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Oprita A, Cotan H, Celmare D, Emilescu R. Rituximab-Induced Kaposi Sarcoma in HIV-Negative Patients: A Narrative Review. Cureus 2023; 15:e45365. [PMID: 37849608 PMCID: PMC10578454 DOI: 10.7759/cureus.45365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
Kaposi sarcoma (KS) is a low-grade mesenchymal angioproliferative disorder that requires infection with human herpes virus 8 (HHV-8) for it to develop. It is commonly seen in HIV-positive patients and rarely in immunosuppressed HIV-negative patients. Rituximab is a monoclonal anti-CD20 chimeric murine/human immunoglobulin G antibody used to treat B cell lymphoproliferative diseases as well as a variety of autoimmune disorders. Several cases of iatrogenic Kaposi sarcoma (iKS) have been described after rituximab treatment. The purpose of this narrative review is to identify the presence of common clinical characteristics among rituximab-induced KS patients that could facilitate better management of this rare condition.
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Affiliation(s)
| | - Horia Cotan
- Oncology, Elias Emergency University Hospital, Bucharest, ROU
| | - Dana Celmare
- Oncology, Saint Nicholas Medical Center, Pitesti, ROU
| | - Radu Emilescu
- Endocrinology, Diabetes and Metabolism, C.I. Parhon National Institute of Endocrinology, Bucharest, ROU
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2
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Peprah S, Engels EA, Horner MJ, Monterosso A, Hall HI, Johnson AS, Pfeiffer RM, Shiels MS. Kaposi Sarcoma Incidence, Burden, and Prevalence in United States People with HIV, 2000-2015. Cancer Epidemiol Biomarkers Prev 2021; 30:1627-1633. [PMID: 34162660 PMCID: PMC8419027 DOI: 10.1158/1055-9965.epi-21-0008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/25/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The introduction of combination antiretroviral therapy (cART) has led to a significant reduction in Kaposi sarcoma (KS) incidence among people with HIV (PWH). However, it is unclear if incidence has declined similarly across key demographic and HIV transmission groups and the annual number of incident and prevalent KS cases remains unquantified. METHODS Using population-based registry linkage data, we evaluated temporal trends in KS incidence using adjusted Poisson regression. Incidence and prevalence estimates were applied to CDC HIV surveillance data, to obtain the number of incident (2008-2015) and prevalent (2015) cases in the United States. RESULTS Among PWH, KS rates were elevated 521-fold [95% confidence intervals (CI), 498-536] compared with the general population and declined from 109 per 100,000 person-years in 2000 to 47 per 100,000 person-years in 2015, at an annual percentage change of -6%. Rates declined substantially (P trend < 0.005) across all demographic and HIV transmission groups. Of the 5,306 new cases estimated between 2008 and 2015, 89% occurred among men who have sex with men. At the end of 2015, 1,904 PWH (0.20%) had been diagnosed with KS in the previous 5 years. CONCLUSIONS A consistent gradual decline in KS incidence has occurred among PWH in the United States during the current cART era. This decrease is uniform across key demographic and HIV transmission groups, though rates remain elevated relative to the general population. IMPACT Continued efforts to control HIV through early cART initiation and retention in care need to be maintained and possibly expanded to sustain declines.
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Affiliation(s)
- Sally Peprah
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | | | | | - H Irene Hall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
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3
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Shepherd L, Ryom L, Law M, Petoumenos K, Hatleberg CI, d'Arminio Monforte A, Sabin C, Bower M, Bonnet F, Reiss P, de Wit S, Pradier C, Weber R, El-Sadr W, Lundgren J, Mocroft A. Cessation of Cigarette Smoking and the Impact on Cancer Incidence in Human Immunodeficiency Virus-infected Persons: The Data Collection on Adverse Events of Anti-HIV Drugs Study. Clin Infect Dis 2020; 68:650-657. [PMID: 29912335 DOI: 10.1093/cid/ciy508] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/13/2018] [Indexed: 12/13/2022] Open
Abstract
Background Cancers are a major source of morbidity and mortality for human immunodeficiency virus (HIV)-infected persons, but the clinical benefits of smoking cessation are unknown. Methods Participants were followed from 1 January 2004 until first cancer diagnosis, death, or 1 February 2016. Smoking status was defined as ex-smoker, current smoker, and never smoker. Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression, adjusting for demographic and clinical factors. Results In total 35442 persons from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study contributed 309803 person-years of follow-up. At baseline, 49% were current smokers, 21% were ex-smokers, and 30% had never smoked. Incidence of all cancers combined (n = 2183) was highest <1 year after smoking cessation compared to never smokers (aIRR, 1.66 [95% confidence interval {CI}, 1.37-2.02]) and not significantly different from never smokers 1-1.9 years after cessation. Lung cancer incidence (n = 271) was elevated <1 year after cessation (aIRR, 19.08 [95% CI, 8.10-44.95]) and remained 8-fold higher 5 years after smoking cessation (aIRR, 8.69 [95% CI, 3.40-22.18]). Incidence of other smoking-related cancers (n = 622) was elevated in the first year after cessation (aIRR, 2.06 [95% CI, 1.42-2.99]) and declined to a level similar to nonsmokers thereafter. Conclusions Lung cancer incidence in HIV-infected individuals remained elevated >5 years after smoking cessation. Deterring uptake of smoking and smoking cessation efforts should be prioritised to reduce future cancer risk.
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Affiliation(s)
- Leah Shepherd
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
| | - Lene Ryom
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section, Rigshospitalet, University of Copenhagen, Denmark
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kathy Petoumenos
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Camilla Ingrid Hatleberg
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section, Rigshospitalet, University of Copenhagen, Denmark
| | - Antonella d'Arminio Monforte
- Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy
| | - Caroline Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Fabrice Bonnet
- Centre Hospitalier Universitaire de Bordeaux and Institut National de la Santé et de la Recherche Médicale, Université de Bordeaux, France
| | - Peter Reiss
- Academic Medical Center, Department of Global Health and Division of Infectious Diseases, University of Amsterdam.,HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Stephane de Wit
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Wafaa El-Sadr
- ICAP-Columbia University and Harlem Hospital, New York, New York
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section, Rigshospitalet, University of Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
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4
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Grover S, Desir F, Jing Y, Bhatia RK, Trifiletti DM, Swisher-McClure S, Kobie J, Moore RD, Rabkin CS, Silverberg MJ, Salters K, Mathews WC, Gill MJ, Thorne JE, Castilho J, Kitahata MM, Justice A, Horberg MA, Achenbach CJ, Mayor A, Althoff KN. Reduced Cancer Survival Among Adults With HIV and AIDS-Defining Illnesses Despite No Difference in Cancer Stage at Diagnosis. J Acquir Immune Defic Syndr 2018; 79:421-429. [PMID: 30211722 PMCID: PMC6203623 DOI: 10.1097/qai.0000000000001842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is not known whether immune dysfunction is associated with increased risk of death after cancer diagnosis in persons with HIV (PWH). AIDS-defining illness (ADI) can signal significant immunosuppression. Our objective was to determine differences in cancer stage and mortality rates in PWH with and without history of ADI. METHODS PWH with anal, oropharynx, cervical, lung cancers, or Hodgkin lymphoma diagnoses from January 2000 to December 2009 in the North American AIDS Cohort Collaboration on Research and Design were included. RESULTS Among 81,865 PWH, 814 had diagnoses included in the study; 341 (39%) had a history of ADI at time of cancer diagnosis. For each cancer type, stage at diagnosis did not differ by ADI (P > 0.05). Mortality and survival estimates for cervical cancer were limited by n = 5 diagnoses. Adjusted mortality rate ratios showed a 30%-70% increase in mortality among those with ADI for all cancer diagnoses, although only lung cancer was statistically significant. Survival after lung cancer diagnosis was poorer in PWH with ADI vs. without (P = 0.0001); the probability of survival was also poorer in those with ADI at, or before other cancers although not statistically significant. CONCLUSIONS PWH with a history of ADI at lung cancer diagnosis had higher mortality and poorer survival after diagnosis compared to those without. Although not statistically significant, the findings of increased mortality and decreased survival among those with ADI (vs. without) were consistent for all other cancers, suggesting the need for further investigations into the role of HIV-related immune suppression and cancer outcomes.
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Affiliation(s)
- Surbhi Grover
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Fidel Desir
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yuezhou Jing
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rohini K. Bhatia
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Daniel M. Trifiletti
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Julie Kobie
- Department of Biostatics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Charles S. Rabkin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Kate Salters
- BC Centre for Excellence in HIV/AIDS, Simon Fraser University, Vancouver, BC, CANADA
| | | | - M. John Gill
- Southern Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada
| | - Jennifer E. Thorne
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Chad J. Achenbach
- The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Angel Mayor
- Universidad Central del Caribe, Bayamón, Puerto Rico
| | - Keri N Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Risk of Cancer among Commercially Insured HIV-Infected Adults on Antiretroviral Therapy. J Cancer Epidemiol 2016; 2016:2138259. [PMID: 27882054 PMCID: PMC5110893 DOI: 10.1155/2016/2138259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to explore the cancer incidence rates among HIV-infected persons with commercial insurance who were on antiretroviral therapy and compare them with those rates in the general population. Paid health insurance claims for 63,221 individuals 18 years or older, with at least one claim with a diagnostic code for HIV and at least one filled prescription for an antiretroviral medication between January 1, 2006, and September 30, 2012, were obtained from the LifeLink® Health Plan Claims Database. The expected number of cancer cases in the general population for each gender-age group (<30, 30–39, 40–49, 50–59, and >60 years) was estimated using incidence rates from the Surveillance Epidemiology and End Results (SEER) program. Standardized incidence ratios (SIRs) were estimated using their 95% confidence intervals (CIs). Compared to the general population, incidence rates for HIV-infected adults were elevated (SIR, 95% CI) for Kaposi sarcoma (46.08; 38.74–48.94), non-Hodgkin lymphoma (4.22; 3.63–4.45), Hodgkin lymphoma (9.83; 7.45–10.84), and anal cancer (30.54; 25.62–32.46) and lower for colorectal cancer (0.69; 0.52–0.76), lung cancer (0.70; 0.54, 0.77), and prostate cancer (0.54; 0.45–0.58). Commercially insured, treated HIV-infected adults had elevated rates for infection-related cancers, but not for common non-AIDS defining cancers.
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6
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Ureshino H, Ando T, Kojima K, Itamura H, Jinnai S, Doi K, Ohshima K, Kurogi K, Miyahara M, Kimura S. Rituximab-containing Chemotherapy (R-CHOP)-induced Kaposi's Sarcoma in an HIV-negative Patient with Diffuse Large B Cell Lymphoma. Intern Med 2015; 54:3205-8. [PMID: 26666614 DOI: 10.2169/internalmedicine.54.5103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Rituximab treatment may cause or exacerbate Kaposi's sarcoma (KS) in patients with human immunodeficiency virus (HIV)-associated multicentric Castleman's disease. Despite the widespread use of rituximab, rituximab-induced KS has not yet been reported in HIV-negative patients with diffuse large B cell lymphoma (DLBCL). We herein report a case of KS that developed after undergoing rituximab-containing chemotherapy in an HIV-negative patient with DLBCL. An 84-year-old man who received rituximab-containing chemotherapy for the treatment of DLBCL developed severe infection, and subsequently KS. Our observations indicate that serious infections under rituximab treatment may trigger KS. KS should therefore be considered when skin tumors appear in lymphoma patients receiving rituximab-containing chemotherapy.
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Affiliation(s)
- Hiroshi Ureshino
- Department of Internal Medicine, Karatsu Red Cross Hospital, Japan
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7
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Luu HN, Amirian ES, Chiao EY, Scheurer ME. Age patterns of Kaposi's sarcoma incidence in a cohort of HIV-infected men. Cancer Med 2014; 3:1635-43. [PMID: 25139791 PMCID: PMC4298390 DOI: 10.1002/cam4.312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 06/21/2014] [Accepted: 07/02/2014] [Indexed: 12/27/2022] Open
Abstract
The life expectancy for HIV-positive individuals has improved over time due to increasing access to highly active antiretroviral therapy (HAART). Yet, as the HIV-positive population ages, their risk of developing cancers also increases. Studies of Kaposi's sarcoma (KS) among elderly HIV-infected persons are quite limited. We examined the age patterns of KS incidence and an association between age and KS risk in a US cohort of 3458 HIV-infected men, the Multicenter AIDS Cohort Study (MACS). Poisson distribution was used to calculate incidence rates and respective 95% confidence intervals (95% CIs). Cox proportional hazards regression was performed to examine the association between age and KS risk. There were 534 incident KS cases with a total follow-up time of 25,134 person-years. The overall KS incidence rate was 2.13 per 100 person-years (95% CI: 1.95–2.32) (Non-HAART users-ever: 5.57 per 100 person-years [95% CI: 5.09–6.10]; HAART users-ever: 0.39 per 100 person-years [95% CI: 0.31–0.51]). Overall, KS frequency and incidence declined with age, even in the oldest age group (ptrend < 0.0001). However, among non-HAART users-ever, the oldest age group had the highest incidence rate ratio compared to younger individuals [15.01, 95% CI: 6.12–44.22]). While the incidence of KS decreased with age, older HIV-infected persons who do not receive HAART are still at increased risk of KS. As KS remains an important malignancy among HIV-infected persons, earlier HIV diagnoses and HAART initiation, particularly in older HIV-infected persons is warranted.
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Affiliation(s)
- Hung N Luu
- Disivion of Epidemiology, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
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8
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Cloarec N, Faucher O, Bregigeon S, Brunet C, Tamalet C, Cano C, Poizot Martin I. Kaposi's sarcoma in a treated and well-controlled HIV infected patient: Discussion on the role of immunosenescence. HIV & AIDS REVIEW 2014. [DOI: 10.1016/j.hivar.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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9
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Winstone TA, Man SFP, Hull M, Montaner JS, Sin DD. Epidemic of lung cancer in patients with HIV infection. Chest 2013; 143:305-314. [PMID: 23381313 DOI: 10.1378/chest.12-1699] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The survival of patients with HIV infection has improved dramatically over the past 20 years, largely owing to a significant reduction in opportunistic infections and AIDs-defining malignancies, such as lymphoma and Kaposi sarcoma. However, with improved survival, patients with HIV are experiencing morbidity and mortality from other (non-AIDs-defining) complications, such as solid organ malignancies. Of these, the leading cause of mortality in the HIV-infected population is lung cancer, accounting for nearly 30% of all cancer deaths and 10% of all non-HIV-related deaths. Importantly, the average age of onset of lung cancer in the HIV-infected population is 25 to 30 years earlier than that in the general population and at lower exposure to cigarette smoke. This article provides an overview of the epidemiology of lung cancer in the HIV-infected population and discusses some of the important risk factors and pathways that may enhance the risk of lung cancer in this population.
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Affiliation(s)
- Tiffany A Winstone
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, BC, Canada
| | - S F Paul Man
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, BC, Canada; UBC James Hogg Research Center, St. Paul's Hospital, Vancouver, BC, Canada
| | - Mark Hull
- Division of AIDS, Department of Medicine, University of British Columbia, BC, Canada; Institute for Heart + Lung Health, and British Columbia Centre for Excellence in HIV/AIDs, St. Paul's Hospital, Vancouver, BC, Canada
| | - Julio S Montaner
- Division of AIDS, Department of Medicine, University of British Columbia, BC, Canada; Institute for Heart + Lung Health, and British Columbia Centre for Excellence in HIV/AIDs, St. Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, BC, Canada; UBC James Hogg Research Center, St. Paul's Hospital, Vancouver, BC, Canada.
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Shrestha S, Johnson DC, Porter DC, Reid E, Palchinsky J, Napravnik S, Mathews WC, Eron JJ, Saag MS. Short communication: lack of occult HIV infection among non-AIDS-defining cancer patients in three academic oncology clinics in the United States. AIDS Res Hum Retroviruses 2013; 29:887-91. [PMID: 23351216 DOI: 10.1089/aid.2012.0344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The Centers for Disease Control (CDC) testing recommendations suggest universal opt-out testing in all health care settings, including cancer clinics. The incidence of non-AIDS-defining cancers (NADCs) is on the rise among HIV patients. However, to date, no data exist on the prevalence of HIV infection among NADC patients in the United States. Knowledge of HIV infection may affect clinical management, prognosis, and overall patient survival and decrease new infections in the population. The purpose of this study was to determine the point seroprevalence of HIV infection in cancer patients being seen in medical oncology clinics. A total of 634 individuals (mean age=53.2 years) participated and were tested for HIV. None of the participants tested positive for HIV in any of the three clinics. Using a futility analysis, the upper end of the 95% confidence interval for prevalence of undiagnosed HIV in cancer patients was less than 0.3%. Most participants were female (59.2%) and non-Hispanic (96.6%). The majority of study participants were white (76.5%) or African-American (17.7%). Breast cancer (19.7%), colon cancer (10.3%), and melanoma (9.7%) were the most commonly reported non-AIDS-defining cancers. While our study suggested that there was no occurrence of undiagnosed HIV among NADC patients, it is important to note that our population was largely white, females with insurance and with a different distribution of cancer than the most prevalent NADC among HIV patients. Furthermore, one-third of the patients did not consent to participate and further studies are needed to assess reasons for their unwillingness along with other populations, specifically minorities and individuals with low socioeconomic status (SES).
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Affiliation(s)
- Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Derek C. Johnson
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Donna C. Porter
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
| | - Erin Reid
- Department of Medicine, University of California San Diego, San Diego, California
| | - Jill Palchinsky
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William C. Mathews
- Department of Medicine, University of California San Diego, San Diego, California
| | - Joseph J. Eron
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael S. Saag
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama
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Older HIV-infected patients--an underestimated population in northern Greece: epidemiology, risk of disease progression and death. Int J Infect Dis 2013; 17:e883-91. [PMID: 23639484 DOI: 10.1016/j.ijid.2013.02.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 02/05/2013] [Accepted: 02/24/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES HIV prevalence among older people is on the increase. The aim of this study was to evaluate the epidemiological and clinical features at diagnosis and survival of older patients. METHODS This was a retrospective analysis of the data of 558 newly diagnosed antiretroviral-naïve patients between January 1998 and December 2008. Patients were divided into two groups according to their age at diagnosis: ≥50 years (n=103) and 18-49 years (n=455). RESULTS The most common risk factor for older patients was heterosexual contact (p<0.013). Older patients were more likely to suffer from hypertension (33.0% vs. 5.1%, p<0.0005), cardiovascular disease (20.4% vs. 2.9%, p<0.0005), neurological disorders (11.7% vs. 5.5%, p=0.02), renal dysfunction (12.6% vs. 5.3%, p=0.01), and infections (66.0% vs. 49.7%, p=0.003) than their younger counterparts, and to have more hospital admissions during follow-up (47.5% vs. 19.6%, p<0.0005). Older patients had a shorter survival time (p<0.0005). A statistically significant increase in CD4+ cell number through time was observed in both groups (p<0.0005). Younger patients reached higher magnitudes of absolute numbers of CD4+ cells during follow-up (p<0.0005) after the initiation of antiretroviral therapy. The total number of patients with clinical AIDS from baseline throughout the study period was also higher in the older age group (35.9% vs. 25.0%). CONCLUSIONS HIV-infected people aged ≥50 years differ in epidemiological and clinical features to younger HIV-infected people. The issue of increasing prevalence of HIV infection is a matter of concern due to existing comorbidities, which probably lead to higher mortality rates and faster progression to clinical AIDS.
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Abstract
As mortality due to AIDS-related causes has decreased with the use of antiretroviral therapy, there has been a rise in deaths related to non-AIDS-defining illnesses. Given the exceedingly high prevalence of cigarette smoking among individuals living with HIV infection, tobacco has been implicated as a major contributor to this paradigm shift. Evidence suggests that smoking-related illnesses, such as cardiovascular disease, respiratory illnesses, and certain malignancies, contribute substantially to morbidity and mortality among HIV-infected persons. In this review, we summarize the adverse health consequences of smoking relevant to HIV-infected individuals and discuss smoking cessation in this unique population, including a discussion of barriers to quitting and a review of studies that have examined smoking cessation interventions.
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13
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Lung cancer incidence and mortality among HIV-infected and HIV-uninfected injection drug users. J Acquir Immune Defic Syndr 2011; 55:510-5. [PMID: 20838223 DOI: 10.1097/qai.0b013e3181f53783] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine the impact of HIV on lung cancer incidence and survival. DESIGN : Prospective study of 2495 HIV-infected and HIV-uninfected injection drug users in Baltimore, MD. METHODS Cancer data were obtained from the Maryland Cancer Registry. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer in 2 strata of packs of cigarettes smoked per day by HIV serostatus, and for mortality by HIV serostatus. RESULTS HIV-infected participants had twice the risk (HR = 2.3; 95% CI: 1.1 to 5.1) of lung cancer. There was no evidence of an interaction between HIV and packs of cigarettes smoked per day (P interaction = 0.18). Compared with participants who smoked <1.43 packs per day, among HIV-uninfected individuals lung cancer risk was 6 times greater (HR = 5.9; 95% CI: 2.1 to 17) and among HIV-infected individuals lung cancer risk was doubled (HR = 2.1; 95% CI: 0.63 to 6.8) in persons who smoked ≥1.43 per day. Additionally, HIV was associated with 4 times the risk of death (HR = 3.8; 95% CI: 0.92 to 15) in lung cancer cases. CONCLUSIONS HIV was associated with increased risk of lung cancer, after adjusting for smoking. However, no evidence was observed for synergistic effects of HIV and smoking. Further, HIV was associated with poorer lung cancer survival after accounting for cancer stage.
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Seaberg EC, Wiley D, Martínez-Maza O, Chmiel JS, Kingsley L, Tang Y, Margolick JB, Jacobson LP. Cancer incidence in the multicenter AIDS Cohort Study before and during the HAART era: 1984 to 2007. Cancer 2010; 116:5507-16. [PMID: 20672354 DOI: 10.1002/cncr.25530] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 06/03/2010] [Accepted: 06/16/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) among human immunodeficiency virus (HIV)-infected individuals declined after the introduction of highly active antiretroviral therapy (HAART) in the mid-1990s, but the cancer risk associated with HIV infection during the HAART era remains to be clarified. METHODS Cancer incidence among HIV-infected and HIV-uninfected participants in the Multicenter AIDS (acquired immunodeficiency syndrome) Cohort Study (MACS) between 1984 and 2007 was compared with the expected incidence using US population-based data from the Surveillance, Epidemiology, and End Results (SEER) program. Age- and race-adjusted cancer incidence rates were also compared HIV by status and over time within the MACS. Exact statistical methods were used for all analyses. RESULTS A total of 933 incident cancers were observed during 77,320 person-years of follow-up. Compared with SEER, MACS HIV-infected men had significantly (P<.05) elevated rates of KS (standardized incidence ratio [SIR], 139.10), NHL (SIR, 36.80), Hodgkin lymphoma (HL)(SIR, 7.30), and anal cancer (SIR, 25.71). Within MACS, HIV infection was found to be independently associated with each of these cancers across the entire follow-up period, and KS (incidence rate ratio [IRR], 54.93), NHL (IRR, 11.18), and anal cancer (IRR, 18.50) were each found to be significantly elevated among HIV-infected men during the HAART era. Among these men, the incidence of KS and NHL declined (IRR, 0.13 and 0.23, respectively), the incidence of anal cancer increased (IRR, 5.84), and the incidence of HL remained statistically unchanged (IRR, 0.75) from the pre-HAART to the HAART era. CONCLUSIONS Cancer risk remains elevated among HIV-infected men who have sex with men, highlighting the continuing need for appropriate cancer screening in this population.
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Affiliation(s)
- Eric C Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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15
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Abstract
The prevalence of HIV in patients over the age of 50 years is increasing. Although older patients may achieve equal or better virologic suppression at equal rates compared with younger patients, the immunologic benefit of highly active antiretroviral therapy (HAART) in older patients may be reduced compared with younger patients. Comorbidities are more common in older patients than younger patients and can impact management of HIV in these patients. Providers must be cognizant of drug-drug interactions and side effects of HAART regimens when selecting an antiretroviral regimen in older HIV patients. As the HIV-infected population ages, there is a growing need to better determine the ideal HAART regimen and timing of HAART initiation in older patients.
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16
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A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr 2009; 52:611-22. [PMID: 19770804 DOI: 10.1097/qai.0b013e3181b327ca] [Citation(s) in RCA: 364] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To estimate summary standardized incidence ratios (SIRs) of non-AIDS cancers among HIV-infected individuals compared with general population rates overall and stratified by gender, AIDS, and highly active antiretroviral therapy (HAART) era. DESIGN A meta-analysis using SIRs from 18 studies of non-AIDS cancer in HIV-infected individuals. METHODS SIRs for non-AIDS cancers in HIV-infected individuals and 95% confidence limits (CLs) were abstracted from each study. Random effects meta-analyses were used to estimate summary SIRs. Modifications by gender, AIDS, and HAART era were estimated with meta-regression. RESULTS Four thousand seven hundred ninety-seven non-AIDS cancers occurred among 625,716 HIV-infected individuals. SIRs for several cancers were elevated. In particular, cancers associated with infections, such as anal (SIR = 28; 95% CL 21 to 35), liver (SIR = 5.6; 95% CL 4.0 to 7.7), and Hodgkin lymphoma (SIR = 11; 95% CL 8.8 to 15) and smoking, such as lung (SIR = 2.6; 95% CL 2.1 to 3.1), kidney (SIR = 1.7; 95% CL 1.3 to 2.2), and laryngeal (SIR = 1.5; 95% CL 1.1 to 2.0). AIDS was associated with greater SIRs for Hodgkin lymphoma, leukemia, lung, brain, and all non-AIDS cancers combined. CONCLUSIONS HIV-infected individuals may be at an increased risk of developing non-AIDS cancers, particularly those associated with infections and smoking. An association with advanced immune suppression was suggested for certain cancers.
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17
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Effect of highly active antiretroviral therapy on survival of HIV infected patients with non-small-cell lung cancer. Lung Cancer 2009; 65:345-50. [PMID: 19135758 DOI: 10.1016/j.lungcan.2008.11.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 11/28/2008] [Accepted: 11/30/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the impact of highly active antiretroviral therapy (HAART) on survival in HIV infected patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS All consecutive HIV infected patients with NSCLC diagnosed between 06/1996 and 03/2007 at two University hospitals in Paris (France) were prospectively followed until death. The association between survival and clinical and biological factors was analyzed by univariate and multivariate models. Survival analysis was performed by Kaplan-Meier estimates and the Cox proportional hazards regression model. RESULTS During the study period, NSCLC was diagnosed in 49 consecutive HIV infected patients (median age 46 years); 84% had advanced disease. Median survival was 8.1 months (range 5-10 months). In multivariate analysis, baseline parameters with significant positive impact on survival included performance status (PS) < or =1 (HR=0.2, 95%CI [0.09, 0.46], p=0.0001), stage I-II disease (HR=0.15, 95%CI [0.04, 0.53], p=0.003), and use of HAART (HR=0.4, 95%CI [0.2, 0.9], p=0.027). CONCLUSION HAART is a good prognostic factor for survival in HIV infected patients with NSCLC. Stage of disease and PS are two other valid survival prognostic factors.
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18
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Abstract
In the US, an estimated 1 million people are infected with HIV, although one-third of this population are unaware of their diagnosis. While HIV infection is commonly thought to affect younger adults, there are an increasing number of patients over 50 years of age living with the condition. UNAIDS and WHO estimate that of the 40 million people living with HIV/AIDS in the world, approximately 2.8 million are 50 years and older. With the introduction of highly active antiretroviral therapy (HAART) in the mid-1990s, survival following HIV diagnosis has risen dramatically and HIV infection has evolved from an acute disease process to being managed as a chronic medical condition. As treated HIV-infected patients live longer and the number of new HIV diagnoses in older patients rise, clinicians need to be aware of these trends and become familiar with the management of HIV infection in the older patient. This article is intended for the general clinician, including geriatricians, and will review epidemiologic data and HIV treatment as well as provide a discussion on medical management issues affecting the older HIV-infected patient.
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Affiliation(s)
- Nancy Nguyen
- University of the Pacific School of Pharmacy and Health Sciences, Stockton, CA, USA
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19
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McGinnis KA, Fultz SL, Skanderson M, Conigliaro J, Bryant K, Justice AC. Hepatocellular Carcinoma and Non-Hodgkin's Lymphoma: The Roles of HIV, Hepatitis C Infection, and Alcohol Abuse. J Clin Oncol 2006; 24:5005-9. [PMID: 17075119 DOI: 10.1200/jco.2006.05.7984] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To explore the relationship of HIV, hepatitis C (HCV), and alcohol abuse/dependence to risk for hepatocellular carcinoma and non-Hodgkin's lymphoma (NHL). Patients and Methods Male veterans (n = 14,018) with a first HIV diagnosis in the Veterans Affairs Healthcare System from October 1997 to September 2004; and 28,036 age-, race-, sex-, and location-matched HIV-negative veterans were identified. We examined the incidence of hepatocellular carcinoma and NHL and presence of HCV and alcohol abuse/dependence using International Classification of Diseases, ninth revision (ICD-9-CM) codes. HIV-positive to HIV-negative incident rate ratios (IRRs) and 95% CIs for the occurrence of hepatocellular carcinoma and NHL were calculated using Poisson regression models. Results HIV-positive veterans were at greater risk for hepatocellular carcinoma than HIV-negative veterans (IRR = 1.68; 95% CI, 1.02 to 2.77). After adjusting for HCV infection and alcohol abuse/dependence, HIV status was not independently associated with hepatocellular cancer (IRR = 0.96; 95% CI, 0.56 to 1.63). HIV-positive veterans had 9.71 times (95% CI, 6.99 to 13.49) greater risk of NHL than HIV-negative veterans. After adjusting for HCV and alcohol abuse/dependence, the IRR for NHL comparing HIV-positive with HIV-negative veterans is similar (IRR = 10.03, 95% CI, 7.19 to 13.97). Conclusion HIV-positive veterans have a higher relative incidence of hepatocellular carcinoma and NHL than HIV-negative veterans. For hepatocellular carcinoma, this association appears to be largely explained by the higher prevalence of HCV and alcohol abuse/dependence. Efforts to decrease hepatocellular carcinoma among persons with HIV should focus primarily on detecting and treating HCV and reducing heavy alcohol use.
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Affiliation(s)
- Kathleen A McGinnis
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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20
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Porntadavity S, Nath A, Prachayasittikul V, Cota-Gomez A, Flores SC, St Clair DK. Different roles of Sp family members in HIV-1 Tat-mediated manganese superoxide dismutase suppression in hepatocellular carcinoma cells. DNA Cell Biol 2005; 24:299-310. [PMID: 15869407 DOI: 10.1089/dna.2005.24.299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The expression of manganese superoxide dismutase (MnSOD) is regulated by agents associated with cancer development. It has been shown that infection with the human immunodeficiency virus type 1 (HIV-1) is associated with the development of liver cancer and that the transactivating transcriptional factor (Tat) of human HIV-1 reduces the expression of MnSOD in several cell types. However, the role of Tat in the expression of MnSOD in hepatocellular carcinoma is unknown. Furthermore, the precise mechanisms whereby Tat suppresses MnSOD expression in hepatocellular carcinoma cells remain unclear. In this report, we build on our original observations that Tat changes the distribution of Sp family members on the MnSOD promoter, which accounts for Tat-dependent changes in basal expression. In hepatic cells, Tat expression upregulates Sp1/Sp3, which play different roles in regulating MnSOD transcription. While overexpression of Sp1 stimulates, overexpression of Sp3 represses transcriptional activity. The transcription repression effect of Sp3 is not due to Sp3 competing for the binding site with Sp1 because only the full-length Sp3 but not the truncated Sp3 suppresses MnSOD promoter activity. These findings suggest a novel mechanism by which Tat modulates the repression of the MnSOD gene and establish a link between HIV infection and liver cancer.
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MESH Headings
- Blotting, Western
- Carcinoma, Hepatocellular
- Cell Line, Transformed
- Cell Line, Tumor
- Gene Expression Regulation, Enzymologic
- Gene Products, tat/genetics
- Genes, Reporter
- HIV-1/genetics
- Humans
- Liver Neoplasms
- Luciferases/analysis
- Luciferases/metabolism
- Plasmids
- Promoter Regions, Genetic
- RNA, Messenger/metabolism
- Sp1 Transcription Factor/genetics
- Sp1 Transcription Factor/metabolism
- Superoxide Dismutase/genetics
- Superoxide Dismutase/metabolism
- Transcription, Genetic
- Transfection
- beta-Galactosidase/metabolism
- tat Gene Products, Human Immunodeficiency Virus
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Affiliation(s)
- Sureerut Porntadavity
- Graduate Center for Toxicology, University of Kentucky, Lexington, Kentucky 40536, USA
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21
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Biggar RJ, Kirby KA, Atkinson J, McNeel TS, Engels E. Cancer Risk in Elderly Persons With HIV/AIDS. J Acquir Immune Defic Syndr 2004; 36:861-8. [PMID: 15213571 DOI: 10.1097/00126334-200407010-00014] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Cancer risks in persons with AIDS are increased, but risks in elderly persons with AIDS (EPWAs) have not been previously described. OBJECTIVE To determine the profile of cancer risks in EPWAs. DATA SOURCES AND ANALYSIS Using AIDS data from 1981-1996, 8828 EPWAs were identified (60+ years old) and their records were linked to data in local cancer registries, finding 1142 cases. Expected case numbers were derived from the cancer incidence in the population matched for age, sex, race, calendar year, and registry. RESULTS Compared with the general population, the relative risk (RR) for Kaposi sarcoma was 545 (95% CI, 406-717) in the 2 years after AIDS onset. For non-Hodgkin lymphoma, the RR was 24.6 (7.5-80.3). No cervical cancers were reported in this interval. From 60 months before to 27 months after AIDS onset, the RR of non-AIDS-defining cancers (n = 548) was 1.3 (1.2-1.4). The cancer types occurring at significant excess during this period were similar to those in younger adults with AIDS: Hodgkin lymphoma (RR: 13.1), anal cancer (8.2), liver cancer (3.9), multiple myeloma (2.7), leukemia (2.4), and lung cancer (1.9). However, none was significantly elevated in the 2 years after the AIDS onset. Prostate cancer risk was low overall (RR: 0.8; 0.6-0.9). CONCLUSIONS The profile of cancer risks in EPWAs generally resembled that in younger adults with AIDS, although RRs were lower because of higher background incidence rates. We speculate that prostate cancer risk was low because of reduced screening for this cancer in EPWAs.
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Affiliation(s)
- Robert J Biggar
- From *Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
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22
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Abstract
PURPOSE OF REVIEW Since the introduction of highly active antiretroviral therapy (HAART), the natural history of human immunodeficiency virus (HIV) infection has changed. Early in the acquired immunodeficiency syndrome (AIDS) epidemic, epidemiologic studies showed that HIV-infected patients were at higher risk for developing specific AIDS-defining malignancies. More recent studies linking HIV/AIDS databases to cancer registries have shown that HIV-infected patients are also at higher risk of developing non-AIDS-defining malignancies. We review the most recent data regarding clinical presentation, pathology, and treatment outcomes for these non-AIDS-defining malignancies. RECENT FINDINGS Recent large cohort studies linking HIV/AIDS databases to cancer registries have shown that HIV-infected patients are also at higher risk of developing non-AIDS-defining malignancies. Besides anal cancer and Hodgkin disease, the cohort studies have identified other malignancies that appear to occur at a higher rate in the HIV-infected population as compared with the general population. These malignancies include lung cancer, skin cancer, germ cell tumors, leiomyosarcomas, cancers of the head and neck, conjunctival cancer, multiple myeloma, and leukemias. SUMMARY As the epidemiology of non-AIDS-defining malignancies continues to evolve, it is unclear whether the appropriate treatments and outcomes for these or other malignancies are changed for HIV-infected patients treated with HAART.
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Affiliation(s)
- Elizabeth Y Chiao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA
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23
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Wu XC, Chen VW, Steele B, Roffers S, Klotz JB, Correa CN, Carozza SE. Cancer incidence in adolescents and young adults in the United States, 1992-1997. J Adolesc Health 2003; 32:405-15. [PMID: 12782451 DOI: 10.1016/s1054-139x(03)00057-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To examine cancer incidence patterns among adolescents and young adults in the United States. METHODS Cancer incidence data from 26 population-based central cancer registries for 1992-1997 were used. Individual cancers were grouped into specific diagnostic groups and subgroups using an integrated classification scheme. The integrated scheme was developed for this study and was based on the most commonly used schemes in population-based epidemiologic studies: Surveillance, Epidemiology, and End Results Program's site groups, International Classification of Childhood Cancer, and International Agency for Research on Cancer's Histological Groups for Comparative Studies. Percent distributions and age-specific incidence rates per million population were computed for adolescents (aged 15-19 years) and young adults (aged 20-24 years) by gender. RESULTS The data for 26,010 cancer cases were examined. Among 15-19-year-olds, the five most common cancers were Hodgkin's disease, leukemia, cancer in the brain and other nervous system, bone cancer, and non-Hodgkin's disease. Among 20-24-year-olds, the five most common cancers were Hodgkin's disease, testicular cancer, thyroid cancer, melanoma of the skin, and leukemia. The proportions and rates of the histologic subtypes for most of the common cancers changed with advancing age. For example, among 15-19-year-olds, acute lymphocytic leukemia accounted for approximately 60% of leukemias in males and 50% in females. Among 20-24-year-olds, however, the corresponding percentages of acute lymphocytic leukemia were 37% in males and 31% in females. For ovarian cancer, the germ cell tumor was the most common subtype (54.6% of all ovarian cancers) among 15-19-year-olds. In contrast, ovarian carcinoma was the predominant subtype (70.4%) among 20-24-year-olds. For both age groups, the incidence rates of nodular Hodgkin's disease, melanoma of the skin, and thyroid cancer were significantly greater in females than in males. CONCLUSIONS Cancer incidence patterns among adolescents and young adults are distinctive. In these age groups, a transition from predominantly pediatric histologic subtypes to adult subtypes was observed for Hodgkin's disease, leukemia, ovarian cancer, and soft tissue sarcoma. Gender differences were found for Hodgkin's disease, melanoma of the skin, and thyroid cancer.
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Affiliation(s)
- Xiao-Cheng Wu
- Department of Public Health and Preventive Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA.
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24
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Dorrucci M, Serraino D, Rezza G. The effect of aging on the incidence of Kaposi's sarcoma among HIV-positive individuals with known dates of seroconversion. Int J Cancer 2003; 104:251-4. [PMID: 12569583 DOI: 10.1002/ijc.10938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Dorrucci
- AIDS and STD Unit, Istituto Superiore di Sanità, Rome, Italy.
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25
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Abstract
The Veterans Aging Cohort Study (VACS) planning meeting was the first of a series of organizational meetings and VA-sponsored conference calls designed to build the scientific foundation and methodological infrastructure for a multisite, longitudinal study of HIV and chronic disease outcomes among aging veterans. More specifically, it served as a consensus conference to determine scientific priorities, develop hypotheses, and to assemble working groups and committees to outline the specific methodological approaches needed. Scientists, physicians from 20 VA clinical facilities in the United States, community members, and experts in the fields of immunology, cancer, sociology, aging, cognition, psychiatry and mental health, epidemiology, large database analysis, and health services research gathered for an intense, 2-day meeting held in Pittsburgh, PA, November 8-9, 2000.
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Affiliation(s)
- M E Danielson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C 11E-124 (130-U), Pittsburgh, PA15240, USA
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