med 2013; 14:596-604. [PMID: 23672663 DOI: 10.1111/hiv.12045] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We present national trends in death rates and the proportion of deaths attributable to AIDS in the era of effective antiretroviral therapy (ART), and examine risk factors associated with an AIDS-related death. METHODS Analyses of the national HIV-infected cohort for England and Wales linked to death records from the Office of National Statistics were performed. Annual all-cause mortality rates were calculated by age group and sex for the years 1999-2008 and rates for 2008 were compared with death rates in the general population. Risk factors associated with an AIDS-related death were investigated using a case-control study design. RESULTS The all-cause mortality rate among persons diagnosed with HIV infection aged 15-59 years fell over the decade: from 217 per 10 000 in 1999 to 82 per 10 000 in 2008, with declines in all age groups and exposure categories except women aged 50-59 years and persons who inject drugs (rate fluctuations in both of these groups were probably a result of small numbers). Compared with the general population (15 per 10 000 in 2008), death rates among persons diagnosed with HIV infection remained high, especially in younger persons (aged 15-29 years) and persons who inject drugs (13 and 20 times higher, respectively). AIDS-related deaths accounted for 43% of all deaths over the decade (24% in 2008). Late diagnosis (CD4 count < 350 cells/μL) was the most important predictor of dying of AIDS [odds ratio (OR) 10.55; 95% confidence interval (CI) 8.22-13.54]. Sixty per cent of all-cause mortality and 81% of all AIDS-related deaths were attributable to late diagnosis. CONCLUSIONS Despite substantial declines, death rates among persons diagnosed with HIV infection continue to exceed those of the general population in the ART era. Earlier diagnosis could have prevented 1600 AIDS-related deaths over the decade. These findings highlight the need to intensify efforts to offer and recommend an HIV test in a wider range of clinical and community settings.
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Affiliation(s)
- R D Simmons
- HIV and STI Department, Public Health England Centre for Infections, London, UK
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Lacombe JM, Boue F, Grabar S, Viget N, Gazaignes S, Lascaux-Cametz AS, Pacanowski J, Partisani M, Launay O, Matheron S, Rosenthal E, Rouveix E, Tattevin P, de Truchis P, Costagliola D, Goedert JJ. Risk of Kaposi sarcoma during the first months on combination antiretroviral therapy. AIDS 2013; 27:635-43. [PMID: 23196937 PMCID: PMC3623279 DOI: 10.1097/qad.0b013e32835cba6c] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether incident AIDS-defining Kaposi sarcoma or Pneumocystis jiroveci pneumonia (PJP) is associated with combination antiretroviral therapy (cART) initiation. DESIGN Compare risk for Kaposi sarcoma and PJP by time on cART and CD4 reconstitution. METHODS : In the FHDH-ANRS CO4 cohort (N = 66 369), Kaposi sarcoma (N = 1811) and PJP (N = 1718) incidence rates were computed by demographic and HIV strata. Crude and adjusted relative risk (RR) with 95% confidence intervals (CIs) following cART initiation were calculated by Poisson regression with untreated patients during 1996-2009 as reference. CD4 cell counts were compared by Wilcoxon rank sum tests. RESULTS The risk of Kaposi sarcoma was very high during months 1-3 on cART (N = 160, RRCrude 3.94, 95% CI 3.26-4.76), which was incompletely attenuated by adjustment for demographics and contemporaneous CD4 cell count (RRAdj 1.25, 95% CI 1.02-1.53). Corresponding PJP risk was minimally elevated (N = 84, RRCrude 1.80, 95% CI 1.42-2.30) and markedly reduced with adjustment on the same variables and PJP prophylaxis (RRAdj 0.52, CI 0.41-0.67). HIV load had no added effect. Median CD4 cell count at cART initiation was much lower in patients with incident Kaposi sarcoma (82 cells/μl) or PJP (61 cells/μl) within 3 months than in those who did not develop these conditions (>250 cells/μl). Notably, median CD4 cell count change was +44 cells/μl per month with incident Kaposi sarcoma within 3 months of cART initiation versus 0 cells/μl per month with incident PJP (P = 0.0003). CONCLUSION Failure of CD4 cell count reconstitution during months 1-3 on cART fully accounted for incident PJP. In contrast, there were 1.6 additional Kaposi sarcoma cases per 1000 person-years during months 1-3 on cART, suggesting that immune reconstitution may contribute to the risk for AIDS-defining Kaposi sarcoma.
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Jakopanec I, Grjibovski AM, Nilsen Ø, Blystad H, Aavitsland P. Trends in HIV infection surveillance data among men who have sex with men in Norway, 1995-2011. BMC Public Health 2013; 13:144. [PMID: 23414557 PMCID: PMC3585925 DOI: 10.1186/1471-2458-13-144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/12/2013] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recent reports on the growing HIV epidemic among men who have sex with men (MSM) in the EU/EEA area were accompanied by an increase of reported HIV among MSM in Oslo, Norway in 2003. Our study with data from 1995 to 2011 has described the recent trends of HIV among MSM in Norway and their socio-demographic and epidemiological characteristics. METHODS The data were collected from the Norwegian Surveillance System for Communicable Diseases. Cases were described by age, place of infection, clinical presentation of HIV infection, STI co-infection and source partner. We used simple linear regression to estimate trends over time. RESULTS During the study period, 991 MSM, aged from 16 to 80 years, were newly diagnosed with HIV. No significant trends over time in overall median age (36 years) were observed. Most of the MSM (505, 51%) were infected in Oslo. In the years 1995-2002, 30 to 45 MSM were diagnosed with HIV each year, while in the years 2003-2011 this increased to between 56 and 97 cases. The proportion of MSM, presenting with either AIDS or HIV illness, decreased over time, while asymptomatic and acute HIV illness increased (p for trend=0.034 or less). STI co-infection was reported in 133 (13%) cases. An overall increase of syphilis co-infected cases was observed (p for trend <0.001). A casual partner was a source of infection in 590 cases (60%). CONCLUSIONS Though the increases described could be attributed to earlier testing and diagnosis, no change in the median age of cases was observed. This indicates that it is likely that there has been an increase in HIV infections among MSM in Norway since 2003. The simultaneous increase in STI co-infections indicates risky sexual behaviour and a potential to spread both HIV and other sexually transmitted infections.
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Papadopoulos AI, Ferwerda B, Antoniadou A, Sakka V, Galani L, Kavatha D, Panagopoulos P, Poulakou G, Protopapas K, van der Meer JW, Netea MG, Giamarellos-Bourboulis EJ. Association of Mal/TIRAP S180L variant polymorphism with decreased infection risk in patients with advanced HIV-1 infection. Cytokine 2012; 60:104-7. [DOI: 10.1016/j.cyto.2012.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 02/27/2012] [Accepted: 05/11/2012] [Indexed: 01/04/2023]
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van de Putte DEF, Fischer K, Roosendaal G, Hoepelman AIM, Mauser-Bunschoten EP. Morbidity and mortality in ageing HIV-infected haemophilia patients. Haemophilia 2012; 19:141-9. [DOI: 10.1111/j.1365-2516.2012.02912.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- D. E. Fransen van de Putte
- Van Creveldkliniek; Department of Haematology; University Medical Center Utrecht; Utrecht; The Netherlands
| | | | - G. Roosendaal
- Van Creveldkliniek; Department of Haematology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - A. I. M. Hoepelman
- Department of Internal Medicine and Infectious Diseases; University Medical Center Utrecht; Utrecht; The Netherlands
| | - E. P. Mauser-Bunschoten
- Van Creveldkliniek; Department of Haematology; University Medical Center Utrecht; Utrecht; The Netherlands
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Lang S, Mary-Krause M, Simon A, Partisani M, Gilquin J, Cotte L, Boccara F, Costagliola D. HIV replication and immune status are independent predictors of the risk of myocardial infarction in HIV-infected individuals. Clin Infect Dis 2012; 55:600-7. [PMID: 22610928 DOI: 10.1093/cid/cis489] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Individuals infected by human immunodeficiency virus (HIV) have a higher risk of cardiovascular disease than the general population. The specific effects of virological and immunological parameters on the risk of myocardial infarction (MI) in HIV-infected individuals are debated. METHODS We conducted a nested case-control study within the French Hospital Database on HIV. Case patients (n = 289) were patients who, between January 2000 and December 2006, had a prospectively recorded and validated first MI. Up to 5 HIV-infected controls (n = 884) matched for age, sex, and clinical center were selected, at random with replacement, among patients with no history of MI. Conditional logistic regression models were used to identify predictors of the risk of MI. RESULTS Plasma HIV-1 RNA levels >50 copies/mL, a low CD4 T-cell nadir, and a high CD8 T-cell count were independently associated with an increased risk of MI, with respective odds ratios of 1.51 (95% confidence interval, 1.09-2.10), 0.90 (.83-.97) per log(2) unit, and 1.48 (1.01-2.18) for the highest tertile of CD8 T-cell counts (>1150 cells/mm(3)) compared with the lowest (≤760 cells/mm(3)). CONCLUSIONS Independently of cardiovascular risk factors and antiretroviral therapy, HIV replication, a low CD4 T-cell nadir and a high current CD8 T-cell count are associated with an increased risk of MI in HIV-infected individuals. This suggests new paths for interventions to diminish the risk of MI in HIV-infected patients.
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Costagliola D, Lodwick R, Ledergerber B, Torti C, van Sighem A, Podzamczer D, Mocroft A, Dorrucci M, Masquelier B, de Luca A, Jansen K, De Wit S, Obel N, Fätkenheuer G, Touoloumi G, Mussini C, Castagna A, Stephan C, García F, Zangerle R, Duval X, Pérez-Hoyos S, Meyer L, Ghosn J, Fabre-Colin C, Kjaer J, Chene G, Grarup J, Phillips A. Trends in virological and clinical outcomes in individuals with HIV-1 infection and virological failure of drugs from three antiretroviral drug classes: a cohort study. THE LANCET. INFECTIOUS DISEASES 2011; 12:119-27. [PMID: 21988895 DOI: 10.1016/s1473-3099(11)70248-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Limited treatment options have been available for people with HIV who have had virological failure of the three original classes of HIV antiretroviral drugs-so-called triple-class virological failure (TCVF). However, introduction of new drugs and drug classes might have improved outcomes. We aimed to assess trends in virological and clinical outcomes for individuals with TCVF in 2000-09. METHODS In our cohort study, we analysed data for adults starting antiretroviral therapy from 1998 in cohorts participating in the PLATO II project, which is part of COHERE, a collaboration of European cohorts. TCVF was defined as virological failure to at least two nucleoside reverse transcriptase inhibitors, one non-nucleoside reverse-transcriptase inhibitor, and one ritonavir-boosted protease inhibitor, with virological failure of a drug defined as one viral-load measurement of greater than 500 copies per mL after at least 4 months of continuous use. We used multivariable generalised estimating equation logistic models and Poisson regression models to study trends in virological suppression and incidence of AIDS or death after TCVF. We adjusted for sex, transmission group, age, AIDS status, CD4 cell count, plasma viral loads at TCVF, achievement of virological response (<50 copies per mL), and number of drug failures before TCVF. FINDINGS 28 of 33 cohorts in COHERE contributed data to the PLATO II project, of which four had no participants eligible for inclusion in this study. 2476 (3%) of 91 764 participants from the remaining 24 cohorts had TCVF and at least one viral load measurement in 2000-09. The proportion of patients with virological response after TCVF increased from 19·5% in 2000 to 57·9% in 2009 (adjusted p<0·0001). Incidence of AIDS decreased from 7·7 per 100 person-years in 2000-02 to 2·3 in 2008 and 1·2 in 2009 (adjusted p<0·0001). Mortality decreased from 4·0 per 100 person-years between 2000 and 2002 to 1·9 in 2007 and 1·4 in 2008 (unadjusted p=0·023), but the trend was not significant after adjustment (p=0·22). INTERPRETATION A substantial improvement in viral load suppression and accompanying decrease in the rates of AIDS in people after extensive failure to drugs from the three original antiretroviral classes during 2000-09 was probably mainly driven by availability of newer drugs with better tolerability and ease of use and small cross-resistance profiles, suggesting the public health benefit of the introduction of new drugs.
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HIV-associated Hodgkin lymphoma during the first months on combination antiretroviral therapy. Blood 2011; 118:44-9. [PMID: 21551234 DOI: 10.1182/blood-2011-02-339275] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hodgkin lymphoma (HL) incidence with HIV infection may have increased with the introduction of combination antiretroviral therapy (cART), suggesting that immune reconstitution may contribute to some cases. We evaluated HL risk with cART during the first months of treatment. With 187 HL cases among 64 368 HIV patients in France, relative rates (RRs) and 95% confidence intervals (CIs) of HL were estimated using Poisson models for duration of cART, CD4 count, and HIV load, with and without adjustment for demographic/clinical covariates. HL risk was unrelated to cART use overall, but it was related to time intervals after cART initiation (P = .006). Risk was especially and significantly elevated in months 1-3 on cART (RR 2.95, CI 1.64-5.31), lower in months 4-6 (RR 1.63), and null with longer use (RR 1.00). CD4 count was strongly associated with HL risk (P < 10⁻⁶), with the highest HL incidence at 50-99 CD4 cells/mm³. With adjustment for CD4 count and covariates, HL risk was elevated, but not significantly (RR 1.42), in months 1-3 on cART. HIV load had no added effect. HL risk increased significantly soon after cART initiation, which was largely explained by the CD4 count. Further studies of HIV-associated HL are needed.
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Hensel M, Goetzenich A, Lutz T, Stoehr A, Moll A, Rockstroh J, Hanhoff N, Jäger H, Mosthaf F. HIV and cancer in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:117-22. [PMID: 21403801 DOI: 10.3238/arztebl.2010.0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 03/22/2010] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cancer is now the leading cause of death in persons with HIV. In this study, we gathered current epidemiological data on Aids-defining (AD) and non-Aids-defining (NAD) malignancies among HIV-positive patients in Germany. METHODS From 2000 to 2007, all 35 specialized HIV outpatient clinics and 189 HIV ambulatory care centers in Germany were contacted and asked to fill out a structured questionnaire on the incidence of malignancies in HIV-positive patients during multiple periods of observation. RESULTS 552 evaluable data sets were reported. 253 (45.8%) of the reported malignancies were AD. Among the 299 cases (54.2%) of NAD malignancies, there were 214 solid tumors, including 71 anal carcinomas (23.7% of all NAD malignancies), and 85 hematopoietic malignancies, including 29 cases of Hodgkin`s lymphoma (9.7% of all NAD malignancies). The high percentage of NAD malignancy remained constant throughout the entire period of the study. Only a single case of primary cerebral lymphoma was reported after 2001. The number of patients with Hodgkin`s lymphoma rose steadily from 2000 to 2007. CONCLUSION The spectrum of HIV-associated malignancies has changed since the early days of the HIV epidemic. In Germany, NAD malignancies have become more common than AD malignancies. In particular, anal carcinoma and Hodgkin's lymphoma are much more common among persons with HIV than in the general population. Persons with HIV need more intensive preventive care for cancer than non-infected persons do.
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Affiliation(s)
- Manfred Hensel
- Mannheimer Onkologie Praxis Q 5, 14–22, 68161 Mannheim, Germany.
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Martín V, García de Olalla P, Orcau A, Caylà JA. Factors associated with tuberculosis as an AIDS-defining disease in an immigration setting. J Epidemiol 2011; 21:108-13. [PMID: 21325728 PMCID: PMC3899502 DOI: 10.2188/jea.je20100072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Immigration can affect the evolution of TB as an AIDS-defining disease (AIDS–TB). Methods The Barcelona AIDS register for 1994–2005 was analyzed, and the global characteristics of AIDS–TB and AIDS–non-TB cases were compared. The Mantel-Haenszel test was used in the trend analysis, and logistic regression was used in the multivariate analysis. Results Of the 3600 cases studied, 1130 had both AIDS and TB. A declining trend in AIDS–TB rates was observed in both sexes among both immigrants and native residents. The percentage of AIDS–TB was significantly higher among immigrants (P = 0.02). The number of cases among immigrants remained constant over the period of study, but decreased among native residents. The sociodemographic and immunological characteristics associated with TB were male sex, age younger than 36 years, inner city residence, a record of incarceration, greater than 200 CD4+ T-cells/mm3, injecting drug use, heterosexual sex, and immigration from Latin America, the Caribbean, or sub-Saharan Africa. Conclusions The incidence of TB as an AIDS-defining disease decreased in Barcelona during a recent 10-year period in both native and immigrant populations. However, immigrants remain a high-risk group for AIDS–TB and should be targeted for surveillance and control of both diseases.
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Affiliation(s)
- Vicente Martín
- IBIOMED. Área de Medicina Preventiva y Salud Pública. Universidad de León. CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Ndiaye B, Salleron J, Vincent A, Bataille P, Bonnevie F, Choisy P, Cochonat K, Fontier C, Guerroumi H, Vandercam B, Melliez H, Yazdanpanah Y. Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997-2007. BMC Infect Dis 2011; 11:11. [PMID: 21226905 PMCID: PMC3032693 DOI: 10.1186/1471-2334-11-11] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/12/2011] [Indexed: 11/12/2022] Open
Abstract
Background Our objective was to determine the frequency and determinants of presentation to care with advanced HIV disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages. Methods We collected data on 1,819 HIV-infected patients in Brussels (Belgium) and Northern France from January 1997 to December 2007. "Advanced HIV disease" was defined as CD4 count <200/mm3 or clinically-defined AIDS at study inclusion and was stratified into two groups: (a) late testing, defined as presentation to care with advanced HIV disease and HIV diagnosis ≤6 months before initiation of HIV care; and (b) delayed presentation to care, defined as presentation to care with advanced HIV disease and HIV diagnosis >6 months before initiation of HIV care. We used multinomial logistic regression to determine the factors associated with delayed presentation to care and late testing. Results Of the 570 patients initiating care with advanced HIV disease, 475 (83.3%) were tested late and 95 (16.7%) had delayed presentation to care. Risk factors for delayed presentation to care were: age 30-50 years, injection drug use, and follow-up in Brussels. Risk factors for late testing were: sub-Saharan African origin, male gender, and older age. HIV transmission through heterosexual contact was associated with an increased risk of both delayed presentation to care and late testing. Patients who initiated HIV care in 2003-2007 were less likely to have been tested late or to have a delayed presentation to care than patients who initiated care before 2003. Conclusion A considerable proportion of HIV-infected patients present to care with advanced HIV disease. Late testing, rather than a delay in initiating care after earlier HIV testing, is the main determinant of presentation to care with advanced HIV disease. The factors associated with delay presentation to care differ from those associated with late testing. Different strategies should be developed to optimize early access to care in these two groups.
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Fontas E, Kousignian I, Pradier C, Poizot-Martin I, Durier C, Weiss L, Levy Y, Costagliola D. IL-2 therapy: potential impact of the CD4 cell count at initiation on clinical efficacy--results from the ANRS CO4 cohort. J Antimicrob Chemother 2010; 65:2215-23. [PMID: 20702463 DOI: 10.1093/jac/dkq296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We investigated why, despite its beneficial effect on the CD4 cell count, IL-2 therapy had no clinical benefit as shown in the ESPRIT and SILCAAT trials. We focused on subgroups of patients defined according to CD4 cell counts at baseline and over time to assess the threshold above which IL-2 therapy was no longer beneficial in a large cohort of HIV-1 infected patients. METHODS Within the French Hospital Database on HIV, a total of 953 IL-2-treated patients were compared with 27 750 IL-2-untreated patients, matched for the date of enrolment, sex, age, and the baseline CD4 cell count and plasma HIV-1 RNA level. The risk of clinical progression, defined as the occurrence of a new AIDS-defining event or death, was studied with multivariable Cox proportional hazards models and Poisson regression models. RESULTS We found no clinical benefit in patients starting IL-2 with CD4 count ≥200 cells/mm(3) [hazard ratio (HR) =1.13; 95% confidence interval (CI), 0.81-1.57], while a benefit was observed in patients with CD4 count <200 cells/mm(3) (HR=0.64; 95% CI, 0.48-0.86). The observed benefit was due to the risk reduction in the 100-350/mm(3) stratum of updated CD4 cell counts (relative rate=0.30; 95% CI, 0.09-1.03). CONCLUSIONS Higher CD4 cell counts at enrolment and shorter follow-up with low to intermediate CD4 cell counts may explain why IL-2 therapy had no observed clinical benefit in the SILCAAT study. Our findings suggest that the benefit of IL-2 is restricted to a narrow range of CD4 cell counts, arguing against the use of IL-2 in HIV infection to reduce the risk of clinical events.
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Affiliation(s)
- Eric Fontas
- Département de santé publique, Centre Hospitalier Universitaire de Nice, Nice F-06003, France.
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Oliva-Moreno J, López-Bastida J, Serrano-Aguilar P, Perestelo-Pérez L. Determinants of health care costs of HIV-positive patients in the Canary Islands, Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2010; 11:405-412. [PMID: 20049503 DOI: 10.1007/s10198-009-0212-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Accepted: 12/09/2009] [Indexed: 05/28/2023]
Abstract
The aims of this study were to estimate medical expenditures on human immunodeficiency virus (HIV) treatment and to identify significant associated variables. We performed a retrospective multi-centre study in the Canary Islands using a sample of 569 patients recruited at outpatient visits. The study examined demographic and clinical variables, health-related quality of life (HRQOL), and health care resources. Clinical data was obtained from medical records and patient interviews. Several empirical models for identifying the relationship between health care costs and independent variables were developed. The greatest expense came from pharmaceutical expenditure (82.1% of direct costs), while hospital costs only represented 4.6% of total expenditure. The data showed a statistically significant association between health care costs and the CD4 count of the previous year. HRQOL was also a significant variable. Therefore, CD4 cell count can be used to predict health care costs in patients. Policymakers could use this information to help guide their decisions in allocating limited health care resources to HIV treatments.
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Affiliation(s)
- Juan Oliva-Moreno
- Department of Economic Analysis and Finances, University of Castilla la Mancha, Toledo, Spain.
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Franceschi S, Lise M, Clifford GM, Rickenbach M, Levi F, Maspoli M, Bouchardy C, Dehler S, Jundt G, Ess S, Bordoni A, Konzelmann I, Frick H, Dal Maso L, Elzi L, Furrer H, Calmy A, Cavassini M, Ledergerber B, Keiser O. Changing patterns of cancer incidence in the early- and late-HAART periods: the Swiss HIV Cohort Study. Br J Cancer 2010; 103:416-22. [PMID: 20588274 PMCID: PMC2920013 DOI: 10.1038/sj.bjc.6605756] [Citation(s) in RCA: 215] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: The advent of highly active antiretroviral therapy (HAART) in 1996 led to a decrease in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL), but not of other cancers, among people with HIV or AIDS (PWHA). It also led to marked increases in their life expectancy. Methods: We conducted a record-linkage study between the Swiss HIV Cohort Study and nine Swiss cantonal cancer registries. In total, 9429 PWHA provided 20 615, 17 690, and 15 410 person-years in the pre-, early-, and late-HAART periods, respectively. Standardised incidence ratios in PWHA vs the general population, as well as age-standardised, and age-specific incidence rates were computed for different periods. Results: Incidence of KS and NHL decreased by several fold between the pre- and early-HAART periods, and additionally declined from the early- to the late-HAART period. Incidence of cancers of the anus, liver, non-melanomatous skin, and Hodgkin's lymphoma increased in the early- compared with the pre-HAART period, but not during the late-HAART period. The incidence of all non-AIDS-defining cancers (NADCs) combined was similar in all periods, and approximately double that in the general population. Conclusions: Increases in the incidence of selected NADCs after the introduction of HAART were largely accounted for by the ageing of PWHA.
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Affiliation(s)
- S Franceschi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France.
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Serraino D, Bruzzone S, Zucchetto A, Suligoi B, De Paoli A, Pennazza S, Camoni L, Dal Maso L, De Paoli P, Rezza G. Elevated risks of death for diabetes mellitus and cardiovascular diseases in Italian AIDS cases. AIDS Res Ther 2010; 7:11. [PMID: 20497520 PMCID: PMC2881872 DOI: 10.1186/1742-6405-7-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 05/24/2010] [Indexed: 12/28/2022] Open
Abstract
After the introduction of highly active antiretroviral therapies (HAART), an increased incidence of insulin resistance, diabetes mellitus (DM), and cardiovascular diseases has been described. The impact of such conditions on mortality in the post-HAART era has been also assessed in various modes in the literature. In this paper, we report on the death risks for DM, myocardial infarction, and chronic ischemic heart diseases that were investigated among 9662 Italian AIDS cases diagnosed between 1999 and 2005. Death certificates reporting DM, myocardial infarction, and chronic ischemic heart diseases were reviewed to identify the underlying cause of death, and to compare the observed numbers of deaths with the expected ones from the sex- and age-matched, general population of Italy. Person-years at risk of death were computed from date of AIDS diagnosis up to date of death or to December 31, 2006. Standardized mortality ratios (SMR) and their 95% confidence intervals (CI) were computed. DM and cardiovascular diseases were the cause of death for 43 out of 3101 deceased AIDS cases (i.e., 1.4% of all deaths). In comparison with the general population, the risks of death were 6.4-fold higher for DM (95% CI:3.5-10.8), 2.3-fold higher for myocardial infarction (95% CI:1.4-3.7) and 3.0 for chronic ischemic heart diseases (95% CI: 1.5-5.2).
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Lodi S, Guiguet M, Costagliola D, Fisher M, de Luca A, Porter K. Kaposi sarcoma incidence and survival among HIV-infected homosexual men after HIV seroconversion. J Natl Cancer Inst 2010; 102:784-92. [PMID: 20442214 PMCID: PMC2879418 DOI: 10.1093/jnci/djq134] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite the success of combination antiretroviral therapy (cART) in reducing the incidence of Kaposi sarcoma, HIV-infected individuals who have responded to treatment continue to be diagnosed with Kaposi sarcoma. We examine factors associated with the incidence of Kaposi sarcoma among cART-treated HIV-infected homosexual men and changes in their survival after its diagnosis over calendar time. METHODS Data were from HIV-infected homosexual men with well-estimated dates of HIV seroconversion (ie, change in status from being HIV negative to having HIV antibodies detected). Incidence of Kaposi sarcoma was calculated. We used Kaplan-Meier methods to determine survival after Kaposi sarcoma diagnosis in three calendar periods: before 1996, 1996-2000, and 2001-2006. Poisson models were used to examine the effect of risk factors such as current and nadir CD4 cell count (ie, the lowest CD4 cell count ever recorded for a person), duration of infection, and age at diagnosis for Kaposi sarcoma incidence in cART-treated men. All statistical tests were two-sided. RESULTS Among the 9473 men, 555 were diagnosed with Kaposi sarcoma in the period 1986-2006, of whom 319 died. The percentage surviving 24 months after Kaposi sarcoma diagnosis rose statistically significantly during the study period from 35% (95% confidence interval [CI] = 29% to 42%) before 1996 to 84% (95% CI = 76% to 90%) in 1996-2000 and to 81% (95% CI = 70% to 88%) in 2001-2006 (P < .001). Seventy men were diagnosed with Kaposi sarcoma after starting cART. Current (ie, within 6 months) CD4 cell count was associated with incidence of Kaposi sarcoma among cART-treated men (rate ratios [RRs] = 18.91, 95% CI = 8.50 to 42.09, for CD4 level category <200 cells per cubic millimeter; RR = 3.55, 95% CI = 1.40 to 9.00, for 200-349 cells per cubic millimeter; and RR = 4.11, 95% CI = 1.74 to 9.70, for 350-499 cells per cubic millimeter; all compared with > or = 500 cells per cubic millimeter). After adjustment for current CD4 cell count, HIV infection duration, age, or nadir CD4 cell count was not associated with Kaposi sarcoma incidence. CONCLUSIONS Among cART-treated HIV-infected homosexual men, current CD4 cell count was the factor most strongly associated with the incidence of Kaposi sarcoma. Survival estimates after Kaposi sarcoma diagnosis have improved over time.
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Affiliation(s)
- Sara Lodi
- Medical Research Council, Clinical Trials Unit, 222 Euston Rd, London NW1 2DA, UK.
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Serraino D, De Paoli A, Zucchetto A, Pennazza S, Bruzzone S, Spina M, De Paoli P, Rezza G, Dal Maso L, Suligoi B. The impact of Kaposi sarcoma and non-Hodgkin lymphoma on mortality of people with AIDS in the highly active antiretroviral therapies era. Cancer Epidemiol 2010; 34:257-61. [PMID: 20413362 DOI: 10.1016/j.canep.2010.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/19/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) have strongly diminished in the HAART era, but their impact on life expectancy of people with AIDS (PWA) needs to be monitored. We aimed at quantifying the burden of KS and NHL on mortality of PWA in the HAART period in Italy. METHODS Death certificates of 3209 PWA diagnosed in 1999-2006 who died as of December 2006 were reviewed to identify those deaths in which KS or NHL was the underlying cause. Standardized mortality ratios (SMR) were computed. RESULTS KS or NHL appeared in 4.3% and 14.6% death certificates, respectively; they were the underlying cause of death in 3.1% and 13.4% of cases. SMR were 8698-fold higher for KS and 349-fold higher for NHL, and tended to decline over the study period. CONCLUSION KS and NHL caused about 16% of deaths of PWA in the HAART era, with 100-fold higher risks of death compared to the Italian general population also in recent years. Clinicians and public health officials should be aware of the persisting negative impact of these cancers on life expectancy of PWA.
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Affiliation(s)
- Diego Serraino
- Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, IRCCS, Via F. Gallini 2, Aviano (PN), Italy.
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Oliva J. Labour participation of people living with HIV/AIDS in Spain. HEALTH ECONOMICS 2010; 19:491-500. [PMID: 19370540 DOI: 10.1002/hec.1487] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study explores the relationship between the employment status of human immunodeficiency virus (HIV)-positive individuals and socioeconomic and health characteristics in Spain. METHODS Data were obtained from four waves of the HIV/AIDS Hospital Survey from the period 2001 to 2004. The sample was composed of 3376 individuals between 16 and 64 years. Assessment of employment participation was performed using a probit model on a wide range of socioeconomic and lifestyle-related variables. RESULTS The main variables explaining the probability of participation in the labour market were age, gender, education level, CD4 cell count, health status, time since HIV diagnosis, psychological impact of contracting the disease or its progression, the most likely means of transmission and intravenous drug use (IDU). The significance of each of these variables differs for men and women as well as for injecting drug users (IDUs) and non-IDUs. CONCLUSIONS The employment status of HIV-positive individuals is directly related to their health status and other personal characteristics. Policies to improve the well-being of HIV-positive individuals should not be limited to any one sector as their needs require strategies with a multidisciplinary approach.
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Affiliation(s)
- Juan Oliva
- Departamento de Análisis Económico y Finanzas, Fundación de Estudios de Economía Aplicada, CIBER Epidemiología y Salud Pública, Universidad de Castilla La-Mancha, Cobertizo de San Pedro Mártir s/n, Toledo, Spain.
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Polesel J, Franceschi S, Suligoi B, Crocetti E, Falcini F, Guzzinati S, Vercelli M, Zanetti R, Tagliabue G, Russo A, Luminari S, Stracci F, De Lisi V, Ferretti S, Mangone L, Budroni M, Limina RM, Piffer S, Serraino D, Bellù F, Giacomin A, Donato A, Madeddu A, Vitarelli S, Fusco M, Tessandori R, Tumino R, Piselli P, Dal Maso L. Cancer incidence in people with AIDS in Italy. Int J Cancer 2010; 127:1437-45. [DOI: 10.1002/ijc.25153] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kivelä PS, Krol A, Salminen MO, Ristola MA. Determinants of late HIV diagnosis among different transmission groups in Finland from 1985 to 2005. HIV Med 2009; 11:360-7. [PMID: 20002776 DOI: 10.1111/j.1468-1293.2009.00783.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study determinants of late HIV diagnosis in a low-HIV-prevalence (<0.1%) country where HIV spread among men who have sex with men (MSM) and heterosexuals in the 1980s, and among injecting drug users (IDUs) in the late 1990s. METHODS Newly diagnosed HIV cases referred to the Helsinki University Central Hospital between 1985 and 2005 were reviewed to identify determinants of late HIV diagnosis, defined as diagnosis when the first CD4 count was <200 cells/microL, or when AIDS occurred within 3 months of HIV diagnosis. Determinants of late diagnosis were analysed using multivariate logistic regression. RESULTS Among 934 HIV cases, 211 (23%) were diagnosed late. In the first 4-year interval of each sub-epidemic (1985-1989 for MSM and heterosexuals, 1998-2001 for IDUs), rates of late HIV diagnosis were 13%, 18% and 6%, respectively, but increased thereafter to 29%, 27% and 37%. Late diagnosis was associated with non-Finnish ethnicity, older age, male gender, lack of earlier HIV testing, diagnosis at health care settings and later stage of the sub-epidemic. CONCLUSIONS The lower rate of late diagnosis in the first 4-year interval of each HIV sub-epidemic suggests that the early stages of the HIV epidemic in Finland were detected early. This factor may have contributed to the low prevalence of HIV infection in Finland. The stage and age of the epidemic should be taken into account when interpreting the data on late HIV diagnosis, especially in cross-country comparisons.
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Affiliation(s)
- P S Kivelä
- Division of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland.
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Survival After AIDS Diagnosis in Italy, 1999-2006: A Population-Based Study. J Acquir Immune Defic Syndr 2009; 52:99-105. [DOI: 10.1097/qai.0b013e3181a4f663] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Kastenbauer U, Wolf E, Kollan C, Hamouda O, Bogner JR. Impaired CD4-cell immune reconstitution upon HIV therapy in patients with toxoplasmic encephalitis compared to patients with pneumocystis pneumonia as AIDS indicating disease. Eur J Med Res 2009; 14:244-9. [PMID: 19541584 PMCID: PMC3352016 DOI: 10.1186/2047-783x-14-6-244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES There is only little data on immune reconstitution in antiretroviral naive AIDS-patients with toxoplasmosis. The observation of several cases with reduced increase of CD4-cells upon start of antiretroviral treatment (ART) prompted us to investigate the topic using the ClinSurv cohort. METHODS 17 German HIV treatment centers contribute to ClinSurv, a multicentre observational cohort under the auspices of the Robert Koch Institute. We retrospectively selected all antiretroviral-naive patients with toxoplasmic encephalitis (TE) and - as comparator group - with pneumocystosis (PCP) between January 1999 and December 2005. RESULTS A total of 257 patients were included in the analysis, 61 with TE and 196 with PCP. Demographic baseline data showed differences with regard to gender, transmission group, and baseline CD4 superset+ counts (60.9 vs. 44.7/microl, p = 0.022). After ART-initiation the increase in CD4 superset+ lymphocytes was lower in the TE- versus the PCP-group in the first, second and fourth three-month-period (74.4 vs. 120.3/microl, p = 0.006; 96.6 vs. 136.2/microl, p = 0.021; 156.5 vs. 211.5/microl, p = 0.013). Viral load (VL) was higher in the PCP-group at baseline (4.46 log subset10cop/ml vs. 5.00 log subset10cop/ml, p = 0.008), while virological success of ART was equal. CONCLUSIONS Our data show for the first time that the average CD4 superset+ T-cell increase of patients with toxoplasmosis is impaired compared to PCP-patients. Most clinicians would not be prepared to discontinue follow-up TE-therapy unless CD4 superset+ counts of 200/microl are reached. Explanation for our finding might be the myelosuppressive side effect of pyrimethamine, possible interactions of toxoplasmosis therapy with ART, or an unknown direct biological influence of toxoplasmosis on immune restoration.
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Affiliation(s)
- U Kastenbauer
- Department of Infectious Diseases, University Hospital Munich, Medizinische Poliklinik, Germany.
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Simonelli C, Tedeschi R, Gloghini A, Talamini R, Bortolin MT, Berretta M, Spina M, Morassut S, Vaccher E, De Paoli P, Carbone A, Tirelli U. Plasma HHV-8 viral load in HHV-8-related lymphoproliferative disorders associated with HIV infection. J Med Virol 2009; 81:888-96. [PMID: 19319955 DOI: 10.1002/jmv.21349] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is a mono-institutional analysis of the clinical features, immunological and virological findings, and prognostic factors of patients with HIV infection and HHV-8-lymphoproliferative disorders. Patients with Multicentric Castleman Disease and HHV-8-related lymphoma diagnosed and treated from April 1987 to June 2004 were included in the study. HHV-8 and HIV plasma viral load, CD4+ count, hematologic parameters, and general wellbeing (performance status) were assessed at the onset of the diseases and analyzed in order to identify possible prognostic factors. Nine patients with Multicentric Castleman disease, and 16 with HHV-8-related lymphomas (13 primary effusion lymphomas and 3 solid lymphomas), were diagnosed and treated out of 327 HIV-related non-Hodgkin's lymphomas. Four patients with Multicentric Castleman disease received only antiretroviral drugs; 5 HAART plus oral etoposide. Nine patients with primary effusion lymphoma were treated with a CHOP-like regimen (Cyclophosphamide, Prednisone anthracyclines, Vinca alkaloids, Bleomycin, Etoposide) and HAART; 1 with etoposide and HAART, 1 with HAART alone. The patients with solid lymphoma underwent CHOP-like chemotherapy. Patients with Multicentric Castleman disease showed lower median values of HHV-8 viral load and longer overall survival compared with HHV-8-related lymphomas. Patients with viral load of HHV-8, >40,000 cp/ml had a significant shorter overall survival. In the univariate analysis, HHV-8-related lymphoma, HHV-8 viral load >40,000 cp/ml and performance status >2 were associated with an increased risk of death. Multivariate analysis confirmed the diagnosis of lymphoma as an independent predictor of shorter survival.
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Affiliation(s)
- C Simonelli
- Division of Medical Oncology A, National Cancer Institute, Aviano, Italy.
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Lanoy E, Lewden C, Lièvre L, Tattevin P, Boileau J, Aouba A, Chêne G, Costagliola D. How does loss to follow-up influence cohort findings on HIV infection? A joint analysis of the French hospital database on HIV, Mortalité 2000 survey and death certificates. HIV Med 2009; 10:236-45. [DOI: 10.1111/j.1468-1293.2008.00678.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lopez-Bastida J, Oliva-Moreno J, Perestelo-Perez L, Serrano-Aguilar P. The economic costs and health-related quality of life of people with HIV/AIDS in the Canary Islands, Spain. BMC Health Serv Res 2009; 9:55. [PMID: 19331682 PMCID: PMC2670289 DOI: 10.1186/1472-6963-9-55] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 03/30/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective was to determine the economic burden, as well as the impact on HRQOL for people with HIV/AIDS in Spain in 2003. METHODS A cross-sectional study of 572 people with HIV were recruited from outpatient clinics in the Canary Islands, Spain. Demographic, health resources utilization, indirect costs and quality of life data were collected through medical records and questionnaires filled out by people with HIV. HRQOL was measured with two generic questionnaires: SF-36 and EQ-5D. RESULTS In 2003 annual costs of caring for patients with asymptomatic HIV, symptomatic HIV and AIDS were euro10,351, euro14,489 and euro15,750, respectively. The HRQOL with the EQ-5D was 0.78. SF-36 summary results for physical and mental health were 48.30 and 38.80, respectively. CONCLUSION HIV/AIDS represent a high economic impact from society point of view. the structure of health care costs have changed due to these new drugs, increasing the weight of pharmaceutical treatment over total costs and decreasing the importance of inpatient care costs. In spite of the therapeutic improvements, labour losses/indirect costs still represent a high cost. Costs and HRQOL were strongly associated with severity. Although the latest drug developments have not yet been able to find the definitive cure, they have allowed an improvement in expectancy of life and in the HRQOL of the patients.
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