Human immunodeficiency virus and cancer. A population of HIV-infected patients at Hospital de Santa Maria and predictors of cancer

Patients with HIV-associated cancers have evidence of increased T cell dysfunction and exhaustion prior to cancer diagnosis

BACKGROUND

People living with HIV (PLWH) have increased risk of developing cancers after controlling traditional risk factors and viral suppression. This study explores whether T cells can serve as a marker of risk for cancer among HIV-infected virally suppressed patients.

METHODS

A nested case control study design was pursued with 17 cancer cases and 73 controls (PLWH without cancer)ouidentified among the US Military HIV Natural History Study cohort, and were matched for CD4 + count, duration of HIV infection, and viral suppression. Cells were obtained from PLWH on an average of 12 months prior to clinical cancer diagnosis. Expression of inhibitory receptors (PD-1, CD160, CD244, Lag-3, and TIGIT), and transcription factors (T-bet, Eomesodermin, TCF-1, and (TOX) was measured on CD8 +T cells from that early time point.

RESULTS

We found that cases have increased expression of PD-1 +CD160+CD244+ ('triple positive') on total and effector CD8 + compared with controls (p=0.02). Furthermore, CD8 +T cells that were both PD-1 +CD160+CD244+ and T-bet^dimEomes^hi were significantly elevated in cases at time point before cancer detection, compared with controls without cancer (p=0.008). This was driven by the finding that transcriptional factor profile of cells was altered in cancers compared with controls. Triple-positive cells were noted to retain the ability for cytotoxicity and cytokine secretion mediated by expression of CD160 and PD-1, respectively. However, triple-positive cells demonstrated high expression of TOX-1, a transcription factor associated with T cell exhaustion.

CONCLUSION

In conclusion, we have found a subset of dysfunctional CD8 +T cells, PD-1 +CD160+CD244+T-bet^dimEomes^hi, that is elevated 12 months before cancer diagnosis, suggesting that peripheral T cell alterations may serve as a biomarker of increased cancer risk among PLWH.

Risk of Skin Cancers in Older Persons Living With HIV: A Systematic Review

Skin cancers-including basal cell carcinoma, squamous cell carcinoma, and melanoma-impose high incidence and morbidity in older persons. As life expectancy continues to increase in persons living with HIV (PLWH), this population may face an increased risk of non-AIDS-defining malignancies, such as skin cancers. We conducted a systematic review on skin cancer risks in PLWH, ages 50 years or older, as compared with age-matched, HIV-uninfected persons. Four studies met criteria and were included. No statistically significant associations were demonstrated between HIV infection and skin cancers in older persons. For those with a history of basal or squamous cell carcinoma, HIV infection was associated with higher risks of subsequent squamous cell carcinoma. Future studies are needed to elucidate and reduce morbidity of primary and multiple skin cancers to promote successful aging in PLWH.

Association Between XRCC1 and WRN as Genetic Markers of Stability and Susceptibility to Cancer in Patients with HIV/AIDS and Cancer: a Cross-Sectional Study

Background: HIV-induced immunodeficiency has been implicated as a key factor for risk of cancer. Neoplasia is considered to result from accumulation of damage to the genome. Polymorphisms in repair genes, such as the XRCC1 and WRN, have been associated with susceptibility to development of cancer in patients with HIV/AIDS. The aim of this study was to analyze the frequency of polymorphisms in XRCC1 (Arg399Gln) and WRN (Cys1367Arg) in patients with HIV/AIDS with or without cancer. Materials and Methods: Genotyping for analysis of polymorphisms was carried out by PCR (Polymerase Chain Reaction) and RFLP (Restriction Fragment Length Polymorphism). Results: In the genotypic and allelic analysis, no increased risk of cancer was observed with any genotype or allele of XRCC1 (Arg399Gln) singly (prevalence ratio 2.82; p-value= 0.24). However, with the WRN (Cys1367Arg) gene, the heterozygous genotype and arginine allele were associated with increased risk (prevalence ratio= 25.62; p-value= 0.0001). Correlation analysis showed no association between gender and the risk (male p-value= 0.639 and women p-value> 1); however, a positive association for the increased risk of cancer was shown with XRCC1 (Arg399Arg) wild-type homozygous and WRN (Cys1367Arg) heterozygous (p-value< 0.001), with heterozygous XRCC1 (Arg399Gln) and WRN (Cys1367Arg) (p-value< 0.001), and with variant homozygous XRCC1 (Gln399Gln) and heterozygous WRN (Cys1367Arg) (p-value< 0.001). Conclusions: There is no increased risk of cancer in patients who are HIV/AIDS carriers of the XRCC1 (Arg399Gln) gene singly. However, there is a high risk in patients with HIV/AIDS who have the heterozygous genotype and the arginine allele in the WRN (Cys1367Arg) gene singly. Those with WRN (Cys1367Arg) heterozygote genotype showed a high risk of cancer with all genotypes of the XRCC1 (Arg399Gln) gene.

Management of accidental exposure to HCV, HBV and HIV in healthcare workers in Romania

INTRODUCTION

Accidental blood exposure in healthcare workers is an important issue worldwide. We present a study which analyzed the route of exposure, the source of infection and the post-exposure prophylaxis treatment administered.

METHOD

We performed retrospective study of occupational exposure to HBV, HCV and HIV and the subsequent post-exposure prophylaxis among healthcare workers at the National Institute of Infectious Diseases "Prof.Dr. Matei Balş", Bucharest, Romania, from December 2002 to December 2011.

RESULTS

Sixty healthcare workers with a mean age of 36 reported an occupational exposure during a period of 9 years, 54 (90%) were females and 6 (10%) were males. 48 (80%) exposed healthcare workers were nurses, 7 (11.6%) were doctors and 5 (8.3%) were medical assisting staff. In 49 (81.6%) cases the exposure was percutaneous and in 11 (18.3%) cases the exposure was mucosal/corneal. Ten (16.6%) exposed healthcare workers had insufficient levels of antibody (HBsAb) response, (below 10 mIU/mL), 6 (10%) had titers between 11 and 500 mIU/mL, 31 (51.6%) between 501-1000 mIU/mL, and 13 (21.6%) above 1000 mIU/mL).

DISCUSSION

The exposure events analysis in this study yielded similar results compared to other previous parallel studies. Minimizing risks to HCWs for acquisition of blood-borne pathogens and correct and rapid post-exposure prophylaxis treatment in case of exposure should be an integral part of the infection control and occupational health programs in all healthcare facilities.

Milk-borne infections. An analysis of their potential effect on the milk industry

In developed countries such as the United States of America, foodborne illnesses account for 48 million infections per year. Developing countries such as India face greater simultaneous challenges particularly since incorrect processing or storage of dairy products can represent a transmission hazard for a large number of pathogens and can be responsible for outbreaks of brucellosis, listeriosis, tuberculosis, etc. It is important to recognize the types of germs which can be transmitted through insufficient thermal preparation of milk or milk products or through post-pasteurization contamination, in order to successfully avoid transmission of milk-borne infections.

Recent advances in the diagnosis of Mycobacterium tuberculosis

Molecular technologies offer the greatest potential for laboratories in resource-rich countries because they have the highest sensitivity and specificity. Continued use of new technologies will be crucial in elucidating the true epidemiology and pathogenesis of a disease, including the less well studied diseases. Continued development of affordable, sensitive, and specific diagnostic tools will be required for use in resource-poor settings, where the incidence of disease is highest.