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Ramaswami R. Antiretroviral therapy prescribing in the real-world and impact on cancer risk. AIDS 2024; 38:423-424. [PMID: 38300159 PMCID: PMC10836815 DOI: 10.1097/qad.0000000000003794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Ramya Ramaswami
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD, USA
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2
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Carbone A, Chadburn A, Gloghini A, Vaccher E, Bower M. Immune deficiency/dysregulation -associated lymphoproliferative disorders. Revised classification and management. Blood Rev 2024; 64:101167. [PMID: 38195294 DOI: 10.1016/j.blre.2023.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
Significant advances in the field of lymphoma have resulted in two recent classification proposals, the International Consensus Classification (ICC) and the 5th edition WHO. A few entities are categorized differently in the ICC compared to the WHO. Nowhere is this more apparent than the immunodeficiency lymphoproliferative disorders. The three previous versions of the WHO classification (3rd, 4th and revised 4th editions) and the ICC focused on four clinical settings in which these lesions arise for primary categorization. In contrast the 2023 WHO 5th edition includes pathologic characteristics including morphology and viral status, in addition to clinical setting, as important information for lesion classification. In addition, the 2023 WHO recognizes a broader number of clinical scenarios in which these lesions arise, including not only traditional types of immune deficiency but also immune dysregulation. With this classification it is hoped that new treatment strategies will be developed leading to better patient outcomes.
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Affiliation(s)
- Antonino Carbone
- Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, National Cancer Institute, Aviano, Italy.
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States of America.
| | - Annunziata Gloghini
- Department of Advanced Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Emanuela Vaccher
- Infectious Diseases and Tumors Unit, Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy.
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK.
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3
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Horner MJ, Shiels MS, McNeel TS, Monterosso A, Miller P, Pfeiffer RM, Engels EA. Real-world use of antiretroviral therapy and risk of cancer among people with HIV in Texas. AIDS 2024; 38:379-386. [PMID: 37890463 PMCID: PMC10842424 DOI: 10.1097/qad.0000000000003770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 06/05/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Combination antiretroviral therapy (cART) may reduce cancer risk among people with HIV (PWH), but cancer-specific associations are incompletely understood. METHODS We linked HIV and cancer registries in Texas to a national prescription claims database. cART use was quantified as the proportion of days covered (PDC). Cox proportional hazards models assessed associations of cancer risk with cART usage, adjusting for demographic characteristics, AIDS status, and time since HIV report. RESULTS We evaluated 63 694 PWH followed for 276 804 person-years. The median cART PDC was 21.4% (interquartile range: 0.0-59.8%). cART use was associated with reduced risk of Kaposi sarcoma [adjusted hazard ratio (aHR) 0.48, 95% confidence interval (CI) 0.34-0.68 relative to unexposed status] and non-Hodgkin lymphoma (aHR 0.41, 95% CI 0.31-0.53), liver cancer (aHR 0.61, 95% CI 0.39-0.96), anal cancer (aHR 0.65, 95% CI 0.46-0.92), and a miscellaneous group of 'other' cancers (aHR 0.80, 95% CI 0.66-0.98). In contrast, cART-exposed status was not associated with risk for cervical, lung, colorectal, prostate or breast cancers. CONCLUSION In a large HIV cohort incorporating data from prescription claims, cART was associated with greatly reduced risks of Kaposi sarcoma and non-Hodgkin lymphoma, and to a lesser degree, reduced risks of liver and anal cancers. These associations likely reflect the beneficial effects of HIV suppression and improved immune control of oncogenic viruses. Efforts to increase cART use and adherence may further decrease cancer incidence among PWH.
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Affiliation(s)
- Marie-Josephe Horner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
| | | | | | - Paige Miller
- Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
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Lao X, Zhang H, Deng M, Li Q, Xiao Q, He L, Ma L, Song A, Liang X, Yu F, Zhao H, Zhang F. Incidence of low-level viremia and its impact on virologic failure among people living with HIV who started an integrase strand transfer inhibitors: a longitudinal cohort study. BMC Infect Dis 2024; 24:8. [PMID: 38166689 PMCID: PMC10759638 DOI: 10.1186/s12879-023-08906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Low-level viremia (LLV) has been identified as a potential precursor to virologic failure (VF), yet its clinical implications, particularly within the context of Integrase Strand Transfer Inhibitors (INSTIs)-based regimens, remain insufficiently explored. The study aimed to investigate the relationship between LLV and VF within ART-naïve patients on INSTIs-based regimens in China. METHODS A longitudinal cohort study was conducted with ART-naïve patients aged ≥ 18 years at Beijing Ditan Hospital, under the Chinese National Free Antiretroviral Treatment Program (NFATP). The LLV was defined as a viral load (VL) ranging from 50 to 199 copies/mL after six months of ART initiation, and VF as a VL ≥ 200 copies/mL. Sensitive analyses were also performed, defining LLV as 50-999 copies/mL and VF as exceeding 1000 copies/mL. Multivariate logistic regression, Kaplan-Meier (KM) curve, and Generalized Estimating Equation (GEE) models were used to evaluate the risk factors associated with LLV and VF events. RESULTS The study involved 830 ART-naïve patients, comprising 600 in the INSTIs group and 230 in the protease inhibitors (PIs) group. LLV events were observed in 10.4% of patients on PIs-based regimens and and 3.2% on INSTIs-based regimens (P < 0.001). INSTIs-based regimens demonstrated a protective effect against LLV events (aHR = 0.27, 95% CI 0.137-0.532). VF events occurred in 10.9% of patients on PIs-based regimens and 2.0% on INSTIs-based regimens, respectively (P < 0.001). The occurrence of LLV events significantly increased the risk of VF by 123.5% (95% CI 7.5%-364.4%), while the integrase inhibitors were associated with a 76.9% (95% CI 59.1%-86.9%) reduction in VF risk. CONCLUSION Our findings indicate that INSTIs-based regimens are critical protective factors against LLV and subsequent VF. These results underscore the importance of HIV viral load monitoring to ensuring effective treatment outcomes, highlighting the necessity for prompt and precise monitoring to refine HIV treatment methodologies.
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Affiliation(s)
- Xiaojie Lao
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Hanxi Zhang
- WHO Collaborating Centre for Comprehensive Management of HIV Treatment and Care, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Meiju Deng
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Qun Li
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Qing Xiao
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Lin He
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Liying Ma
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Aqian Song
- Department of Gastroenterology, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Xuelei Liang
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Fengting Yu
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Hongxin Zhao
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Fujie Zhang
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China.
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Omland LH, Gerstoft J, Kronborg G, Johansen IS, Larsen CS, Wiese L, Dalager-Pedersen M, Leth S, Obel N. Cancer risk and temporal trends in people with HIV during a quarter of a century - a nationwide population-based matched cohort study. Infect Dis (Lond) 2024; 56:11-18. [PMID: 37755422 DOI: 10.1080/23744235.2023.2260864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND It is important to understand current trends in cancer risk among people living with HIV (PLWH) to improve outcomes and to commission and delivery appropriate services. METHODS Nationwide, population-based, matched cohort study on all adult PLWH treated at Danish HIV health care centres since 1 January 1995 and a comparison cohort, randomly selected from the background population and matched on sex and date of birth. RESULTS We included 6327 PLWH and 63,270 individuals in the comparison cohort - 74% were men and median age was 37 (interquartile range: 30-46). For both smoking related cancers, virological cancers and other cancers, incidence was substantially higher in the first year of observation for PLWH than for the remaining observation period. The risk of smoking related cancer remained stably increased throughout the observation period, whereas the relative risk of virological cancers decreased, especially in the first year of follow up. Finally, the risk of other cancers for PLWH decreased to a level below that of the background population during the study period. CONCLUSION The fact that the risk of other cancers was probably not higher among PLWH than in the comparison cohort is encouraging, as the excess risk of virological and smoking related cancers is potentially preventable by timely treatment of HIV and smoking cessation.
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Affiliation(s)
- Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Carsten S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Michael Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Steffen Leth
- Department of Infectious Diseases & Internal Medicine, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Wang J, Wang G, Zhu X, Li L, Kang D, Liu Y, Zhang N. The care status and factors affecting antiretroviral therapy timing for people living with HIV: a retrospective cohort study in Shandong Province, China. AIDS Care 2023; 35:1963-1970. [PMID: 36919489 DOI: 10.1080/09540121.2023.2185197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
This study described the care status of People Living with HIV (PLWH) including antiretroviral therapy (ART) and viral suppression from 2018 to 2020. We recognized that immediate ART was associated with improved viral suppression. Therefore, we also aimed to explore the factors affecting the early initiation of ART. We initiated a retrospective cohort study to evaluate the care status of people living with HIV in Shandong Province. From 2018 to 2020, patients infected by homosexual transmission in particular had a higher ART rate (78.82%, 79.69%, and 87.72%, respectively). Of PLWH who received ART, 79.57%, 77.63%, and 67.71% achieved viral suppression, respectively. However, COVID-19 may affect the rate of ART and viral suppression, which we need to explore in our research. From 2018 to 2020, the proportion of immediate antiretroviral therapy within 30 days of diagnosis increased from 48.12% to 65.42%. Multivariate logistic regression demonstrated that patients with junior college degree or above (OR, 1.39 [95%CI, 1.12-1.73]) and key population or medical institutions (OR, 3.62 [95%CI, 2.18-6.16]; OR, 3.88 [95%CI, 2.33-6.59]) were substantially likely to receive ART immediately, while patients outside the province (OR, 0.60 [95%CI, 0.50-0.73]) were less likely to receive ART immediately.
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Affiliation(s)
- Jiongjiong Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Guoyong Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Xiaoyan Zhu
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Ling Li
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Dianmin Kang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Na Zhang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
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Bourdeau B, Shade SB, Koester KA, Rebchook GM, Steward WT, Agins BM, Myers JJ, Phan SH, Matosky M. Rapid start antiretroviral therapies for improved engagement in HIV care: implementation science evaluation protocol. BMC Health Serv Res 2023; 23:503. [PMID: 37198586 DOI: 10.1186/s12913-023-09500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND In 2020, the Health Resources and Services Administration's HIV/AIDS Bureau funded an initiative to promote implementation of rapid antiretroviral therapy initiation in 14 HIV treatment settings across the U.S. The goal of this initiative is to accelerate uptake of this evidence-based strategy and provide an implementation blueprint for other HIV care settings to reduce the time from HIV diagnosis to entry into care, for re-engagement in care for those out of care, initiation of treatment, and viral suppression. As part of the effort, an evaluation and technical assistance provider (ETAP) was funded to study implementation of the model in the 14 implementation sites. METHOD The ETAP has used implementation science methods framed by the Dynamic Capabilities Model integrated with the Conceptual Model of Implementation Research to develop a Hybrid Type II, multi-site mixed-methods evaluation, described in this paper. The results of the evaluation will describe strategies associated with uptake, implementation outcomes, and HIV-related health outcomes for patients. DISCUSSION This approach will allow us to understand in detail the processes that sites to implement and integrate rapid initiation of antiretroviral therapy as standard of care as a means of achieving equity in HIV care.
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Affiliation(s)
- Beth Bourdeau
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA.
| | - Starley B Shade
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly A Koester
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Greg M Rebchook
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Wayne T Steward
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce M Agins
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Janet J Myers
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Son H Phan
- Division of Policy and Data, Health Resources and Services Administration HIV/AIDS Bureau, Rockville, MD, USA
| | - Marlene Matosky
- Division of Policy and Data, Health Resources and Services Administration HIV/AIDS Bureau, Rockville, MD, USA
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Nkwonta CA, Zhang J, Chen S, Weissman S, Olatosi B, Li X. Prevalence and trend of AIDS-defining cancers and non-AIDS-defining cancers and their association with antiretroviral therapy among people living with HIV in South Carolina: a population-based cohort study. AIDS Care 2023; 35:753-763. [PMID: 35578401 PMCID: PMC9666704 DOI: 10.1080/09540121.2022.2074957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
ABSTRACTMonitoring cancer trends and risk is critical as cancer remains a growing problem in persons living with HIV (PLWH). Recent population-based data are limited regarding the cancer trends among PLWH. Our study examined the prevalence and trends in the rate of AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC) and their risk factors in PLWH in South Carolina. Utilizing linked population-based HIV data (2005-2020), time-dependent proportional hazards model was used to identify associated risk predictors of developing cancer in PLWH. Among 11,238 PLWH, 250 individuals developed ADC and 454 developed NADC. The median time from HIV diagnosis to cancer diagnosis was 1.9 years for ADC and 3.8 years for NADC. Individuals who developed ADC or NADC were more likely to be older, male, use substances, have hepatitis infection, hypothyroidism, hypertension, and renal disease. Individuals with viral load >100,000 copies/ml were more likely to develop ADC while those with CD4 count >350 cells/mm3 were less likely to develop ADC or NADC. Our findings suggest that long-term viral suppression may contribute to risk reduction for cancer in PLWH. Early HIV diagnosis along with viral load suppression should be a part of ongoing cancer prevention efforts.
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Affiliation(s)
- Chigozie A. Nkwonta
- Rory Meyers College of Nursing, New York University, New York, NY, USA, 10010
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Shujie Chen
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Sharon Weissman
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA, 29208
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
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Di Ciaccio PR, Van Leeuwen MT, Amin J, Vajdic CM, McGregor S, Poynten IM, Templeton DJ, Law M, Grulich AE, Polizzotto MN, Jin F. Second Primary Cancers in People With HIV/AIDS: A National Data Linkage Study of Incidence and Risk Factors. J Acquir Immune Defic Syndr 2023; 93:25-33. [PMID: 36804500 PMCID: PMC10484748 DOI: 10.1097/qai.0000000000003172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/27/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Evidence regarding the characteristics of second primary cancer (SPC) in people living with HIV (PLWHIV) is limited. SETTING We performed a national population-based data linkage study to determine the incidence and risk factors of SPC in PLWHIV in Australia between 1982 and 2012. METHODS We conducted a probabilistic data linkage study to compare the incidence of SPC over time, defined using HIV treatment eras, for SPCs related to oncogenic viral infection in comparison with non-infection-related SPCs. Risk factors considered included age at diagnosis of cancer, sex, HIV exposure modality, and CD4 + count. RESULTS Of 29,383 individuals diagnosed with HIV, 3123 individuals who developed a first primary cancer were included in the analysis. Among them, 229 cases of SPC were identified across 27,398 person-years of follow-up. The most common SPCs were non-Hodgkin lymphomas (n = 71, 31%). The incidence of SPC overall did not change over time; however, there was an increase in individuals diagnosed with HIV in later eras ( P trend =0.001). The incidence of non-infection-related SPC increased over time and was associated with older age ( P trend = 0.005) and the acquisition of HIV in later eras ( P trend <0.001). Conversely, the incidence of infection-related SPC decreased ( P trend <0.001), but this was no longer significant after adjustment for age ( P trend = 0.14). CONCLUSIONS The risk of SPC in PLWHIV in Australia remains high, with a temporal increase observed in non-infection-related cancer, likely due to aging of the population. Optimal screening and prevention strategies for SPC in PLWHIV are increasingly important.
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Affiliation(s)
- Pietro R. Di Ciaccio
- Department of Haematology, Sydney Adventist Hospital, Sydney, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Marina T. Van Leeuwen
- Cancer Epidemiology Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Janaki Amin
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Claire M. Vajdic
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Skye McGregor
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Isobel M. Poynten
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - David J. Templeton
- Department of Sexual Health Medicine and Sexual Assault Medicine, Sydney Local Health District, Sydney, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Matthew Law
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Andrew E. Grulich
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Mark N. Polizzotto
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
- Clinical Hub for Interventional Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Fengyi Jin
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
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Ruffieux Y, Muchengeti M, Olago V, Dhokotera T, Bohlius J, Egger M, Rohner E. Age and Cancer Incidence in 5.2 Million People With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study. Clin Infect Dis 2023; 76:1440-1448. [PMID: 36461916 PMCID: PMC10319970 DOI: 10.1093/cid/ciac925] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Old age is an important risk factor for developing cancer, but few data exist on this association in people with human immunodeficiency virus (HIV, PWH) in sub-Saharan Africa. METHODS The South African HIV Cancer Match study is a nationwide cohort of PWH based on a linkage between HIV-related laboratory records from the National Health Laboratory Service and cancer diagnoses from the National Cancer Registry for 2004-2014. We included PWH who had HIV-related tests on separate days. Using natural splines, we modeled cancer incidence rates as a function of age. RESULTS We included 5 222 827 PWH with 29 580 incident cancer diagnoses-most commonly cervical cancer (n = 7418), Kaposi sarcoma (n = 6380), and breast cancer (n = 2748). In young PWH, the incidence rates for infection-related cancers were substantially higher than for infection-unrelated cancers. At age 40 years, the most frequent cancer was cervical cancer in female and Kaposi sarcoma in male PWH. Thereafter, the rates of infection-unrelated cancers increased steeply, particularly among male PWH, where prostate cancer became the most frequent cancer type at older age. Whereas Kaposi sarcoma rates peaked at 34 years (101/100 000 person-years) in male PWH, cervical cancer remained the most frequent cancer among older female PWH. CONCLUSIONS Infection-related cancers are common in PWH in South Africa, but rates of infection-unrelated cancers overtook those of infection-related cancers after age 54 years in the overall study population. As PWH in South Africa live longer, prevention and early detection of infection-unrelated cancers becomes increasingly important. Meanwhile, control strategies for infection-related cancers, especially cervical cancer, remain essential.
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Affiliation(s)
- Yann Ruffieux
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Olago
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Tafadzwa Dhokotera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Julia Bohlius
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Eliane Rohner
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Duarte NL, Bueno APS, Sanches BS, Ramos GA, Santos JMBD, Silva HFHE, Pondé JDO, Sá JGD, Rossi PM, Horn PRCB, Sztajnbok DCDN, Rubini NDPM, da Costa ES, Milito CB, de Abreu TF, Land MGP. Prognostic Factors in Children and Adolescents with Lymphomas and Vertical Transmission of HIV in Rio de Janeiro, Brazil: A Multicentric Hospital-Based Survival Analysis Study. Cancers (Basel) 2023; 15:cancers15082292. [PMID: 37190220 DOI: 10.3390/cancers15082292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Lymphomas related to HIV are generally aggressive and have a poor prognosis, despite the use of combined antiretroviral therapy (cART) and effective chemotherapy treatment. To determine survival and prognostic factors in children and adolescents living with HIV (CLWH) in Rio de Janeiro (RJ), Brazil, who developed lymphomas, we performed a retrospective and observational study of vertically infected CLWH aged from 0 to 20 incomplete years during1995 to 2018 at five reference centers for cancer and HIV/AIDS treatment. Of the 25 lymphomas, 19 were AIDS-defining malignancies (ADM) and 6 were non-AIDS-defining malignancies (NADM). The 5-year overall survival (OS) and 5-year event-free survival (EFS) probabilities were both 32.00% (95% CI = 13.72-50.23%), and the 5-year disease-free survival (DFS) probability was 53.30% (95% CI = 28.02-78.58%). In the multivariate Cox regression analysis, performance status 4 (PS 4) was considered a poor prognostic factor for OS (HR 4.85, 95% CI = 1.81-12.97, p = 0.002) and EFS (HR 4.95, 95% CI = 1.84-13.34, p = 0.002). For the DFS, higher CD4+ T-cell counts were considered a better prognostic factor (HR 0.86, 95% CI = 0.76-0.97, p = 0.017) in the multivariate Cox regression analysis. This study demonstrates, for the first time, survival and prognostic factors for CLWH who developed lymphomas in RJ, Brazil.
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Affiliation(s)
- Nathalia Lopez Duarte
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Internal Medicine Postgraduate Program, Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Ana Paula Silva Bueno
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Pediatric Hematology Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Bárbara Sarni Sanches
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Gabriella Alves Ramos
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Faculty of Medical Sciences (FCM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Brazil
| | - Julia Maria Bispo Dos Santos
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Henrique Floriano Hess E Silva
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Janaina de Oliveira Pondé
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - José Gilberto de Sá
- Department of Infectious and Parasitic Diseases, Hospital Municipal Jesus (HMJ), Municipal Health Secretariat (SMS-RJ), Rio de Janeiro 20550-200, Brazil
| | - Priscila Mazucanti Rossi
- Department of Infectious and Parasitic Diseases, Hospital Municipal Jesus (HMJ), Municipal Health Secretariat (SMS-RJ), Rio de Janeiro 20550-200, Brazil
| | | | - Denise Cardoso das Neves Sztajnbok
- Pediatric Infectious Diseases Division, Department of Pediatrics, Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Brazil
| | - Norma de Paula Motta Rubini
- Department of Allergy and Immunology, School of Medicine and Surgery, Gaffrée and Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil
| | - Elaine Sobral da Costa
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Internal Medicine Postgraduate Program, Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Pediatric Hematology Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Cristiane Bedran Milito
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Department of Pathology, Faculty of Medicine (FM), Clementino Fraga Filho University Hospital (HUCFF), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | - Thalita Fernandes de Abreu
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Infectious and Parasitic Diseases Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
| | - Marcelo Gerardin Poirot Land
- Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Internal Medicine Postgraduate Program, Faculty of Medicine (FM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
- Transdisciplinary Center for Research in Child and Adolescent Health (NTISCA), Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
- Pediatric Hematology Service, Institute of Pediatrics and Childcare Martagão Gesteira (IPPMG), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-612, Brazil
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12
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Lim KJC, Di Ciaccio P, Polizzotto MN, Milliken S, Cochrane T, Goh Z, Shaw B, Perry E, Gilbertson M, Kermode W, Cheah CY, Latimer M, Hamad N, Ku M. Outcomes of human immunodeficiency virus-associated Burkitt lymphoma and diffuse large B-cell lymphoma treated in Australia: A report from the Australasian Lymphoma Alliance. Br J Haematol 2023; 201:865-873. [PMID: 36866733 DOI: 10.1111/bjh.18704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 03/04/2023]
Abstract
Antiretroviral therapy (ART) has improved outcomes for human immunodeficiency virus-associated non-Hodgkin lymphoma (HIV-NHL). This is an analysis of 44 patients with HIV with Burkitt lymphoma (HIV-BL) and diffuse large B-cell lymphoma (HIV-DLBCL) treated in Australia over a 10-year period (2009-2019) during the ART and rituximab era. At HIV-NHL diagnosis, the majority of presenting patients had adequate CD4 counts and undetectable HIV viral load <50 copies/mL. More than 80% of patients received chemotherapy with curative intent, rituximab, and concurrent ART with chemotherapy (immunotherapy). R-CODOX-M/IVAC or R-Hyper-CVAD (55%) were most commonly used in HIV-BL. CHOP (58%) was the most commonly used chemotherapy backbone for HIV-DLBCL, although 45% of patients received more intense chemotherapy regimens. Overall, 93% of patients who received curative therapy completed their intended course. The 2-year progression-free survival (PFS) and overall survival (OS) for the HIV-BL cohort was 67% and 67% respectively. The 2-year PFS and OS for the HIV-DLBCL cohort was 77% and 81% respectively. Treatment related mortality was 5%. In all, 83% of patients achieved a CD4 count of >0.2 ×109 /L 6 months after the end of treatment. Current Australian practice favours the treatment of HIV-BL and HIV-DLBCL similarly to the HIV-negative population with the use of concurrent ART, achieving outcomes comparable to the HIV-negative population.
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Affiliation(s)
- Kenneth J C Lim
- Department of Haematology, St Vincent's Hospital Melbourne, Sydney, Melbourne, Australia
| | - Pietro Di Ciaccio
- Department of Haematology, St Vincent's Hospital Sydney, Fitzroy, New South Wales, Australia.,College of Health and Medicine, Australian National University, Canberra, Australia
| | - Mark N Polizzotto
- College of Health and Medicine, Australian National University, Canberra, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Sam Milliken
- Department of Haematology, St Vincent's Hospital Sydney, Fitzroy, New South Wales, Australia
| | - Tara Cochrane
- Gold Coast University Hospital, Southport, Queensland, Australia.,Griffiths University, Nathan, Queensland, Australia
| | - Zhong Goh
- Gold Coast University Hospital, Southport, Queensland, Australia.,Griffiths University, Nathan, Queensland, Australia
| | - Briony Shaw
- Monash Hospital, Clayton, Victoria, Australia
| | - Evelyn Perry
- Department of Haematology, St Vincent's Hospital Melbourne, Sydney, Melbourne, Australia
| | | | - William Kermode
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Chan Y Cheah
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| | - Maya Latimer
- Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Fitzroy, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital Melbourne, Sydney, Melbourne, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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Chigona RK, Mipando ALN. "There Are Just Too Many Rooms Here!" Perception of Clients and Health Care Workers on the Implementation of Test and Treat Strategy at Area 25 Health Center in Lilongwe, Malawi. J Int Assoc Provid AIDS Care 2023; 22:23259582231154224. [PMID: 36760147 PMCID: PMC9943958 DOI: 10.1177/23259582231154224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Background: Malawi adopted World Health Organisation test-and-treat policy in 2016. The policy initiates early antiretroviral treatment to all clients diagnosed with HIV, irrespective of their CD4 count. However, some facilities record low linkage following the strategy. Perceptions of clients and health care workers on the implementation of test-and-treat strategy were explored in Malawi. Methods: A descriptive qualitative approach was conducted in which 21 in-depth interviews, 9 key informant interviews, and 15 non-participatory observations were conducted. Data were analyzed following thematic approach. Results: Most participants had positive perceptions of the test-and-treat strategy. However, negative perceptions stemmed from the fragmented structure of the facility with multiple rooms in which the client navigates through as well as limited privacy. Conclusion: Optimal implementation of the test-and-treat strategy will need to strengthen privacy and minimize unintended disclosure that is inherent in the organization of services.
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Affiliation(s)
- Regina Kasiya Chigona
- School of Public Health and Family Medicine, 37610University of Malawi College of Medicine, Chichiri, Blantyre, Malawi
| | - Alinane Linda Nyondo Mipando
- Lecturer - Health Systems and Policy, Director - MBA in Health Systems Management Program, Department of Health Systems and Policy, School of Public Health and Family Medicine, Kamuzu University of Health Sciences (formerly College of Medicine), Chichiri, Blantyre, Malawi
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14
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Incidence and Clinical Description of Lymphomas in Children and Adolescents with Vertical Transmission of HIV in Rio de Janeiro, Brazil, in Pre- and Post-Combined Antiretroviral Therapy Eras: A Multicentric Hospital-Based Survival Analysis Study. Cancers (Basel) 2022; 14:cancers14246129. [PMID: 36551614 PMCID: PMC9776495 DOI: 10.3390/cancers14246129] [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] [Received: 10/20/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
The incidence of cancer in children living with HIV (CLWH) is high and lymphomas are the most common type of cancer in this population. The combined antiretroviral therapy (cART) changed the natural history of HIV infection. To determine the incidence and profile of these CLWH malignancies in Rio de Janeiro (RJ), Brazil, we conducted a retrospective and observational study of vertically infected CLWH, ranging from 0−20 incomplete years, from 1995 to 2018, at five reference centers. The study period was divided into three eras in accordance with the widespread use of cART in Brazil. 1306 patients were included. Of the 25 lymphomas found, 19 were AIDS-defining malignancies (ADM); 6 were non-AIDS-defining malignancies (NADM). The incidence rate (IR) of lymphoma developing was 1.70 per 1000 children-year (95% CI 1.09−2.50). ADM development IR decreased from 2.09−1.75−0.19 per 1000 children-year (p < 0.001) through cART eras. Cumulative Nelson−Aalen hazards of developing ADM over a 20-year period were 3.73% in the Early-cART era, 3.07% in the Mid-cART era, and 0.32% in the Late-cART era (p = 0.013). This study demonstrates the IR of lymphoma in CLWH in RJ, Brazil, as well as the benefit of cART in reducing ADM and death occurrence in the Post-cART era.
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15
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Mathias-Machado MC, Peixoto RD, Moniz CMV, Jácome AA. Biomarkers in Anal Cancer: Current Status in Diagnosis, Disease Progression and Therapeutic Strategies. Biomedicines 2022; 10:2029. [PMID: 36009576 PMCID: PMC9405643 DOI: 10.3390/biomedicines10082029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Squamous cell carcinoma of the anal canal (SCCA) is a rare neoplasm, but with rising incidence rates in the past few decades; it is etiologically linked with the human papillomavirus (HPV) infection and is especially prevalent in immunocompromised patients, mainly those infected with HIV. Fluoropyrimidine-based chemoradiotherapy remains the cornerstone of the treatment of non-metastatic disease, but the locally advanced disease still presents high rates of disease recurrence and systemic therapy of SCCA is an unmet clinical need. Despite sharing common molecular aspects with other HPV-related malignancies, such as cervical and head and neck cancers, SCCA presents specific epigenomic, genomic, and transcriptomic abnormalities, which suggest that genome-guided personalized therapies should be specifically designed for this disease. Actionable mutations are rare in SCCA and immune checkpoint inhibition has not yet been proven useful in an unselected population of patients. Therefore, advances in systemic therapy of SCCA will only be possible with the identification of predictive biomarkers and the subsequent development of targeted therapies or immunotherapeutic approaches that consider the unique tumor microenvironment and the intra- and inter-tumoral heterogeneity. In the present review, we address the molecular characterization of SCCA and discuss potential diagnostic, predictive and prognostic biomarkers of this complex and challenging disease.
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Affiliation(s)
- Maria Cecília Mathias-Machado
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, São Paulo 04538-132, Brazil
- Department of Oncology, ICESP—Instituto do Cancer do Estado de São Paulo, University of São Paulo, São Paulo 01246-000, Brazil
| | | | - Camila Motta Venchiarutti Moniz
- Department of Oncology, ICESP—Instituto do Cancer do Estado de São Paulo, University of São Paulo, São Paulo 01246-000, Brazil
| | - Alexandre A. Jácome
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Belo Horizonte 34000-000, Brazil
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16
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Luo Q, Pfeiffer RM, Noone AM, Horner MJ, Engels EA, Shiels MS. Years of life lost to cancer among the United States HIV population, 2006-2015. AIDS 2022; 36:1279-1286. [PMID: 35608110 PMCID: PMC9283267 DOI: 10.1097/qad.0000000000003249] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We estimated years of life lost (YLLs) to all causes of death and YLL lost to cancer among persons with HIV (PWH) in the United States. DESIGN Linked HIV and cancer registry data from the HIV/AIDS Cancer Match Study were used to identify incident cancers and deaths among PWH in 11 regions of the United States during 2006-2015. METHODS Mean YLL (MYLL) to all causes of death and MYLL to cancer during 2006-2015 were derived from the restricted mean survival estimated from Cox proportional hazards regression models. MYLLs were then upweighted to the national population of PWH to obtain all-cause total YLL (TYLL) and cancer-related TYLL in the United Staets during 2006-2015. RESULTS Among 466 234 PWH in the study population, 25 772 (5.5%) developed cancer during 2006-2015. Nationally, an estimated 134 986 years of life were lost to cancer of all types during 2006-2015 among PWH, representing 9.6% of TYLL to all causes. Non-Hodgkin lymphoma (NHL), Kaposi sarcoma, anal cancer, and lung cancer were the four largest cancer contributors (45% of TYLL to cancer). The largest fraction of TYLL occurred among back PWH, MSM, and PWH aged 40-59 years old. CONCLUSION PWH have higher mortality rates after developing cancer. NHL, Kaposi sarcoma and anal and lung cancers were large contributors to YLL to cancer in the United States population of PWH, highlighting opportunities to reduce cancer mortality through improved access to antiretroviral treatment, prevention, and screening.
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Affiliation(s)
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
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17
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Bai R, Du J, Lv S, Hua W, Dai L, Wu H. Benefits and Risks of Rapid Initiation of Antiretroviral Therapy: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:898449. [PMID: 35721164 PMCID: PMC9205577 DOI: 10.3389/fphar.2022.898449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: To compare the benefits and risks between Rapid ART and standard/delayed treatment for HIV.Methods: Databases of PubMed, Cochrane Library, Embase and Web of science were searched from the inception to 28 October 2021. Two investigators independently screened studies related to Rapid ART, extracted data, and evaluated the literature quality. The risk of bias was assessed by Cochrane Collaboration Risk of Bias Tool and the statistical software Stata15.0 was used for meta-analysis.Results: Ten eligible studies were included in this meta-analysis, the results showed Rapid ART was superior to standard/delayed treatment in continuing care for at least 8 months (RR = 1.13, 95%CI: 1.03∼1.25, Z = 2.44, p = 0.015), and severe bacterial infection (RR = 0.42, 95%CI: 0.25∼0.70, Z = 3.33, p = 0.001). At 12 months following treatment, there was no statistically significant difference in viral load <100 copies/mL (RR = 1.05, 95%CI: 0.80∼1.39, Z = 0.35, p = 0.726), mortality (RR = 0.77, 95%CI: 0.47∼1.24, Z = 1.09, p = 0.277), or the incidence of adverse events (RR = 0.52, 95%CI: 0.16∼1.76, Z = 1.05, p = 0.294) compared with standard/delayed treatment.Conclusion: In comparison to standard/delayed treatment, rapid ART can reduce the incidence of TB and severe bacterial infections in HIV patients. Our findings suggest that rapid ART should be utilized when clinical conditions and the patient’s physical state allow.Systematic Review Registration: [https://inplasy.com/?s=202210004], identifier [INPLASY202210004].
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Affiliation(s)
- Ruojing Bai
- Beijing Key Laboratory for HIV/AIDS Research, Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Beijing Key Laboratory for HIV/AIDS Research, Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Shiyun Lv
- Beijing Key Laboratory for HIV/AIDS Research, Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wei Hua
- Travel Clinic, Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lili Dai
- Travel Clinic, Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Lili Dai, ; Hao Wu,
| | - Hao Wu
- Beijing Key Laboratory for HIV/AIDS Research, Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Lili Dai, ; Hao Wu,
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18
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Serrano-Villar S, Wu K, Hunt PW, Lok JJ, Ron R, Sainz T, Moreno S, Deeks SG, Bosch RJ. Predictive value of CD8+ T cell and CD4/CD8 ratio at two years of successful ART in the risk of AIDS and non-AIDS events. EBioMedicine 2022; 80:104072. [PMID: 35644125 PMCID: PMC9156990 DOI: 10.1016/j.ebiom.2022.104072] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While increased CD8 counts and low CD4/CD8 ratio during treated HIV correlate with immunosenescence, their additional predictive values to identify individuals with HIV at higher risk of clinical events remain controversial. METHODS We selected treatment-naive individuals initiating ART from ACTG studies 384, 388, A5095, A5142, A5202, and A5257 who had achieved viral suppression at year 2. We examined the effect of CD8+ T cell counts and CD4/CD8 at year 2 on the probability of AIDS and serious non-AIDS events in years 3-7. We used inverse probability weighting methods to address informative censoring, combined with multivariable logistic regression models. FINDINGS We analyzed 5133 participants with a median age of 38 years; 959 (19%) were female, pre-ART median CD4 counts were 249 (Q1-Q3 91-372) cell/µL. Compared to participants with CD8 counts between 500/µL and 1499/µL, those with >1500/µL had a higher risk of clinical events during years 3-7 (aOR 1.75; 95%CI 1.33-2.32). CD4/CD8 ratio was not predictive of greater risk of events through year 7. Additional analyses revealed consistent CD8 count effect sizes for the risk of AIDS events and noninfectious non-AIDS events, but opposite effects for the risk of severe infections, which were more frequent among individuals with CD8 counts <500/µL (aOR 1.70; 95%CI 1.09-2.65). INTERPRETATION The results of this analysis with pooled data from clinical trials support the value of the CD8 count as a predictor of clinical progression. People with very high CD8 counts during suppressive ART might benefit from closer monitoring and may be a target population for novel interventions. FUNDING This research was supported by NIH/NIAID awards UM1 AI068634, UM1 AI068636, and UM1 AI106701 and Carlos III Health Institute and FEDER funds (BA21/00017 and BA21/00022).
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Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain; San Francisco General Hospital, San Francisco, CA, USA.
| | - Kunling Wu
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter W Hunt
- San Francisco General Hospital, San Francisco, CA, USA
| | | | - Raquel Ron
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain
| | - Talía Sainz
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario La Paz and La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Carretera de Colmenar Viejo, km 9.100, Madrid 28034, Spain; Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ronald J Bosch
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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19
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Proulx J, Ghaly M, Park IW, Borgmann K. HIV-1-Mediated Acceleration of Oncovirus-Related Non-AIDS-Defining Cancers. Biomedicines 2022; 10:biomedicines10040768. [PMID: 35453518 PMCID: PMC9024568 DOI: 10.3390/biomedicines10040768] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
With the advent of combination antiretroviral therapy (cART), overall survival has been improved, and the incidence of acquired immunodeficiency syndrome (AIDS)-defining cancers has also been remarkably reduced. However, non-AIDS-defining cancers among human immunodeficiency virus-1 (HIV-1)-associated malignancies have increased significantly so that cancer is the leading cause of death in people living with HIV in certain highly developed countries, such as France. However, it is currently unknown how HIV-1 infection raises oncogenic virus-mediated cancer risks in the HIV-1 and oncogenic virus co-infected patients, and thus elucidation of the molecular mechanisms for how HIV-1 expedites the oncogenic viruses-triggered tumorigenesis in the co-infected hosts is imperative for developing therapeutics to cure or impede the carcinogenesis. Hence, this review is focused on HIV-1 and oncogenic virus co-infection-mediated molecular processes in the acceleration of non-AIDS-defining cancers.
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Malmström S, Wagner P, Yilmaz A, Svedhem V, Carlander C. Failure to restore CD4+ cell count associated with infection-related and noninfection-related cancer. AIDS 2022; 36:447-457. [PMID: 34711738 DOI: 10.1097/qad.0000000000003117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess incidence and relative risk of cancer in Sweden, by HIV status, from 1988 to 2017. DESIGN Population-based register study. METHODS From the Swedish Total Population Register, all people born between 1940 and 2000 (n = 8 587 629), and resident in Sweden sometime 1983-2017 were identified and linked to National HIV Register InfCareHIV, National Cancer Register, and LISA database. We present incidence and adjusted hazard ratios (adjHR) of infection and noninfection-related cancer for three periods between 1988 and 2017. RESULTS Incidence and relative risk of infection-related cancer decreased but remained higher in people with HIV (PWH) than in HIV-negative. The proportion attributable to infection remained higher in PWH than in HIV-negative (44 vs. 9%). Women with HIV had lower risk of infection-related cancer than men with HIV [adjusted hazard ratio (adjHR) 0.6, 95% CI 0.4-0.9], mainly driven by lower incidence of Kaposi's sarcoma (adjHR 0.1, 95% CI 0.0-0.4). Current viral suppression (adjHR 0.3, 95% CI 0.2-0.5) was associated with lower risk of infection-related cancer. Current CD4+ cell count less than 200 cells/μl was associated with both infection-related (adjHR 15.3, 95% CI 10.7-21.8) and noninfection-related cancer (adjHR 2.5, 95% CI 1.5-4.1), as was CD4+ cell count increases less than 100 cells/μl post antiretroviral therapy (ART) (infection-related cancer adjHR 6.6, 95% CI 4.2-10.6, noninfection-related cancer adjHR 2.0, 95% CI 1.2-3.3). CONCLUSION Current CD4+ cell count and failure to restore CD4+ cell count both associated with infection and noninfection-related cancer. Viral suppression associated with lower risk of infection-related cancer. Early HIV detection and early adherent ART remain essential for cancer prevention.
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Affiliation(s)
- Stina Malmström
- Department of Infectious Diseases, Västmanland County Hospital Västerås
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
| | - Philippe Wagner
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | | | - Christina Carlander
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
- Department of Medicine Huddinge
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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21
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Makuku R, Seyedmirzaei H, Tantuoyir MM, Rodríguez-Román E, Albahash A, Mohamed K, Moyo E, Ahmed AO, Razi S, Rezaei N. Exploring the application of immunotherapy against HIV infection in the setting of malignancy: A detailed review article. Int Immunopharmacol 2022; 105:108580. [PMID: 35121225 DOI: 10.1016/j.intimp.2022.108580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/27/2022]
Abstract
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), as of 2019, approximately 42.2 million people have died from acquired immunodeficiency syndrome (AIDS)-related illnesses since the start of the epidemic. Antiretroviral therapy (ART) has significantly reduced mortality, morbidity, and incidence of the human immunodeficiency virus (HIV)/AIDS-defining cancers, taming once-dreaded disease into a benign chronic infection. Although the treatment has prolonged the patients' survival, general HIV prevalence has increased and this increase has dovetailed with an increasing incidence of Non-AIDS-defining cancers (NADCs) among people living with HIV (PLWH). This is happening when new promising approaches in both oncology and HIV infection are being developed. This review focuses on recent progress witnessed in immunotherapy approaches against HIV-related, Non-AIDS-defining cancers (NADCs), and HIV infection.
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Affiliation(s)
- Rangarirai Makuku
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Universal Scientific Education and Research Network (USERN), Harare, Zimbabwe
| | - Homa Seyedmirzaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Marcarious M Tantuoyir
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Accra, Ghana; Biomedical Engineering Unit, University of Ghana Medical Center (UGMC), Accra, Ghana
| | - Eduardo Rodríguez-Román
- Center for Microbiology and Cell Biology, Instituto Venezolano de Investigaciones Científicas, Caracas 1020A, Venezuela; Universal Scientific Education and Research Network (USERN), Caracas, Venezuela
| | - Assil Albahash
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kawthar Mohamed
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Universal Scientific Education and Research Network (USERN), Manama, Bahrain
| | - Ernest Moyo
- Universal Scientific Education and Research Network (USERN), Harare, Zimbabwe; Department of Mathematics and Statistics, Midlands State University, Zimbabwe
| | | | - Sepideh Razi
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Stockholm, Sweden.
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22
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Wong IKJ, Grulich AE, Poynten IM, Polizzotto MN, van Leeuwen MT, Amin J, McGregor S, Law M, Templeton DJ, Vajdic CM, Jin F. Time trends in cancer incidence in Australian people living with HIV between 1982 and 2012. HIV Med 2022; 23:134-145. [PMID: 34585487 PMCID: PMC10499845 DOI: 10.1111/hiv.13179] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of the study was to describe time trends in cancer incidence in people living with HIV (PLHIV) in Australia between 1982 and 2012. METHODS A population-based prospective study was conducted using data linkage between the national HIV and cancer registries. Invasive cancers identified in PLHIV were grouped into AIDS-defining cancers (ADCs), infection-related non-ADCs (NADCs), and non-infection-related NADCs. Crude and age-standardized incidence rates of cancers were calculated and compared over five time periods: 1982-1995, 1996-1999, 2000-2004, 2005-2008 and 2009-2012, roughly reflecting advances in HIV antiretroviral therapy. Standardized incidence ratios (SIRs) compared with the Australian general population were calculated for each time period. Generalized linear models were developed to assess time trends in crude and age-standardized incidences. RESULTS For ADCs, the crude and age-standardized incidences of Kaposi sarcoma and non-Hodgkin lymphoma substantially declined over time (P-trend < 0.001 for all) but SIRs remained significantly elevated. For infection-related NADCs, there were significant increases in the crude incidences of anal, liver and head and neck cancers. Age-standardized incidences increased for anal cancer (P-trend = 0.002) and liver cancer (P-trend < 0.001). SIRs were significantly elevated for anal cancer, liver cancer and Hodgkin lymphoma. For non-infection-related NADCs, the crude incidence of colorectal, lung and prostate cancers increased over time, but age-standardized incidences remained stable. CONCLUSIONS Continuous improvements and high coverage of antiretroviral therapy have reduced the incidence of ADCs in PLHIV in Australia. Clinical monitoring of anal and liver cancers in people living with HIV should be performed, given the increasing incidence of these cancers.
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Affiliation(s)
- Ian K J Wong
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | | | | | | | - Janaki Amin
- Department of Health Systems and Populations, Faculty of Medicine and Health Science, Macquarie University, Sydney, NSW, Australia
| | - Skye McGregor
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - David J Templeton
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District, Camperdown, NSW, Australia
- Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Brites C, Borges ÁH, Sprinz E, Page K. Editorial: HIV and Viral Co-infections. Front Microbiol 2021; 12:731337. [PMID: 34531845 PMCID: PMC8439274 DOI: 10.3389/fmicb.2021.731337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Eduardo Sprinz
- Universidade Federal do Rio Grande do SUL, Porto Alegre, Brazil
| | - Kimberly Page
- University of New Mexico, Albuquerque, NM, United States
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24
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Choi JY, Lui GCY, Liao CT, Yang CJ. Managing cardiovascular risk in people living with HIV in Asia - where are we now? HIV Med 2021; 23:111-120. [PMID: 34494350 DOI: 10.1111/hiv.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
As the life expectancy of people living with HIV (PLWH) approaches that of the general population, the burden of comorbidities such as cardiovascular disease (CVD) is increasing. Regardless of HIV status, about 50% of CVD deaths worldwide occur in Asia, and Asian PLWH have a high prevalence of conventional CVD risk factors, such as smoking, dyslipidaemia, hypertension and insulin resistance or diabetes. As well as conventional CVD risk factors, PLWH have HIV-specific risk factors such as chronic inflammation, immune activation and endothelial damage, as well as risk factors related to antiretroviral therapy. This review describes the current knowledge on the epidemiology and risk factors of CVD in Asian PLWH and provides an Asian perspective on the recommendations for managing CVD risk in PLWH.
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Affiliation(s)
- Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Grace Chung Yan Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chia-Te Liao
- Division of Cardiology, Chi-Mei Medical Centre, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chia-Jui Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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25
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Hematological cancers in individuals infected by HIV. Blood 2021; 139:995-1012. [PMID: 34469512 DOI: 10.1182/blood.2020005469] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022] Open
Abstract
HIV infection increases cancer risk and is linked to cancers associated to infectious agents classified as carcinogenic to humans by the International Agency for Research on Cancer. Lymphomas represent one of the most frequent malignancies among individuals infected by HIV. Diffuse large B-cell lymphoma remains a leading cancer after the introduction of combined antiretroviral therapy (cART). The incidence of other lymphomas including Burkitt lymphoma, primary effusion lymphomas, and plasmablastic lymphoma of the oral cavity remain stable, while the incidence of Hodgkin lymphoma and Kaposi sarcoma-associated herpesvirus (KSHV)-associated Multicentric Castleman Disease has increased. The heterogeneity of lymphomas in individuals infected by HIV likely depends on the complexity of involved pathogenetic mechanisms, i.e. HIV-induced immunosuppression, genetic abnormalities, cytokine dysregulation, co-infection with the gamma-herpesviruses, Epstein Barr virus and KSHV, and the dysregulation of the immune responses controlling these viruses. In the modern cART era, standard treatments for HIV-associated lymphoma including stem cell transplantation in relapsed/refractory disease, mirrors that of the general population. The combination of cART and anti neoplastic treatments has resulted in remarkable prolongation of long-term survival. However, oncolytic and immunotherapic strategies, and therapies targeting specific viral oncogenes will need to be developed primarily.
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26
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Silverberg MJ, Leyden W, Hernández-Ramírez RU, Qin L, Lin H, Justice AC, Hessol NA, Achenbach CJ, D’Souza G, Engels EA, Althoff KN, Mayor AM, Sterling TR, Kitahata MM, Bosch RJ, Saag MS, Rabkin CS, Horberg MA, Gill MJ, Grover S, Mathews WC, Li J, Crane HM, Gange SJ, Lau B, Moore RD, Dubrow R, Neugebauer RS. Timing of Antiretroviral Therapy Initiation and Risk of Cancer Among Persons Living With Human Immunodeficiency Virus. Clin Infect Dis 2021; 72:1900-1909. [PMID: 32785640 PMCID: PMC8315132 DOI: 10.1093/cid/ciaa1046] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Persons living with human immunodeficiency virus (HIV; PLWH) experience a high burden of cancer. It remains unknown which cancer types are reduced in PLWH with earlier initiation of antiretroviral therapy (ART). METHODS We evaluated AIDS-free, ART-naive PLWH during 1996-2014 from 22 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. PLWH were followed from first observed CD4 of 350-500 cells/µL (baseline) until incident cancer, death, lost-to-follow-up, or December 2014. Outcomes included 6 cancer groups and 5 individual cancers that were confirmed by chart review or cancer registry linkage. We evaluated the effect of earlier (in the first 6 months after baseline) versus deferred ART initiation on cancer risk. Marginal structural models were used with inverse probability weighting to account for time-dependent confounding and informative right-censoring, with weights informed by subject's age, sex, cohort, baseline year, race/ethnicity, HIV transmission risk, smoking, viral hepatitis, CD4, and AIDS diagnoses. RESULTS Protective results for earlier ART were found for any cancer (adjusted hazard ratio [HR] 0.57; 95% confidence interval [CI], .37-.86), AIDS-defining cancers (HR 0.23; 95% CI, .11-.49), any virus-related cancer (HR 0.30; 95% CI, .16-.54), Kaposi sarcoma (HR 0.25; 95% CI, .10-.61), and non-Hodgkin lymphoma (HR 0.22; 95% CI, .06-.73). By 15 years, there was also an observed reduced risk with earlier ART for virus-related NADCs (0.6% vs 2.3%; adjusted risk difference -1.6; 95% CI, -2.8, -.5). CONCLUSIONS Earlier ART initiation has potential to reduce the burden of virus-related cancers in PLWH but not non-AIDS-defining cancers (NADCs) without known or suspected viral etiology.
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Affiliation(s)
- Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Raúl U Hernández-Ramírez
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Li Qin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Haiqun Lin
- Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- School of Nursing, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, USA
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- Research Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA
| | - Chad J Achenbach
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angel M Mayor
- Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico
| | - Timothy R Sterling
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ronald J Bosch
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles S Rabkin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - W Christopher Mathews
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Romain S Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Immunophenotypic characterization of TCR γδ T cells and MAIT cells in HIV-infected individuals developing Hodgkin's lymphoma. Infect Agent Cancer 2021; 16:24. [PMID: 33865435 PMCID: PMC8052713 DOI: 10.1186/s13027-021-00365-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background Despite successful combined antiretroviral therapy (cART), the risk of non-AIDS defining cancers (NADCs) remains higher for HIV-infected individuals than the general population. The reason for this increase is highly disputed. Here, we hypothesized that T-cell receptor (TCR) γδ cells and/or mucosal-associated invariant T (MAIT) cells might be associated with the increased risk of NADCs. γδ T cells and MAIT cells both serve as a link between the adaptive and the innate immune system, and also to exert direct anti-viral and anti-tumor activity. Methods We performed a longitudinal phenotypic characterization of TCR γδ cells and MAIT cells in HIV-infected individuals developing Hodgkin’s lymphoma (HL), the most common type of NADCs. Cryopreserved PBMCs of HIV-infected individuals developing HL, matched HIV-infected controls without (w/o) HL and healthy controls were used for immunophenotyping by polychromatic flow cytometry, including markers for activation, exhaustion and chemokine receptors. Results We identified significant differences in the CD4+ T cell count between HIV-infected individuals developing HL and HIV-infected matched controls within 1 year before cancer diagnosis. We observed substantial differences in the cellular phenotype mainly between healthy controls and HIV infection irrespective of HL. A number of markers tended to be different in Vδ1 and MAIT cells in HIV+HL+ patients vs. HIV+ w/o HL patients; notably, we observed significant differences for the expression of CCR5, CCR6 and CD16 between these two groups of HIV+ patients. Conclusion TCR Vδ1 and MAIT cells in HIV-infected individuals developing HL show subtle phenotypical differences as compared to the ones in HIV-infected controls, which may go along with functional impairment and thereby may be less efficient in detecting and eliminating malignant cells. Further, our results support the potential of longitudinal CD4+ T cell count analysis for the identification of patients at higher risk to develop HL. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-021-00365-4.
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Adinani H, Campbell L, El-Mallawany NK, Slone J, Mehta P, Bacha J. Use of Paclitaxel to Successfully Treat Children, Adolescents, and Young Adults with Kaposi Sarcoma in Southwestern Tanzania. CHILDREN-BASEL 2021; 8:children8040275. [PMID: 33918352 PMCID: PMC8067189 DOI: 10.3390/children8040275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022]
Abstract
Treating Kaposi sarcoma (KS) in children, adolescents, and young adults (AYA) remains a challenge in low- and middle-income countries (LMIC) where chemotherapy options and availability are limited. We describe a retrospective cohort review of pediatric patients with KS treated with paclitaxel in Mbeya, Tanzania, between 1 March 2011 and 31 December 2019. Paclitaxel was given to patients who had KS relapse, a contraindication to bleomycin, vincristine, and doxorubicin (ABV), special circumstances in which a clinician determined that paclitaxel was preferable to ABV, or experienced treatment failure, defined as persistent KS symptoms at the completion of treatment. All patients also received multidisciplinary palliative care. Seventeen patients aged 5.1–21.3 years received paclitaxel, of whom 47.1% (8/17) had treatment failure, 29.4% (5/17) received paclitaxel as initial treatment, and 23.5% (4/17) had relapsed. All HIV positive patients (16/17) were given anti-retroviral therapy (ART) and 87.5% (14/16) achieved viral load <1000 cp/mL. At censure, 82.3% (14/17) of patients were alive—71.4% (10/14) achieved complete clinical remission and 28.6% (4/14) achieved a partial response. The median follow up was 37.3 months (range 8.0–83.5, IQR 19.7–41.6), and no patients were lost to follow up. In this cohort, high rates of long-term survival and favorable outcomes were possible with paclitaxel treatment.
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Affiliation(s)
- Hamidu Adinani
- Department of Health and Social Welfare, Tanzania Ministry of Health, Community De-velopment, Gender, Elderly and Children, Tarime District, Mara Region 31401, Tanzania;
| | - Liane Campbell
- Department of Pediatrics, Baylor College of Medicine Children’s Foundation—Tanzania, Mbeya 53107, Tanzania;
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children’s Hospital, Houston, TX 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (N.K.E.-M.); (J.S.); (P.M.)
- Correspondence: ; Tel.: +255-759-339918
| | - Nader Kim El-Mallawany
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (N.K.E.-M.); (J.S.); (P.M.)
- Global HOPE, Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Jeremy Slone
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (N.K.E.-M.); (J.S.); (P.M.)
- Global HOPE, Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Parth Mehta
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (N.K.E.-M.); (J.S.); (P.M.)
- Global HOPE, Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Jason Bacha
- Department of Pediatrics, Baylor College of Medicine Children’s Foundation—Tanzania, Mbeya 53107, Tanzania;
- Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children’s Hospital, Houston, TX 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (N.K.E.-M.); (J.S.); (P.M.)
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Abstract
BACKGROUND It is unknown if the carcinogenic effect of smoking is influenced by CD4+ cell count and viral load in persons living with HIV. MATERIAL AND METHODS RESPOND participants with known smoking status were included. Poisson regression adjusting for baseline confounders investigated the interaction between current CD4+/viral load strata [good (CD4+ cell count ≥500 cells/μl and viral load <200 copies/ml], poor [CD4+ cell count ≤350 cells/μl and viral load >200 copies/ml] and intermediate [all other combinations]), smoking status and all cancers, non-AIDS defining cancers (NADCs), smoking-related cancers (SRCs) and infection-related cancers (IRCs). RESULTS Out of 19 602 persons, 41.3% were never smokers, 44.4% current and 14.4% previous smokers at baseline. CD4+/viral load strata were poor in 3.4%, intermediate in 44.8% and good in 51.8%. There were 513 incident cancers; incidence rate 6.9/1000 person-years of follow-up (PYFU) [95% confidence interval (95% CI) 6.3-7.5]. Current smokers had higher incidence of all cancer (adjusted incidence rate ratio 1.45; 1.17-1.79), NADC (1.65; 1.31-2.09), SRC (2.21; 1.53-3.20) and IRC (1.38; 0.97-1.96) vs. never smokers. Those with poor CD4+/viral load had increased incidence of all cancer (5.36; 95% CI 3.71-7.75), NADC (3.14; 1.92-5.14), SRC (1.82; 0.76-4.41) and IRC (10.21; 6.06-17.20) vs. those with good CD4+/viral load. There was no evidence that the association between smoking and cancer subtypes differed depending on the CD4+/viral load strata (P > 0.1, test for interaction). CONCLUSION In the large RESPOND consortium, the impact of smoking on cancer was clear and reducing smoking rates should remain a priority. The association between current immune deficiency, virological control and cancer was similar for never smokers, current smokers and previous smokers suggesting similar carcinogenic effects of smoking regardless of CD4+ cell count and viral load.
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Elvstam O, Marrone G, Medstrand P, Treutiger CJ, Svedhem V, Gisslén M, Björkman P. Associations Between Plasma Human Immunodeficiency Virus (HIV) Ribonucleic Acid Levels and Incidence of Invasive Cancer in People With HIV After Initiation of Combination Antiretroviral Therapy. Open Forum Infect Dis 2021; 8:ofab131. [PMID: 34189159 PMCID: PMC8231372 DOI: 10.1093/ofid/ofab131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) viremia could be involved in the increased risk of cancer in people with HIV (PWH) receiving combination antiretroviral therapy (cART). We analyzed the association between plasma HIV ribonucleic acid levels in PWH starting cART and incident invasive cancer using the Swedish cohort InfCare HIV linked with national registers. Methods Adults starting cART in 1996–2017 were included if they had ≥1 viral load (VL) measurement before receiving any antiretroviral agent (pre-ART VL) and ≥2 VLs ≥6 months after start of cART. Viremia during cART was analyzed both as viremia-copy-years and categorized as suppression (<50 copies/mL), low-level viremia ([LLV] 50–999 copies/mL), and nonsuppression (≥1000 copies/mL). The main outcome was a composite of invasive malignancies with increased incidence among PWH. We fitted proportional subhazard models (including sex, age, pre-ART CD4 count, and injection drug use) for both pre-ART VL and viremia during cART. Results After 32 105 person-years, 3254 of 4931 participants (66%) were classified as suppressed, 438 (9%) were classified as LLV, and 1221 (25%) were classified as nonsuppressed. Neither viremia category nor cumulative viremia during cART had a statistically significant association with cancer. Higher pre-ART VL was associated with cancer (adjusted subhazard ratio, 1.4; 95% confidence interval, 1.0–1.8); this remained statistically significant with viremia during cART in the model. In subanalysis, the association with pre-ART VL was statistically significant for acquired immune deficiency syndrome (AIDS)-defining and infection-related non-AIDS-defining cancer, but not for other malignancies. Conclusions In this nationwide cohort, pre-ART VL was an independent predictor of invasive cancer, whereas viremia profile during cART was not associated with cancer incidence.
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Affiliation(s)
- Olof Elvstam
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Gaetano Marrone
- Department of Infectious Diseases and Clinical Virology, Karolinska University Hospital, Stockholm, Sweden
| | - Patrik Medstrand
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Carl Johan Treutiger
- Department of Infectious Diseases/Venhälsan, South General Hospital, Stockholm, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Björkman
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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31
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Shih WL, Fang CT, Chen PJ. Chapter XX Antiviral Treatment and Cancer Control. Recent Results Cancer Res 2021; 217:325-354. [PMID: 33200371 DOI: 10.1007/978-3-030-57362-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hepatitis B virus (HBV), hepatitis C virus (HCV), human papilloma virus (HPV), Epstein-Barr virus (EBV), human T-cell lymphotropic virus type 1 (HTLV-1), Kaposi's sarcoma-associated herpesvirus (KSHV), and Merkel cell polyomavirus (MCV) contribute to about 10-15% global burden of human cancers. Conventional chemotherapy or molecular target therapies have been used to treat virus-associated cancers. However, a more proactive approach would be the use of antiviral treatment to suppress or eliminate viral infections to prevent the occurrence of cancer in the first place. Antiviral treatments against chronic HBV and HCV infection have achieved this goal, with significant reduction in the incidence of hepatocellular carcinoma in treated patients. Antiviral treatments for EBV, KSHV, and HTLV-1 had limited success in treating refractory EBV-associated lymphoma and post-transplant lymphoproliferative disorder, KSHV-associated Kaposi's sarcoma in AIDS patients, and HTLV-1-associated acute, chronic, and smoldering subtypes of adult T-cell lymphoma, respectively. Therapeutic HPV vaccine and RNA interference-based therapies for treating HPV-associated infection or cervical cancers also showed some encouraging results. Taken together, antiviral therapies have yielded promising results in cancer prevention and treatment. More large-scale studies in a real-world setting are necessary to confirm the efficacy of antiviral therapy. Further investigation for more effective and convenient antiviral regimens warrants more attention.
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Affiliation(s)
- Wei-Liang Shih
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Jer Chen
- Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.
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32
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Johnson NW, Anaya-Saavedra G, Webster-Cyriaque J. Viruses and oral diseases in HIV-infected individuals on long-term antiretroviral therapy: What are the risks and what are the mechanisms? Oral Dis 2020; 26 Suppl 1:80-90. [PMID: 32862541 DOI: 10.1111/odi.13471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Abstract
As a result of the extension of life span produced by increasing access to combined antiretroviral therapy, people living with HIV/AIDS (PLWH) face new challenges from comorbidities. Although advances in medical care for HIV infection have dramatically reduced opportunistic infections and AIDS-defining cancers, some non-AIDS-defining cancers (NADC) and specific oral diseases such as periodontitis and salivary gland disease are now more prevalent. Cancer prevention is, therefore, a priority issue in care of PLWH, stressing both restoration of immune function and reduction of non-HIV cancer risk factors (tobacco in all its forms; areca nut; heavy alcohol consumption; diets lacking antioxidant vitamins and minerals; and oncogenic virus infections) through specific interventions, especially tobacco and areca nut cessation and alcohol moderation. Detection of oral high-risk human papillomaviruses (HR-HPV) and the universal preventive HPV vaccination among PLWH should be promoted to reduce the malignancy burden, along with routine oral examinations which remain the cheapest, most reliable, most reproducible, and non-invasive tool to identify suspicious lesions. Also, considerations of oral inflammation and periodontal health are important to replication and gene expression of viruses in the mouth. Considering that a key risk factor for this scenario is the presence of oncogenic virus infection such as several members of the human herpesvirus and human papillomavirus families, here we analyze the variables involved in the seeming increase in comorbidities in PLWH.
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Affiliation(s)
- Newell W Johnson
- Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia.,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College, London, UK
| | - Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Mexico City, Mexico
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33
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Nürnberg M, Arastéh K, Stocker H. [Early detection of gastrointestinal cancer in people living with HIV]. MMW Fortschr Med 2020; 162:37-39. [PMID: 32583250 DOI: 10.1007/s15006-020-0644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Nürnberg
- St. Joseph Krankenhaus, Klinik für Infektiologie, Wüsthoffstr. 15, D-12101, Berlin, Deutschland.
| | - Keikawus Arastéh
- St. Joseph Krankenhaus, Klinik für Infektiologie, Berlin, Deutschland
| | - Hartmut Stocker
- St. Joseph Krankenhaus, Klinik für Infektiologie, Berlin, Deutschland
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34
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Mortality and causes of death in people living with HIV in the era of combination antiretroviral therapy compared with the general population in Japan. AIDS 2020; 34:913-921. [PMID: 32039993 PMCID: PMC7170431 DOI: 10.1097/qad.0000000000002498] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives: To determine the mortality and causes of death in people living with HIV (PLHIV) in Japan. Design: A prospective cohort study at AIDS Clinical Center, Tokyo, which treats approximately 10% of PLHIV in care in Japan. Methods: Either PLHIV who visited our center for the first time between January 2005 and December 2014 or PLHIV who started their regular visit before January 2005 and visited us between January and March 2005 were included and followed by the end of 2016. Causes of death were defined according to the CoDe protocol. Results: Two thousand, seven hundred and ninety-seven PLHIV were analysed with total of 18 858 person-years of follow-up, which constitutes 14% of the estimated number of PLHIV in care in Japan. One hundred and sixty-five (5.9%) PLHIV died with all-cause mortality rate of 8.75 per 1000 person-years. All-cause mortality rate for PLHIV in care in Japan was estimated to be 8.75 per 1000 person-years (95% CI 5.53–12.0). Among causes of death, AIDS-defining illnesses accounted for 39% and malignancy contributed to 47%. Standardized mortality ratio (SMR) for all-cause mortality, malignancy-related mortality, and suicide were 5.96 (95% CI 5.05–6.87), 7.76 (95% CI 6.02–9.51), and 3.24 (95% CI 1.54–4.94), respectively. Even among the patients who were diagnosed early or without history of AIDS, SMR was four times higher than the general population. Conclusion: Mortality of PLHIV, even among those with early diagnosis, is substantially higher than that of the general population in Japan, highlighting the importance of further efforts towards prevention, early diagnosis and prompt treatment initiation.
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35
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Trickey A, May MT, Gill MJ, Grabar S, Vehreschild J, Wit FWNM, Bonnet F, Cavassini M, Abgrall S, Berenguer J, Wyen C, Reiss P, Grabmeier-Pfistershammer K, Guest JL, Shepherd L, Teira R, d'Arminio Monforte A, Del Amo J, Justice A, Costagliola D, Sterne JAC. Cause-specific mortality after diagnosis of cancer among HIV-positive patients: A collaborative analysis of cohort studies. Int J Cancer 2020; 146:3134-3146. [PMID: 32003460 PMCID: PMC7187452 DOI: 10.1002/ijc.32895] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Abstract
People living with HIV (PLHIV) are more likely than the general population to develop AIDS-defining malignancies (ADMs) and several non-ADMs (NADMs). Information is lacking on survival outcomes and cause-specific mortality after cancer diagnosis among PLHIV. We investigated causes of death within 5 years of cancer diagnosis in PLHIV enrolled in European and North American HIV cohorts starting antiretroviral therapy (ART) 1996-2015, aged ≥16 years, and subsequently diagnosed with cancer. Cancers were grouped: ADMs, viral NADMs and nonviral NADMs. We calculated cause-specific mortality rates (MR) after diagnosis of specific cancers and compared 5-year survival with the UK and France general populations. Among 83,856 PLHIV there were 4,436 cancer diagnoses. Of 603 deaths after ADM diagnosis, 292 (48%) were due to an ADM. There were 467/847 (55%) and 74/189 (39%) deaths that were due to an NADM after nonviral and viral NADM diagnoses, respectively. MR were higher for diagnoses between 1996 and 2005 versus 2006-2015: ADMs 102 (95% CI 92-113) per 1,000 years versus 88 (78-100), viral NADMs 134 (106-169) versus 111 (93-133) and nonviral NADMs 264 (232-300) versus 226 (206-248). Estimated 5-year survival for PLHIV diagnosed with liver (29% [19-39%]), lung (18% [13-23%]) and cervical (75% [63-84%]) cancer was similar to general populations. Survival after Hodgkin's lymphoma diagnosis was lower in PLHIV (75% [67-81%]). Among ART-treated PLHIV diagnosed with cancer, MR and causes of death varied by cancer type, with mortality highest for liver and lung cancers. Deaths within 5 years of NADM diagnoses were more likely to be from cancer than AIDS.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Margaret T May
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - M John Gill
- Division of Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidemiologie et de Santé Publique (IPLESP), Paris, France.,Unité de Biostatistique et d'Épidémiologie Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Janne Vehreschild
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Ferdinand W N M Wit
- Stichting HIV Monitoring, Amsterdam, The Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Fabrice Bonnet
- University of Bordeaux, ISPED, INSERM U1219, Bordeaux, France.,CHU de Bordeaux, Bordeaux, France
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Sophie Abgrall
- Department of Internal Medicine, Antoine Béclère Hospital, Clamart, France.,University of Paris Saclay, Paris-Sud University, UVSQ, Le Kremlin-Bicêtre, France.,CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Christoph Wyen
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | | | - Jodie L Guest
- Rollins School of Public Health, Atlanta, GA.,Emory School of Medicine, Atlanta, GA
| | - Leah Shepherd
- Institute of Global Health, University College London, London, United Kingdom
| | - Ramon Teira
- Unit of Infectious Diseases, Hospital Sierrallana, Torrelavega, Spain
| | | | - Julia Del Amo
- National Epidemiology Center, Carlos III Health Institute, Madrid, Spain
| | - Amy Justice
- Yale University School of Medicine and Public Health, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidemiologie et de Santé Publique (IPLESP), Paris, France
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36
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Heer E, Hackl M, Ferlitsch M, Waldhoer T, Yang L. Trends in incidence of anal cancer in Austria, 1983-2016. Wien Klin Wochenschr 2020; 132:438-443. [PMID: 32130523 PMCID: PMC7445201 DOI: 10.1007/s00508-020-01622-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
Abstract
Background Recent reports have noted increasing rates of anal cancer among high-income countries worldwide; however, little is known about these trends in Austria. Methods Data on anal cancer from 1983 to 2016 were obtained from Statistics Austria. All tumors (n = 3567) were classified into anal squamous cell carcinomas (ASCC), anal adenocarcinomas (AADC), and others (unspecified carcinoma and other specific carcinoma). Anal cancer incidence rates were calculated in 5‑year cycles and incidence average annual percentage change (AAPC) to evaluate trends by sex, histology and age group. Results The incidence rate of anal cancer was higher among females than males (relative risk, RR = 1.66, 95% confidence interval, CI: 1.55–1.79, p < 0.0001). From 1983 through 2016, incident anal cancer increased significantly (0.92 per 100,000 person-years to 1.85 per 100,000 person-years, AAPC = 1.93, 95% CI: 1.52 to 2.34, p < 0.0001), particularly among those 40–69 years old. From 1983 through 2016, the increasing anal cancer incidence was primarily driven by ASCC (0.47–1.20 per 100,000 person-years, AAPC = 2.23, 95% CI: 1.58 to 2.88, p < 0.0001) and others (other than ASCC and AADC, AAPC = 1.78, 95% CI: 1.01–2.55), yet stable in AADC (AAPC = 0.88, 95% CI: −0.48–2.25). Conclusions Despite being a rare cancer in Austria, the increase in anal cancer incidence rate from 1983 to 2016 was substantial, particularly in ASCC. The observed rising trends reflect the need to investigate associated risk factors that have increased over time to inform preventive measures. Electronic supplementary material The online version of this article (10.1007/s00508-020-01622-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily Heer
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Monika Hackl
- Austrian National Cancer Registry, Statistics Austria, Vienna, Austria
| | - Monika Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Waldhoer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna, Austria.
| | - Lin Yang
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada.,Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, Vienna, Austria.,Department of Oncology & Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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37
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Kelly H, Chikandiwa A, Alemany Vilches L, Palefsky JM, de Sanjose S, Mayaud P. Association of antiretroviral therapy with anal high-risk human papillomavirus, anal intraepithelial neoplasia, and anal cancer in people living with HIV: a systematic review and meta-analysis. Lancet HIV 2020; 7:e262-e278. [PMID: 32109408 DOI: 10.1016/s2352-3018(19)30434-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The effect of antiretroviral therapy (ART) on the natural history of anal high-risk HPV and anal lesion progression is not well established. We reviewed the association of ART and other HIV-related factors on anal HPV infection, anal intraepithelial neoplasia (AIN), and anal cancer among people living with HIV. METHODS For this systematic review and meta-analysis, we searched MEDLINE and EMBASE for studies published between Jan 1, 1996, and Oct 30, 2019, that reported the association of HIV-related exposures (ART or highly active ART [HAART], HIV-RNA plasma viral load [PVL], and nadir or current CD4 cell count) with outcomes of anal high-risk HPV prevalence, incidence, and persistence; prevalence, incidence, progression, or regression of anal histological and cytological abnormalities; and anal cancer incidence. Effect estimates were extracted whenever available; otherwise, they were calculated from raw data. We assessed the risk of bias of included studies using the Newcastle-Ottawa scale, and random-effects meta-analyses were done to examine heterogeneity using the I2 statistic. This study is registered on the PROSPERO database, CRD42018007271. FINDINGS We identified 6777 studies, of which 5377 were excluded before full-text review. 122 studies providing estimates for 130 distinct populations matched the inclusion criteria. The populations comprised 417 006 people living with HIV (women, men who have sex with men, and men who have sex with women). 41 (32%) population estimates were not stratified by sex or sexual orientation. People living with HIV receiving ART had 35% lower high-risk HPV prevalence than ART-naive people (crude odds ratio [OR] 0·65, 95% CI 0·54-0·79; I2 12·1%, p=0·31) in 18 studies, and prolonged ART use was associated with a 10% reduction per year in high-risk HPV prevalence in two studies (adjusted OR 0·90, 0·85-0·95; I2 0%, p=0·88). People living with HIV with undetectable PVL had lower HSIL-AIN2+ prevalence than those with detectable PVL (crude OR 0·84, 0·72-0·98; I2 0%, p=0·80) in 16 studies, particularly if sustained for more than 1 year (crude OR 0·62, 0·47-0·81; I2 0%, p=0·51). ART was not associated with anal cancer incidence when adjusted for years living with HIV in three studies (adjusted hazard ratio [HR] 1·11, 95% CI 0·68-1·80; I2 0%, p=0·57), but ART users with sustained undetectable HIV PVL had 44% lower risk of anal cancer than those without (adjusted HR 0·56, 0·44-0·70; I2 0%, p=0·94) and for each increase in nadir CD4 cell counts of 100 cells per μL, there was a 40% decrease in anal cancer incidence (crude HR 0·60, 0·46-0·78; I2 21·7%, p=0·26). INTERPRETATION Effective ART use and early initiation at high nadir CD4 counts might reduce anal high-risk HPV infection and anal cancer risk. Although most studies were cross-sectional in design and few adjusted for potential confounders, this analysis provides comprehensive estimates of the effect of ART and HIV-related factors on the natural history of anal HPV-related disease in people living with HIV. FUNDING EU Marie Skłodowska-Curie Actions programme.
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Affiliation(s)
- Helen Kelly
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
| | - Admire Chikandiwa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laia Alemany Vilches
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joel M Palefsky
- Department of Infectious Diseases, School of Medicine, University of California, San Francisco, CA, USA
| | - Silvia de Sanjose
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain; PATH, Seattle, WA, USA
| | - Philippe Mayaud
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Malignancy and all-cause mortality; incidence in adolescents and young adults living with perinatally acquired HIV. J Virus Erad 2020; 6:30-33. [PMID: 32175089 PMCID: PMC7043901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Adults living with HIV have an increased risk of malignancy yet there is a paucity of data for adolescents and young adults (AYA) with perinatally acquired HIV (PaHIV). METHODS Retrospective cohort analysis of all-cause mortality and malignancies in AYA with PaHIV aged 10-24 years attending a tertiary unit from 01 January 2004 to 31 December 2017, assessing cancer presentation, immunology and comparing mortality and malignancy incidence to age-matched UK general population rates. RESULTS A total of 290 AYA with PaHIV contributed 2644 person-years of follow up. Six (2.0%) died within the study period at a median age of 17 years (interquartile range [IQR]15-19), 3 of malignancy, 2 with end-stage HIV and 1 with cryptococcal meningitis. Overall mortality rate was 2.3/1000 person-years, with an age-matched general population rate of 0.2/1000 person-years. Eight (2.8%) were diagnosed with a malignancy; 6 with lymphoma (n=3 Hodgkin's, n=1 Burkitt's, n=2 B-cell) and one each with hepatocellular carcinoma and gastrointestinal adenocarcinoma. At cancer diagnosis the median age was 19 years (IQR 14-23), median CD4 T cell count was 453 cells/mm3 (IQR 231-645) and median length of HIV viremia was 15 years (IQR 12-17). The incidence rate of a malignancy was 3.0/1000 person-years in AYA with PaHIV, whilst that in the age-matched general population is 0.2/1000 person-years. CONCLUSION AYA living with PaHIV had an increased risk of all-cause mortality and of malignancy compared to their uninfected peers, with the excess in malignancy driven by lymphomas. It is hoped that earlier access to antiretroviral therapy will mitigate some of the AIDS-defining and non-AIDS defining risks for future generations.
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Cañas-Ruano E, Martín-Castillo M, Raventós B, Burgos J, Curran A, Navarro J, García J, Suanzes P, Ribera E, Falcó V. Incidence of malignancy in a Spanish cohort of patients infected by the human immunodeficiency virus. Med Clin (Barc) 2020; 155:288-294. [PMID: 32005558 DOI: 10.1016/j.medcli.2019.12.001] [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] [Received: 06/13/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION A higher incidence of malignancies has been described in patients with HIV infection compared to the general population. PATIENTS AND METHODS Observational retrospective study in patients with HIV infection followed up at the Vall d'Hebron University Hospital (Barcelona, Spain) between 2009 and 2017. The objective of this research was to estimate the incidence of malignancies in HIV patients and their surveillance. Age and sex-adjusted incidence was compared to the incidence calculated by the Spanish Cancer Registry network (REDECAN) in 2015. RESULTS We included 2,773 patients (41,238 patients-year). Two hundred and eleven malignancies were diagnosed in 182 patients. Non-AIDS defining cancers accounted for 78.2% of the malignancies. The global incidence of cancer was 485 cases per 100,000 person-years. Twenty-year mortality rate was 31.2% in patients with cancer and 7.8% in patients without cancer. In men, adjusted for age, the incidence of malignancies was higher than the incidence in the general population (978.4 vs. 641 cases per 100,000 person-years, P<.001). The most common malignancies in men were lung cancer, Kaposi sarcoma and Hodgkin lymphoma. In women, the incidence of malignancies was not higher than in the general population (340.6 vs. 404.7 cases per 100,000 person-years, P=.27). The most common malignancies among women were lung cancer, head and neck cancer, cervical cancer and Hodgkin's lymphoma. CONCLUSIONS Men with HIV infection showed a statistically significant higher incidence of malignancies compared to the general Spanish population. Lung cancer was the most common non-AIDS defining cancer.
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Affiliation(s)
- Esperanza Cañas-Ruano
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | | | | | - Joaquín Burgos
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Adrià Curran
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Jordi Navarro
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Jorge García
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Paula Suanzes
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Esteban Ribera
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Vicenç Falcó
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
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40
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da Silva Neto MM, Brites C, Borges ÁH. Cancer during HIV infection. APMIS 2020; 128:121-128. [PMID: 31990100 DOI: 10.1111/apm.13020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/24/2019] [Indexed: 12/11/2022]
Abstract
HIV+ persons have a significantly increased risk of cancer when compared to the general population. The excess cancer risk observed during HIV infection is particularly higher for infection-related malignancies. Mechanisms underlying this remain unclear, but both HIV-related and HIV-unrelated factors have been postulated to play a role. Here, we (i) review newly published data on cancer burden in the setting of HIV infection with a focus on HIV-related risk factors for cancer; (ii) discuss emerging data on cancer among HIV+ persons living in low- and middle-income countries; and (iii) review guideline recommendations for cancer screening among HIV+ persons and discuss ongoing studies investigating strategies for cancer screening among HIV+ patients.
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Affiliation(s)
- Marinho Marques da Silva Neto
- Department of Life Sciences, Bahia State University, Salvador, Bahia, Brazil.,Health Sciences School, Salvador University, Laureate International Universities, Salvador, Bahia, Brazil
| | - Carlos Brites
- LAPI - Laboratório de Pesquisa em Infectologia, Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Álvaro H Borges
- Department of Infectious Diseases Immunology, Statens Serum Institut, Copenhagen, Denmark
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Zhao Y, Wu Z, McGoogan JM, Sha Y, Zhao D, Ma Y, Brookmeyer R, Detels R, Montaner JSG. Nationwide Cohort Study of Antiretroviral Therapy Timing: Treatment Dropout and Virological Failure in China, 2011-2015. Clin Infect Dis 2020; 68:43-50. [PMID: 29771296 PMCID: PMC6293037 DOI: 10.1093/cid/ciy400] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/04/2018] [Indexed: 12/21/2022] Open
Abstract
Background People living with human immunodeficiency virus (PLWH) are still being diagnosed late, rendering the benefits of "early" antiretroviral therapy (ART) unattainable. Therefore, we aimed to evaluate the benefits of "immediate" ART. Methods A nationwide cohort of PLWH in China who initiated ART January 1, 2011, to December 31, 2014 and had baseline CD4 results >200 cells/μL were censored at 12 months, dropout, or death, whichever came first. Treatment dropout and virological failure (viral load ≥400 copies/mL) were measured. Determinants were assessed by Cox and log-binomial regression. Results The cohort included 123605 PLWH. The ≤30 days group had a significantly lower treatment dropout rate of 6.72%, compared to 8.91% for the 91-365 days group and to 12.64% for the >365 days group. The ≤30 days group also had a significantly lower virological failure rate of 5.45% (31-90 days: 7.39%; 91-365 days: 9.64%; >365 days: 12.67%). Greater risk of dropout (91-365 days: adjusted hazard ratio [aHR] = 1.33, 95% confidence interval [CI] = 1.25-1.42; >365 days: aHR = 1.55, CI = 1.47-1.54), and virological failure (31-90 days: adjusted risk ratio [aRR] = 1.35, CI = 1.26-1.45; 91-365 days: aRR = 1.66, CI = 1.55-1.78; >365 days: aRR = 1.85, CI = 1.74-1.97) were observed for those who delayed treatment. Conclusions ART within 30 days of HIV diagnosis was associated with significantly reduced risk of treatment failure, highlighting the need to implement test-and-immediately-treat policies.
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Affiliation(s)
- Yan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Department of Epidemiology, University of California, Los Angeles (UCLA) Fielding School of Public Health
| | - Jennifer M McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiyi Sha
- Tsinghua University, Beijing, China
| | - Decai Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ye Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ron Brookmeyer
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
| | - Roger Detels
- Department of Epidemiology, University of California, Los Angeles (UCLA) Fielding School of Public Health
| | - Julio S G Montaner
- British Columbia Center for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
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Chhabra S, Fidler S, Ayers S, Bower M, Lyall H, Foster C. Malignancy and all-cause mortality; incidence in adolescents and young adults living with perinatally acquired HIV. J Virus Erad 2020. [DOI: 10.1016/s2055-6640(20)30008-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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43
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Borges ÁH, Neuhaus J, Sharma S, Neaton JD, Henry K, Anagnostou O, Staub T, Emery S, Lundgren JD. The Effect of Interrupted/Deferred Antiretroviral Therapy on Disease Risk: A SMART and START Combined Analysis. J Infect Dis 2019; 219:254-263. [PMID: 30032171 DOI: 10.1093/infdis/jiy442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/12/2018] [Indexed: 12/15/2022] Open
Abstract
Background Pooled data from the SMART and START trials were used to compare deferred/intermittent versus immediate/continuous antiretroviral therapy (ART) on disease risk. Methods Endpoints assessed were AIDS, serious non-AIDS (SNA), cardiovascular disease (CVD), cancer, and death. Pooled (stratified by study) hazard ratios (HRs) from Cox models were obtained for deferred/intermittent ART versus immediate/continuous ART; analyses were conducted to assess consistency of HRs across baseline-defined subgroups. Results Among 10156 participants, there were 124 AIDS, 247 SNA, 117 cancers, 103 CVD, and 120 deaths. Interventions in each trial led to similar differences in CD4 count and viral suppression. Pooled HRs (95% confidence interval) of deferred/intermittent ART versus immediate/continuous ART were for AIDS 3.63 (2.37-5.56); SNA 1.62 (1.25-2.09); CVD 1.59 (1.07-2.37); cancer 1.93 (1.32-2.83); and death 1.80 (1.24-2.61). Underlying risk was greater in SMART than START. Given the similar HRs for each trial, absolute risk differences between treatment groups were greater in SMART than START. Pooled HRs were similar across subgroups. Conclusions Treatment group differences in CD4 count and viral suppression were similar in SMART and START. Likely as a consequence, relative differences in risk of AIDS and SNA between immediate/continuous ART and deferred/intermittent ART were similar. Clinical Trials Registration NCT00027352 and NCT00867048.
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Affiliation(s)
- Álvaro H Borges
- Center of Excellence for Health, Infections and Immunity, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - Jacqueline Neuhaus
- Division of Biostatistics, School of Public Health, University of Minnesota
| | - Shweta Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota
| | - Keith Henry
- Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Teresa Staub
- Centre Hospitalier de Luxembourg, Service des Maladies Infectieuses, Luxembourg
| | - Sean Emery
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jens D Lundgren
- Center of Excellence for Health, Infections and Immunity, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
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Huang YC, Sun HY, Chuang YC, Huang YS, Lin KY, Huang SH, Chen GJ, Luo YZ, Wu PY, Liu WC, Hung CC, Chang SC. Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan. BMJ Open 2019; 9:e033246. [PMID: 31542770 PMCID: PMC6756335 DOI: 10.1136/bmjopen-2019-033246] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Rapid initiation of antiretroviral therapy (ART) engenders faster viral suppression but with suboptimal rates of durable viral suppression and engagement in care, as reported by clinical trials in resource-limited settings. Real-world experience with rapid ART initiation remains limited in resource-rich settings. DESIGN Retrospective cohort study. SETTING A tertiary hospital in metropolitan Taipei, Taiwan. PARTICIPANTS We included 631 patients newly diagnosed as having HIV infection between March 2014 and July 2018. MAIN OUTCOME MEASURES Rapid ART initiation was defined as starting ART within 7 days after HIV diagnosis confirmation. HIV diagnosis, ART initiation and viral suppression dates and clinical outcome data were collected by reviewing medical records. The rates of loss to follow-up (LTFU), engagement in care and virological rebound at 12 months were compared between patients with rapid ART initiation and those with standard initiation. RESULTS Rapid ART initiation increased from 33.8% in 2014 to 68.3% in 2017, and the median interval between HIV diagnosis and viral suppression (HIV RNA load <200 copies/mL) decreased from 138 to 47 days. Patients with rapid ART initiation had a significantly higher rate of engagement in care at 12 months than did those with standard initiation (88.3% vs 79.0%; p=0.002). Patients aged <30 years had a higher risk of LTFU (HR: 2.19; 95% CI 1.20 to 3.98); and rapid ART initiation was associated with a lower risk of LTFU (HR: 0.41; 95% CI 0.24 to 0.83). Patients aged <30 years were more likely to acquire incident sexually transmitted infections (STIs) before achieving viral suppression. CONCLUSIONS Rapid ART initiation was associated with a higher rate of engagement in care at 12 months and shortened interval from diagnosis to HIV suppression. Delayed ART initiation may increase onwards HIV transmission considering the high rates of STIs. ETHICS APPROVAL The study was approved by the Research Ethics Committee of National Taiwan University Hospital (Registration No. 201003112R).
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Affiliation(s)
- Yi-Chia Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Yu-Zheng Luo
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Ying Wu
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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45
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Lundgren JD, Borges AH, Neaton JD. Serious Non-AIDS Conditions in HIV: Benefit of Early ART. Curr HIV/AIDS Rep 2019; 15:162-171. [PMID: 29504063 DOI: 10.1007/s11904-018-0387-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Optimal control of HIV can be achieved by early diagnosis followed by the initiation of antiretroviral therapy (ART). Two large randomised trials (TEMPRANO and START) have recently been published documenting the clinical benefits to HIV-positive adults of early ART initiation. Main findings are reviewed with a focus on serious non-AIDS (SNA) conditions. RECENT FINDINGS Data from the two trials demonstrated that initiating ART early in the course of HIV infection resulted in marked reductions in the risk of opportunistic diseases and invasive bacterial infections. This indicates that HIV causes immune impairment in early infection that is remedied by controlling viral replication. Intriguingly, in START, a marked reduction in risk of cancers, both infection-related and unrelated types of cancers, was observed. Like the findings for opportunistic infections, this anti-cancer effect of early ART shows how the immune system influences important pro-oncogenic processes. In START, there was also some evidence suggesting that early ART initiation preserved kidney function, although the clinical consequence of this remains unclear. Conversely, while no adverse effects were evident, the trials did not demonstrate a clear effect on metabolic-related disease outcomes, pulmonary disease, or neurocognitive function. HIV causes immune impairment soon after acquisition of infection. ART reverses this harm at least partially. The biological nature of the immune impairment needs further elucidation, as well as mechanisms and clinical impact of innate immune activation. Based on the findings from TEMPRANO and START, and because ART lowers the risk of onward transmission, ART initiation should be offered to all persons following their diagnosis of HIV.
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Affiliation(s)
- Jens D Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100, Copenhagen Ø, Denmark.
| | - Alvaro H Borges
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100, Copenhagen Ø, Denmark
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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46
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High Baseline Anal Human Papillomavirus and Abnormal Anal Cytology in a Phase 3 Trial of the Quadrivalent Human Papillomavirus Vaccine in Human Immunodeficiency Virus-Infected Individuals Older Than 26 Years: ACTG 5298. Sex Transm Dis 2019. [PMID: 29528986 DOI: 10.1097/olq.0000000000000745] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The quadrivalent human papillomavirus (HPV) vaccine (qHPV; types 6, 11, 16, 18) is indicated for men and women aged 9 to 26 years to prevent HPV associated anogenital high-grade squamous intraepithelial lesions (HSIL) and cancer. ACTG 5298 was a randomized placebo controlled Phase 3 study in human immunodeficiency virus (HIV)-infected men who have sex with men, and women of qHPV to prevent persistent anal HPV infection. Baseline data are presented here. METHODS Human immunodeficiency virus-infected men who have sex with men, and women 27 years or older without previous anogenital or oral cancer were enrolled. Baseline anal cytology, high-resolution anoscopy and collection of anal, oral, and vaginal specimens for HPV genotyping were performed and acceptability assessed. RESULTS Five hundred seventy-five (575) participants were enrolled (82% men and 18% women). Median age was 47 years. Race/ethnicity was 46% white, 31% black, and 20% Hispanic. Plasma HIV-1 RNA was less than 50 copies/mL in 83% and median CD4 T count was 602 cells/μL. Abnormal anal cytology was detected in 62%, with corresponding HSIL on biopsy (bHSIL) in 33%. Anal HPV 6, 11, 16, and 18 were detected in 25%, 13%, 32%, and 18% of the participants, respectively. Prevalence of 0, 1, 2, 3, and 4 qHPV types was 40%, 38%, 17%, 4%, and 1%, respectively. Oral infection with 1 or more qHPV type was detected in 10% of the participants. Study procedures were generally acceptable. CONCLUSIONS At study baseline, there was a high prevalence of abnormal anal cytology, bHSIL, and HPV infection. Sixty percent of the participants had anal infection with preventable qHPV types.
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47
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Vivancos MJ, Martínez-Sanz J, Moreno S. HIV infection epidemiology: a change of scenery. Eur Geriatr Med 2019; 10:169-174. [PMID: 34652748 DOI: 10.1007/s41999-018-0147-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/28/2018] [Indexed: 02/02/2023]
Abstract
Combination antiretroviral therapy has completely changed the landscape of HIV infection through the control of viral replication of the virus, the restoration of the immune system damage, and the reduction of the complications associated with immunodeficiency. As a consequence, the average age of people living with HIV has been increasing progressively, with a high proportion of diagnosed, as well as newly diagnosed, HIV-infected patients being older than 50 years throughout the world. With the longer life expectancy, characteristics commonly observed in aging are occurring in people with long-term HIV infection, including multiple chronic diseases, changes in cognitive and physical abilities, and the use of multiple medications. HIV-related specific factors, as well as a higher prevalence of environmental, classical factors, increase the risk of comorbidities in the aging HIV-infected population. A close collaboration between different specialists (HIV specialists, geriatricians, primary care physicians, and other specialists) is required to manage the clinical problems that older HIV-infected patients may present.
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Affiliation(s)
- Maria J Vivancos
- Department of Infectious Diseases, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá de Henares University, Carretera de Colmenar, Km 9.100, 28034, Madrid, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá de Henares University, Carretera de Colmenar, Km 9.100, 28034, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá de Henares University, Carretera de Colmenar, Km 9.100, 28034, Madrid, Spain.
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48
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Abstract
PURPOSE OF REVIEW Adults living with HIV have an increased risk of malignancy yet there is little data for adolescents and young adults. We reviewed recently published cancer epidemiology, treatment, and outcome data for adolescents and young adults living with HIV (AYALHIV) aged 10 to less than 25 years between 2016 and 2017. RECENT FINDINGS AYALHIV are at increased risk of developing cancer compared to their uninfected peers. Kaposi sarcoma and non-Hodgkin lymphoma occur most frequently with variation by geographical region. Increased cancer risk is associated with HIV-related immunosuppression and coinfection with oncogenic viruses. Published data, particularly on posttreatment outcomes, remain limited and analyses are hampered by lack of data disaggregation by age and route of HIV transmission. SUMMARY Although data are sparse, the increased cancer risk for AYALHIV is the cause for concern and must be modified by improving global access and uptake of antiretroviral therapy, human papilloma virus (HPV) and hepatitis B virus (HBV) vaccination, screening for hepatitis B and C infection, and optimized cancer screening programs. Education aimed at reducing traditional modifiable cancer risk factors should be embedded within multidisciplinary services for AYALHIV.
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49
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Althoff KN, Gebo KA, Moore RD, Boyd CM, Justice AC, Wong C, Lucas GM, Klein MB, Kitahata MM, Crane H, Silverberg MJ, Gill MJ, Mathews WC, Dubrow R, Horberg MA, Rabkin CS, Klein DB, Lo Re V, Sterling TR, Desir FA, Lichtenstein K, Willig J, Rachlis AR, Kirk GD, Anastos K, Palella FJ, Thorne JE, Eron J, Jacobson LP, Napravnik S, Achenbach C, Mayor AM, Patel P, Buchacz K, Jing Y, Gange SJ. Contributions of traditional and HIV-related risk factors on non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults with HIV in the USA and Canada: a collaboration of cohort studies. Lancet HIV 2019; 6:e93-e104. [PMID: 30683625 DOI: 10.1016/s2352-3018(18)30295-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/03/2018] [Accepted: 10/19/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Adults with HIV have an increased burden of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease. The objective of this study was to estimate the population attributable fractions (PAFs) of preventable or modifiable HIV-related and traditional risk factors for non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes. METHODS We included participants receiving care in academic and community-based outpatient HIV clinical cohorts in the USA and Canada from Jan 1, 2000, to Dec 31, 2014, who contributed to the North American AIDS Cohort Collaboration on Research and Design and who had validated non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, or end-stage renal disease outcomes. Traditional risk factors were tobacco smoking, hypertension, elevated total cholesterol, type 2 diabetes, renal impairment (stage 4 chronic kidney disease), and hepatitis C virus and hepatitis B virus infections. HIV-related risk factors were low CD4 count (<200 cells per μL), detectable plasma HIV RNA (>400 copies per mL), and history of a clinical AIDS diagnosis. PAFs and 95% CIs were estimated to quantify the proportion of outcomes that could be avoided if the risk factor was prevented. FINDINGS In each of the study populations for the four outcomes (1405 of 61 500 had non-AIDS-defining cancer, 347 of 29 515 had myocardial infarctions, 387 of 35 044 had end-stage liver disease events, and 255 of 35 620 had end-stage renal disease events), about 17% were older than 50 years at study entry, about 50% were non-white, and about 80% were men. Preventing smoking would avoid 24% (95% CI 13-35) of these cancers and 37% (7-66) of the myocardial infarctions. Preventing elevated total cholesterol and hypertension would avoid the greatest proportion of myocardial infarctions: 44% (30-58) for cholesterol and 42% (28-56) for hypertension. For liver disease, the PAF was greatest for hepatitis C infection (33%; 95% CI 17-48). For renal disease, the PAF was greatest for hypertension (39%; 26-51) followed by elevated total cholesterol (22%; 13-31), detectable HIV RNA (19; 9-31), and low CD4 cell count (13%; 4-21). INTERPRETATION The substantial proportion of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes that could be prevented with interventions on traditional risk factors elevates the importance of screening for these risk factors, improving the effectiveness of prevention (or modification) of these risk factors, and creating sustainable care models to implement such interventions during the decades of life of adults living with HIV who are receiving care. FUNDING National Institutes of Health, US Centers for Disease Control and Prevention, the US Agency for Healthcare Research and Quality, the US Health Resources and Services Administration, the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long Term Care, and the Government of Alberta.
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Affiliation(s)
- Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Kelly A Gebo
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Richard D Moore
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia M Boyd
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amy C Justice
- Yale School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Cherise Wong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory M Lucas
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | | | | | | | | | - Fidel A Desir
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Anita R Rachlis
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Jennifer E Thorne
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph Eron
- University of North Carolina, Chapel Hill, NC, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Pragna Patel
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Buchacz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yuezhou Jing
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Li AH, Wu ZY, Jiang Z, McGoogan JM, Zhao Y, Duan S. Duration of Human Immunodef iciency Virus Infection at Diagnosis among New Human Immunodef iciency Virus Cases in Dehong, Yunnan, China, 2008-2015. Chin Med J (Engl) 2018; 131:1936-1943. [PMID: 30082524 PMCID: PMC6085858 DOI: 10.4103/0366-6999.238152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: On diagnosis of human immunodeficiency virus (HIV) infection, a person may have been infected already for many years. This study aimed to estimate the duration of HIV infection at the time of diagnosis. Methods: Newly diagnosed HIV cases in Dehong, China, from 2008 to 2015 were studied. Duration of infection at the time of diagnosis was calculated using the first CD4 cell count result after diagnosis and a CD4 depletion model of disease progression. Multiple linear regression analysis was used to investigate the associated risk factors. Results: A total of 5867 new HIV cases were enrolled. Overall, mean duration of infection was 6.3 years (95% confidence interval [CI]: 6.2, 6.5). After adjusting for confounding, significantly shorter durations of infection were observed among participants who were female (beta: −0.37, 95% CI: −0.64, −0.09), Dai ethnicity (beta: −0.28, 95% CI: −0.57, 0.01), and infected through injecting drug use (beta: −1.82, 95% CI: −2.25, −1.39). Compared to the hospital setting, durations were shorter for those diagnosed in any other settings, and compared to 2008, durations were shorter for those diagnosed all years after 2010. Results: A total of 5867 new HIV cases were enrolled. Overall, mean duration of infection was 6.3 years (95% confidence interval [CI]: 6.2, 6.5). After adjusting for confounding, significantly shorter durations of infection were observed among participants who were female (beta: −0.37, 95% CI: −0.64, −0.09), Dai ethnicity (beta: −0.28, 95% CI: −0.57, 0.01), and infected through injecting drug use (beta: −1.82, 95% CI: −2.25, −1.39). Compared to the hospital setting, durations were shorter for those diagnosed in any other settings, and compared to 2008, durations were shorter for those diagnosed all years after 2010. Conclusion: Although the reduction in duration of infection at the time of diagnosis observed in Dehong was significant, it may not have had a meaningful impact.
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Affiliation(s)
- Ai-Hua Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Zun-You Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Zhen Jiang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Jennifer M McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Yan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Song Duan
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan 678400, China
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