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Kampouri E, Little JS, Crocchiolo R, Hill JA. Human herpesvirus-6, HHV-8 and parvovirus B19 after allogeneic hematopoietic cell transplant: the lesser-known viral complications. Curr Opin Infect Dis 2024; 37:245-253. [PMID: 38726832 DOI: 10.1097/qco.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW Viral infections continue to burden allogeneic hematopoietic cell transplant (HCT) recipients. We review the epidemiology, diagnosis, and management of human herpesvirus (HHV)-6, HHV-8 and parvovirus B19 following HCT. RECENT FINDINGS Advances in HCT practices significantly improved outcomes but impact viral epidemiology: post-transplant cyclophosphamide for graft-versus-host disease prevention increases HHV-6 reactivation risk while the impact of letermovir for CMV prophylaxis - and resulting decrease in broad-spectrum antivirals - is more complex. Beyond the well established HHV-6 encephalitis, recent evidence implicates HHV-6 in pneumonitis. Novel less toxic therapeutic approaches (brincidofovir, virus-specific T-cells) may enable preventive strategies in the future. HHV-8 is the causal agent of Kaposi's sarcoma, which is only sporadically reported after HCT, but other manifestations are possible and not well elucidated. Parvovirus B19 can cause severe disease post-HCT, frequently manifesting with anemia, but can also be easily overlooked due to lack of routine screening and ambiguity of manifestations. SUMMARY Studies should establish the contemporary epidemiology of HHV-6, and other more insidious viruses, such as HHV-8 and parvovirus B19 following HCT and should encompass novel cellular therapies. Standardized and readily available diagnostic methods are key to elucidate epidemiology and optimize preventive and therapeutic strategies to mitigate the burden of infection.
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Affiliation(s)
- Eleftheria Kampouri
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jessica S Little
- Dana-Farber Cancer Institute
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Joshua A Hill
- Vaccine and Infectious Disease Division
- Clinical Research Division, Fred Hutchinson Cancer Center
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Mukasine MC, Mulundu G, Kawimbe M, Mutale K, Mumba C, Lidenge SJ, Ngalamika O. Association between KSHV-Specific Humoral and T Cell Responses with Recurrence of HIV-Associated Kaposi Sarcoma. Trop Med Infect Dis 2024; 9:134. [PMID: 38922046 PMCID: PMC11209129 DOI: 10.3390/tropicalmed9060134] [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: 04/29/2024] [Revised: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
Kaposi sarcoma (KS) is an AIDS-defining angio-proliferative malignancy, with the Kaposi sarcoma-associated herpes virus (KSHV) as its etiologic agent. Upon treatment with chemotherapy, a proportion of HIV-associated KS patients experience disease recurrence within a few months of completing treatment. We aimed at determining whether KSHV-specific adaptive immune responses were associated with KS recurrence upon complete remission. We conducted a prospective cohort study. The primary outcome was the recurrence of HIV-associated KS. An immunofluorescence assay was used to determine anti-KSHV antibodies, an enzyme-linked immunospot was conducted for T cell responses, PCR was carried out to determine KSHV status, and flow cytometry was used for CD4 counting and immunophenotyping. KSHV detection in PBMCs was high and not associated with KS recurrence-free survival (p = 0.29). Anti-KSHV antibody titers were high and not associated with recurrence-free survival (p = 0.63). KSHV-specific T cell responses dropped from baseline levels among individuals with recurrence, but the drop was not statistically significant. Individuals experiencing KS recurrence had a significantly higher proportion of T cell subsets expressing PD1, while those with sustained remission had a significant increase in CD4 T cell counts from baseline levels during the follow-up period (p = 0.02). Anti-KSHV antibodies are not a good correlate of protection from KS recurrence. T cells in individuals experiencing KS recurrence hadhigh PD1 expression, while an increase in CD4 counts was associated with sustained KS remission.
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Affiliation(s)
- Marie-Claire Mukasine
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia; (M.-C.M.); (G.M.); (C.M.)
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
| | - Gina Mulundu
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia; (M.-C.M.); (G.M.); (C.M.)
| | - Musonda Kawimbe
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
| | - Keagan Mutale
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
| | - Chibamba Mumba
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia; (M.-C.M.); (G.M.); (C.M.)
| | - Salum J. Lidenge
- Ocean Road Cancer Institute, Dar es Salaam P.O. Box 3592, Tanzania;
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Owen Ngalamika
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
- Dermatology and Venereology Division, University Teaching Hospital, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia
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Gong H, Zhang S, Dou J, Chen J. Is human herpesvirus 8 infection more common in men than in women? an updated meta-analysis. BMC Infect Dis 2024; 24:454. [PMID: 38684967 PMCID: PMC11059601 DOI: 10.1186/s12879-024-09346-5] [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: 10/22/2023] [Accepted: 04/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Clinically, most patients with Kaposi's sarcoma (KS) are male, and several direct and indirect mechanisms may underlie this increased susceptibility in men, Kaposi's sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV-8), is considered to be the primary etiological agent responsible for KS. Thus, we propose the hypothesis that men are more susceptible to HHV-8 infection, leading to a higher incidence of Kaposi's sarcoma among males. A meta-analysis was conducted to evaluate the association between gender and HHV-8 seropositivity in the general population. METHODS A comprehensive literature search was performed using 6 online databases: PubMed, EMBASE, Cochrane library, Web of Science, CNKI, and Wanfang. Studies published before March 15, 2023, were included. RESULTS In all, 33 articles including 41 studies were included in the meta-analysis. In the included adult population. men had a higher risk of HHV-8 infection than did women in adult populations from all over the world (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.01-1.15), but no differences were found in child population from all over the world (OR: 0.90, 95% CI: 0.79-1.01). There was a significant difference in HHV-8 seroprevalence between men and women in sub-Saharan Africa (SSA) adult population (OR: 1.15, 95% CI: 1.05-1.26). However, no significant differences were observed in sub-Saharan Africa (SSA) child population (OR: 0.90, 95%CI 0.78-1.03). As for other continents, the results showed no significant difference, such as the Asian population (OR: 1.03, 95%CI: 0.92-1.16). or the European and American populations (OR 1.01, 95%CI 0.87-1.17). CONCLUSION There was a slight gender disparity for HHV-8 infection in the adult population. Among the adult populations from SSA and globally, men were more likely to be infected with HHV-8 than were women. However, no statistical significance was observed in the child populations from SSA and globally. In the future, the inclusion of more standardized studies may strengthen the results of this study.
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Affiliation(s)
- Haibo Gong
- Department of Dermatology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, Zhengzhou, Henan, 450003, China.
| | - Shuai Zhang
- Department of Dermatology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, Zhengzhou, Henan, 450003, China
| | - Jinfa Dou
- Department of Dermatology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, Zhengzhou, Henan, 450003, China
| | - Jing Chen
- Department of Dermatology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, Zhengzhou, Henan, 450003, China
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Motlhale M, Muchengeti M, Bradshaw D, Chen WC, Singini MG, de Villiers CB, Lewis CM, Bender N, Mathew CG, Newton R, Waterboer T, Singh E, Sitas F. Kaposi sarcoma-associated herpesvirus, HIV-1 and Kaposi sarcoma risk in black South Africans diagnosed with cancer during antiretroviral treatment rollout. Int J Cancer 2023; 152:2081-2089. [PMID: 36727526 DOI: 10.1002/ijc.34454] [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: 07/13/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023]
Abstract
Kaposi sarcoma-associated herpesvirus (KSHV) causes Kaposi sarcoma (KS). The risk of KS is amplified in HIV-immunosuppressed individuals and antiretroviral therapy (ART) reduces KS incidence. Reliable data on the relationship between these factors are lacking in Africa. We used questionnaires and serum from 7886 black South Africans (18-74 years) with incident cancer, recruited between 1995 and 2016. ART rollout started in 2004. We measured associations between KS, HIV-1 and KSHV before and after ART rollout. We measured seropositivity to HIV-1, KSHV latency-associated nuclear antigen (LANA) and glycoprotein (K8.1) and calculated case-control-adjusted odds ratios (ORadj ) and 95% confidence intervals (CI) in relation to KS and KSHV infection, before (1995-2004), early (2005-2009) and late (2010-2016) ART rollout periods. KSHV seropositivity among 1237 KS cases was 98%. Among 6649 controls, KSHV seropositivity was higher in males (ORadj = 1.4 [95%CI 1.23-1.52]), in persons with HIV, (ORadj = 4.2 [95%CI 3.74-4.73]) and lower in high school leavers (ORadj = 0.7 [95%CI 0.59-0.83]). KSHV seropositivity declined over the three ART rollout periods (37%, 28% and 28%, Ptrend < .001) coinciding with increases in high school leavers over the same periods (46%, 58% and 67%, Ptrend < .001). HIV-1 seroprevalence increased from 10% in the pre-ART period to 22% in the late ART period (Ptrend < .001). Compared to HIV-1 and KSHV seronegatives, KSHV seropositives yielded an OR for KS of 26 (95%CI 11-62) in HIV-1 seronegative participants and an OR of 2501 (95%CI 1083-5776) in HIV-1 seropositive participants. HIV-1 increases the risk of KS in those infected with KSHV by 100-fold. Declines in KSHV seroprevalence coincide with ART rollout and with improvements in educational standards and general hygiene.
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Affiliation(s)
- Melitah Motlhale
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mwiza Gideon Singini
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Noemi Bender
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christopher G Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York, UK
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Freddy Sitas
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for Primary Health Care and Equity, School of Population Health, University of New South Wales Sydney, Sydney, Australia
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Sydney, Australia
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Biatougou NMB, Ouedraogo MS, Soubeiga ST, Zohoncon TM, Ouedraogo P, Obiri-Yeboah D, Tapsoba ASA, Kiendrebeogo TI, Sagna T, Niamba P, Traore A, Simpore J. Molecular Epidemiology of Human Herpes Virus Type 8 Among Patients with Compromised Immune System in Ouagadougou, Burkina Faso. HIV AIDS (Auckl) 2022; 14:311-317. [PMID: 35836752 PMCID: PMC9275423 DOI: 10.2147/hiv.s353166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Human herpesvirus type 8 (HHV-8) is the main etiological agent of Kaposi's sarcoma. This virus is frequently associated with immunocompromision. This study aimed to detect HHV-8 in people with compromised immune system. Patients and Methods This is a cross-sectional study that included 180 subjects: 179 HIV-infected patients and 1 patient with bullous pemphigoid. Blood samples were taken from all subjects, and swabs of lesions were then taken from individuals with symptoms of Kaposi's sarcoma. Viral load and CD4+ T lymphocytes count were performed for persons living with HIV and real-time PCR detection of HHV-8 DNA was performed in all subjects in the study. Results Among HIV-infected persons, 13.41% had a viral load of more than 10,000 copies/mL, and 22.91% had a CD4+ T lymphocytes count of fewer than 350 cells/µL. A total of four (three HIV-1 infected patients and one patient with bullous pemphigoid) patients (2.22%) had apparent lesions of Kaposi's sarcoma. In the plasmas and swabs from associated lesions, HHV-8 DNA was found in only two individuals, with an HHV-8 prevalence of 1.11% (2/180) with 0.55% (1/179) in an HIV-infected patient on antiretroviral therapy. Conclusion These results exposing low prevalence levels of HHV-8 in HIV-infected patients could be due to the beneficial effect of antiretroviral drugs.
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Affiliation(s)
- Nakougou Moϊ-bohm Biatougou
- Biochemistry and Microbiology Department, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Muriel S Ouedraogo
- Department of Dermatology, Yalgado Ouedraogo Hospital University Centre, Ouagadougou, Burkina Faso
| | - Serge Theophile Soubeiga
- Department of Biomedical Research, Biomolecular Research Centre Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
- Department of Biomedical and Public Health, Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | - Theodora Mahoukede Zohoncon
- Biochemistry and Microbiology Department, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Department of Medicine, Saint Thomas d’Aquin University (USTA), Ouagadougou, Burkina Faso
| | - Paul Ouedraogo
- Department of Medicine, Saint Thomas d’Aquin University (USTA), Ouagadougou, Burkina Faso
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, University of Cape Coast, Cape Coast, Ghana
| | - Aziz Sidi Aristide Tapsoba
- Biochemistry and Microbiology Department, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Touwendpoulimdé Isabelle Kiendrebeogo
- Biochemistry and Microbiology Department, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Department of Biomedical Research, Biomolecular Research Centre Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Tani Sagna
- Department of Biomedical and Public Health, Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | - Pascal Niamba
- Department of Dermatology, Yalgado Ouedraogo Hospital University Centre, Ouagadougou, Burkina Faso
| | - Adama Traore
- Department of Dermatology, Yalgado Ouedraogo Hospital University Centre, Ouagadougou, Burkina Faso
| | - Jacques Simpore
- Biochemistry and Microbiology Department, Laboratory of Molecular Biology and Genetics (LABIOGENE), University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Department of Biomedical Research, Biomolecular Research Centre Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
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Htet KZ, Waul MA, Leslie KS. Topical treatments for Kaposi sarcoma: A systematic review. SKIN HEALTH AND DISEASE 2022; 2:e107. [PMID: 35677916 PMCID: PMC9168015 DOI: 10.1002/ski2.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/13/2022]
Abstract
Background While treatment options exist for solitary or disseminated Kaposi sarcoma (KS) disease, there are currently no standardized clinical treatment guidelines for cutaneous KS. Objective This systematic review seeks to identify safe and effective topical treatments for cutaneous KS lesions. Methods We conducted a systematic review using peer-reviewed articles from January 1970 to September 2021 published in the PubMed/MEDLINE and EMBASE databases. Results From the initial search that yielded 590 studies, 34 met the inclusion criteria and were selected. Of the 34 studies, seven were clinical trials, 26 were case reports/series and one was a multicentre study. A total of 634 patients were included in our review. The three most common topical treatments used for cutaneous KS were imiquimod, alitretinoin and timolol. Topical alitretinoin was used in three case reports and three clinical trials. Topical imiquimod was used in eight case reports, one prospective phase II cohort study and one comparative single-blinded non-controlled clinical study. Topical timolol was used in nine case reports/series. Our review also identified reports of less widely used topical treatments for cutaneous KS. These include topical diphencyprone (DPCP), all-trans-retinoic-acid, rapamycin and bleomycin-dimethylsulfoxide (BLM-DMSO) which achieved variable response rates but have not been widely studied. Conclusion Topical alitretinoin, imiquimod and timolol demonstrated positive responses for cutaneous KS and the treatments were well tolerated. These three topical treatment modalities could be considered by clinicians when treating cutaneous KS.
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Affiliation(s)
- Kyaw Zin Htet
- Tulane University School of MedicineNew OrleansLouisianaUSA
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McLigeyo A, Owuor K, Ng’ang’a E, Mwangi J, Wekesa P. Characteristics and Treatment Response of Patients with HIV Associated Kaposi's Sarcoma in Central Kenya. HIV AIDS (Auckl) 2022; 14:207-215. [PMID: 38808105 PMCID: PMC11130515 DOI: 10.2147/hiv.s359278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/01/2022] [Indexed: 05/30/2024] Open
Abstract
Introduction Kaposi's sarcoma (KS) is the most common HIV-associated malignancy in Sub Saharan Africa. In 2018, it was the 7th most common cancer and the 10th most common cause of cancer death in Kenya. This study aimed to describe the baseline and clinical characteristics and treatment response observed following combined antiretroviral treatment (ART) and chemotherapy in KS patients. Methods This was a descriptive analysis of patients aged ≥15 years treated for KS and HIV at 11 treatment hubs in Central Kenya between 2011 and 2014. Data on baseline and clinical characteristics, ART and chemotherapy regimens as well as treatment responses were collected from patient files and KS registers. Results A total of 95 patients presenting with clinically suspected KS with no history of prior treatment with chemotherapy were reviewed. All had histological diagnostic samples taken with 67 (71%) having confirmed KS. All were on ART, either newly initiated or continuing on ART, and 63 of the 67 (94.0%) confirmed to have KS received chemotherapy. Among the 67 patients with confirmed KS, mean age was 37.2 years (± 13.2) and 40 (59.7%) were male. More than 80% had normal baseline and follow-up BMI, and 34 (50.7%) were on a TDF-based regimen, 52 (77.6%) were treated with the Adriamycin, bleomycin and vinblastine protocol, and 55 (82.1%) had KS diagnosis before HIV diagnosis. All 67 patients had mucocutaneous lesions. Complete, partial response and stable disease occurred in 27 (40.3%), 10 (14.9%) and 7 (10.4%), respectively, 11 (16.4%) defaulted care during treatment, six patients died during treatment, four patients died before treatment while two patients had progressive disease during chemotherapy. Conclusion The diagnosis of KS preceded HIV in the majority of cases reviewed, with histology helpful to reduce misdiagnosis. Patients generally complied with their chemotherapy, with overall good response rate for this intervention implemented at primary health-care facilities.
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Affiliation(s)
| | - Kevin Owuor
- Center for Health Solutions - Kenya, Nairobi, Kenya
| | | | - Jonathan Mwangi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Paul Wekesa
- Center for Health Solutions - Kenya, Nairobi, Kenya
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Motlhale M, Sitas F, Bradshaw D, Chen WC, Singini MG, de Villiers CB, Lewis CM, Muchengeti M, Waterboer T, Mathew CG, Newton R, Singh E. Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study. Cancer Epidemiol 2022; 78:102158. [PMID: 35421713 DOI: 10.1016/j.canep.2022.102158] [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: 09/16/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/15/2022]
Abstract
Kaposi Sarcoma (KS) is endemic in several countries in Southern and Eastern Africa, relatively rare worldwide but a leading cancer among people living with HIV. KS has always been more common in adult males than females. We assessed the prevalence of known cancer modifying factors (parity, hormonal contraceptive use in females, sex-partners, smoking and alcohol consumption in both sexes), and their relationship to KS, and whether any of these could account for the unequal KS sex ratios. We calculated logistic regression case-control adjusted odds ratios (ORadj), and 95% confidence intervals (95%CI), between KS and each of the modifying factors, using appropriate comparison controls. Controls were cancer types that had no known relationship to exposures of interest (infection or alcohol or smoking or contraceptive use). The majority of the 1275 KS cases were HIV positive (97%), vs. 15.7% in 10,309 controls. The risk of KS among those with HIV was high in males (ORadj=116.70;95%CI=71.35-190.88) and females (ORadj=93.91;95%CI=54.22-162.40). Among controls, the prevalence of smoking and alcohol consumption was five and three times higher in males vs. females. We found a positive association between KS and heavy vs. non-drinking (ORadj=1.31;95%CI=1.03-1.67), and in current heavy vs. never smokers (ORadj=1.82;95%CI=1.07-3.10). These associations remained positive for alcohol consumption (but with wider CIs) after stratification by sex, and restriction to HIV positive participants. We found no evidence of interactions of smoking and alcohol by sex. Smoking and alcohol consumption may provide a possible explanation for the KS sex differences, given both exposures are more common in men, but confounding and bias cannot be fully ruled out. The role smoking and alcohol play in relation to viral loads of HIV/KSHV, differences in immunological responses or other genetic differences between males and females warrant further studies.
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Affiliation(s)
- Melitah Motlhale
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Freddy Sitas
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Centre for Primary Health Care and Equity, School of Population Health, University of New South Wales Sydney, Australia; Menzies Centre of Health Policy, School of Public Health, University of Sydney, Australia
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mwiza Gideon Singini
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8AF, United Kingdom; Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christopher G Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; University of York, York, United Kingdom
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Megasari NLA, Oktafiani D, Soetjipto S. The Emergence of HHV-8 Infection among HIV-positive Individuals Residing in Bali, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background:
Human herpesvirus 8 (HHV-8) is considered as the etiological agent of Kaposi’s sarcoma (KS). In people living with human immunodeficiency virus (HIV) (PLHIV), KS defines acquired immunodeficiency syndrome (AIDS). Previous study found that HIV-positive individuals were more likely to be HHV-8 seropositive than HIV-negative individuals. Reports regarding the presence of HHV-8 and HIV co-infection in Indonesia is severely limited.
Aim:
This study aimed to identify HHV-8 infection among HIV-positive individuals in Bali, Indonesia.
Materials and Methods:
Forty three plasma samples were collected from 16 antiretroviral therapy (ART) naive and 27 ART-experienced individuals residing in Buleleng Regency, Bali, Indonesia. Detection of HHV-8 antigen was performed by using ELISA method. The Fisher's Exact test and the Spearman correlation test would be used to analysed data accordingly.
Results:
Seven samples (7/43, 16.3%), one of ART-naive individual (1/16, 6.25%) and six of ART-experienced individuals (6/27, 22.2%), were tested positive for HHV-8 antigen. Human herpesvirus 8 infection was correlated neither to sex (p=1.000) and age (p=0.716), nor to ART status (p=0.178) and length of ART (p=0.465).
Conclusion:
This study indicates the emergence of HHV-8 infection among HIV-positive individuals residing in Bali, Indonesia. Sufficient diagnosis of HHV-8 should be considered for all HIV-positive individuals in order to deliver appropriate treatment. Extensive researches is suggested to be conducted in more regions of Indonesia in order to determine the magnitude of HHV-8 infection among HIV-positive individuals.
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Ding M, Wu J, Sun R, Yan L, Bai L, Shi J, Feng H, Zhang Y, Lan K, Wang X. Androgen receptor transactivates KSHV noncoding RNA PAN to promote lytic replication-mediated oncogenesis: A mechanism of sex disparity in KS. PLoS Pathog 2021; 17:e1009947. [PMID: 34543357 PMCID: PMC8483343 DOI: 10.1371/journal.ppat.1009947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/30/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023] Open
Abstract
Kaposi’s sarcoma-associated herpesvirus (KSHV) preferentially infects and causes Kaposi’s sarcoma (KS) in male patients. However, the biological mechanisms are largely unknown. This study was novel in confirming the extensive nuclear distribution of the androgen receptor (AR) and its co-localization with viral oncoprotein of latency-associated nuclear antigen in KS lesions, indicating a transcription way of AR in KS pathogenesis. The endogenous AR was also remarkably higher in KSHV-positive B cells than in KSHV-negative cells and responded to the ligand treatment of 5α-dihydrotestosterone (DHT), the agonist of AR. Then, the anti-AR antibody-based chromatin immunoprecipitation (ChIP)-associated sequencing was used to identify the target viral genes of AR, revealing that the AR bound to multiple regions of lytic genes in the KSHV genome. The highest peak was enriched in the core promoter sequence of polyadenylated nuclear RNA (PAN), and the physical interaction was verified by ChIP–polymerase chain reaction (PCR) and the electrophoretic mobility shift assay (EMSA). Consistently, male steroid treatment significantly transactivated the promoter activity of PAN in luciferase reporter assay, consequently leading to extensive lytic gene expression and KSHV production as determined by real-time quantitative PCR, and the deletion of nuclear localization signals of AR resulted in the loss of nuclear transport and transcriptional activity in the presence of androgen and thus impaired the expression of PAN RNA. Oncogenically, this study identified that the AR was a functional prerequisite for cell invasion, especially under the context of KSHV reactivation, through hijacking the PAN as a critical effector. Taken together, a novel mechanism from male sex steroids to viral noncoding RNA was identified, which might provide a clue to understanding the male propensity in KS. Although the incidence of Kaposi’ sarcoma (KS) is higher in men, little is known about the mechanisms by which male sex steroids contribute to this disparity. The present study confirmed the striking expression of the androgen receptor (AR) and its concordant nuclear distribution in KS tissues. High-throughput chromatin immunoprecipitation sequencing analysis showed that the AR had extensive binding sites in the KSHV genome, in which the highest enriched gene was PAN. PAN also exhibited the strongest upregulation of promoter activity and RNA transcription among various KSHV lytic genes after the male hormone treatment. Specifically, the effect was a result of the DNA-binding capability of AR to PAN promoter. Moreover, the AR induced dramatic cell invasion, especially under KSHV lytic replication, and the effect was greatly impaired by the inhibitory effect of siRNA on PAN RNA. This study provided a unique insight into the reason why KS occurred predominantly in men.
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Affiliation(s)
- Mingzhu Ding
- Key Laboratory of Gastrointestinal Cancer (Ministry of Education), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, P.R. China
| | - Jinfeng Wu
- Key Laboratory of Gastrointestinal Cancer (Ministry of Education), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, P.R. China
| | - Rui Sun
- State Key Laboratory of Virology, College of Life Sciences, Medical Research Institute, Wuhan University, Wuhan, P.R. China
| | - Lijun Yan
- State Key Laboratory of Virology, College of Life Sciences, Medical Research Institute, Wuhan University, Wuhan, P.R. China
| | - Lei Bai
- State Key Laboratory of Virology, College of Life Sciences, Medical Research Institute, Wuhan University, Wuhan, P.R. China
| | - Jiajian Shi
- Key Laboratory of Gastrointestinal Cancer (Ministry of Education), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, P.R. China
| | - Hua Feng
- Omics Core, Bio-Med Big Data Center, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, P.R. China
| | - Yuqi Zhang
- Key Laboratory of Gastrointestinal Cancer (Ministry of Education), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, P.R. China
| | - Ke Lan
- State Key Laboratory of Virology, College of Life Sciences, Medical Research Institute, Wuhan University, Wuhan, P.R. China
- * E-mail: (KL); (XW)
| | - Xing Wang
- Key Laboratory of Gastrointestinal Cancer (Ministry of Education), School of Basic Medical Sciences, Fujian Medical University, Fuzhou, P.R. China
- * E-mail: (KL); (XW)
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11
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Abstract
PURPOSE OF REVIEW Biological and societal influences are different for men and women leading to different HIV outcomes and related infectious and non-infectious complications. This review evaluates sex differences in the epidemiology and immunological response to HIV and looks at major complications and coinfections, as well as care delivery systems focusing on low- and middle-income countries (LMICs) where most people with HIV live. RECENT FINDINGS More women than men access testing and treatment services in LMIC; women are more likely to be virologically suppressed in that environment. There is a growing recognition that the enhanced immunological response to several pathogens including HIV may result in improved outcomes for infectious comorbidities but may result in a greater burden of non-communicable diseases. Men and women have different requirements for HIV care. Attention to these differences may improve outcomes for all.
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12
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Rossi G, Cozzi I, Della Starza I, De Novi LA, De Propris MS, Gaeta A, Petrucci L, Pulsoni A, Pulvirenti F, Ascoli V. Human herpesvirus-8-positive primary effusion lymphoma in HIV-negative patients: Single institution case series with a multidisciplinary characterization. Cancer Cytopathol 2020; 129:62-74. [PMID: 32975904 DOI: 10.1002/cncy.22344] [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: 04/29/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Primary effusion lymphoma (PEL) is a very rare non-Hodgkin lymphoma caused by human herpesvirus-8 (HHV8) that grows in liquid phase within body cavities. The diagnosis of PEL is based on cytology but requires confirmatory ancillary tests. PEL occurs mainly in association with HIV infection. This study describes 9 cases of PEL in HIV-negative patients and compares their characteristics with 10 HIV-associated cases of PEL diagnosed at a single institution in Italy between 1995 and 2019. METHODS Clinical records were reviewed for demographic data, comorbidities, laboratory abnormalities, and outcome. PEL samples were evaluated for cytomorphology, immunophenotype, immunoglobulin (IG)/T cell receptor (TR) rearrangements, and HHV8 and Epstein-Barr virus (EBV) viral loads in effusion supernatants. RESULTS HIV-unrelated PEL occurred in 8 elderly patients (7 men, 1 woman) and 1 young adult with primary antibody deficiency. Cytology revealed HHV8-positive lymphoma cells lacking B/T cell antigens and exhibiting 2 cell patterns (polymorphous or monotonous). IG was clonally rearranged in all cases; aberrant TRG occurred in 2 cases. Effusion supernatants had more than 106 HHV8 DNA copies per mL and variable loads of EBV DNA. Compared with HIV-associated PEL, the HIV-negative cohort was characterized by older age, less frequent association with Kaposi sarcoma and/or multicentric Castleman disease, comparable but less abnormal laboratory parameters, and a nonsignificant survival benefit. PEL cases with low apoptosis were associated with better prognosis. CONCLUSION To the best of our knowledge, our case series of HIV-unrelated PEL is the largest thus far, expands the spectrum of cytological findings, and supports the need for a multidisciplinary approach in the diagnostic workup.
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Affiliation(s)
- Giovanni Rossi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Ilaria Cozzi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Irene Della Starza
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.,GIMEMA Foundation, Rome, Italy
| | - Lucia Anna De Novi
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Aurelia Gaeta
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Luigi Petrucci
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Federica Pulvirenti
- Department of Infectious Diseases and Internal Medicine, Sapienza University, Rome, Italy
| | - Valeria Ascoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
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13
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Demba RN, Aradi SM, Mwau M, Mwanda WO. Kaposi's sarcoma-associated herpesvirus protein ORF75 among HIV-1 patients in Kenya. Afr J Lab Med 2020; 9:939. [PMID: 32934910 PMCID: PMC7479412 DOI: 10.4102/ajlm.v9i1.939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 05/15/2020] [Indexed: 12/26/2022] Open
Abstract
Background Histology is used to identify Kaposi’s sarcoma (KS) in countries with low resources to fund healthcare costs. Approximately 95% of KS cases can be detected using a polymerase chain reaction. Objective To determine the presence of the open reading frame 75 (ORF75) gene associated with Kaposi’s sarcoma herpes virus among HIV-1/AIDS patients and to describe morphological presentations of KS. Methods This was a retrospective, descriptive study of archived tissue blocks collected from 2013 to 2016. Haematoxylin and eosin staining was used to identify KS. Deoxyribonucleic acid from archived tissue blocks was extracted and a nested polymerase chain reaction was used to detect the ORF75 gene. Results All 81 cases in this study had been diagnosed as HIV-1 positive, of which 68 had hallmark features of KS in the histology report and 13 had features suggestive of KS (‘KS-like’). Microscopic identification of KS by haematoxylin and eosin staining was considered a significant indicator of KS herpes virus ORF75 gene positivity (p = 0.002). The ORF75 gene was detected in 60.5% (49/81) of tissue blocks; 27.2% were men (22/81) and 33.3% were women (27/81). The ORF75 gene was observed to be present in up to 15.4% (2/13) of the cases reported to have KS-like features. Conclusion Following the initial diagnosis of KS by histology, the ORF75 gene was fur-ther detected from both cases that had hallmark features of KS as well as among cases with KS-like fea-tures.
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Affiliation(s)
- Rodgers N Demba
- School of Health Sciences, Kisii University, Kisii, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Sylviah M Aradi
- Department of Internal Medicine, University of Nairobi, Nairobi, Kenya
| | - Matilu Mwau
- Center for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Walter O Mwanda
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
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14
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Chakraborty R, Pandya D, Kar PP, Sethi JK. Kaposi's sarcoma associated with advanced HIV infection: A case report. J Family Med Prim Care 2020; 9:4463-4466. [PMID: 33110887 PMCID: PMC7586607 DOI: 10.4103/jfmpc.jfmpc_913_20] [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: 05/18/2020] [Revised: 06/19/2020] [Accepted: 07/11/2020] [Indexed: 11/24/2022] Open
Abstract
Acquired immunodeficiency syndrome was recognized in the early 1980s. It was more common in men who had sex with previously healthy men and young people and were affected by atypical pneumopathy caused by an opportunistic microorganism, identified as Pneumocystis carinii, and presently known as Pneumocystis jiroveci. Histopathology of the purplish or brown nodular lesions revealed Kaposi's sarcoma (KS). KS is the most frequent neoplasm in patients with human immunodeficiency virus infection. Its pathophysiology has been associated with the presence of a herpes virus, whose etiologic agent is a member of herpes virus type 8 family, which gets transmitted through sexual contact. Here, we present a case report to present the diagnosis and bring the light of knowledge to the Dentist the need of therapeutic measures in the treatment of the pathology.
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Affiliation(s)
- Rakashree Chakraborty
- Department of Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, India
| | - Divya Pandya
- Department of Oral Medicine and Radiology, Kusum Devi Sundarlal Dugar Jain Dental College and Hospital, Kolkata, West Bengal, India
| | - Pinak Pani Kar
- Department of Oral and Maxillofacial Surgery, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India
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Lidenge SJ, Kossenkov AV, Tso FY, Wickramasinghe J, Privatt SR, Ngalamika O, Ngowi JR, Mwaiselage J, Lieberman PM, West JT, Wood C. Comparative transcriptome analysis of endemic and epidemic Kaposi's sarcoma (KS) lesions and the secondary role of HIV-1 in KS pathogenesis. PLoS Pathog 2020; 16:e1008681. [PMID: 32706839 PMCID: PMC7406108 DOI: 10.1371/journal.ppat.1008681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/05/2020] [Accepted: 06/03/2020] [Indexed: 02/08/2023] Open
Abstract
In sub-Saharan Africa, endemic Kaposi's sarcoma (EnKS) is still prevalent despite high incidence of epidemic Kaposi's sarcoma (EpKS) resulting from the on-going HIV-1 epidemic. While KSHV is clearly the etiologic agent of KS, the mechanisms underlying KS development are not fully understood. For example, HIV-1 co-infection and concomitant immune dysfunction have been associated with EpKS development. However, the direct or indirect role(s) of HIV-1, and therefore of immune suppression, in EpKS remains unclear. How, or whether, EpKS is mechanistically distinct from EnKS is unknown. Thus, the absence of HIV-1 co-infection in EnKS provides a unique control for investigating and deciphering whether HIV-1 plays a direct or indirect role in the EpKS tumor microenvironment. We hypothesized that HIV-1 co-infection would induce transcriptome changes that differentiate EpKS from EnKS, thereby defining the direct intra-tumor role of HIV-1 in KS. Comparison of ART-treated and -naïve patients would further define the impact of ART on the KS transcriptome. We utilized RNA-seq followed by multiparameter bioinformatics analysis to compare transcriptomes from KS lesions to uninvolved control skin. We provide the first transcriptomic comparison of EpKS versus EnKS, ART-treated vs-naïve EpKS and male vs female EpKS to define the roles of HIV-1 co-infection, the impact of ART, and gender on KS gene expression profiles. Our findings suggest that ART-use and gender have minimal impact on transcriptome profiles of KS lesions. Gene expression profiles strongly correlated between EpKS and EnKS patients (Spearman r = 0.83, p<10-10). A subset of genes involved in tumorigenesis and inflammation/immune responses showed higher magnitude, but not unique dysregulation in EnKS compared to EpKS. While gender and ART had no detectable contribution, the trend toward higher magnitude of gene dysregulation in EnKS coupled with the absence of HIV-1 transcripts in EpKS may suggest an indirect or systemic effect of HIV-1 to promote KS tumorigenesis.
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Affiliation(s)
- Salum J. Lidenge
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska, Lincoln, Nebraska, United States of America
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - For Yue Tso
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska, Lincoln, Nebraska, United States of America
| | | | - Sara R. Privatt
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska, Lincoln, Nebraska, United States of America
| | - Owen Ngalamika
- Dermatology and Venereology section, University Teaching Hospitals, University of Zambia School of Medicine, Lusaka, Zambia
| | - John R. Ngowi
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Julius Mwaiselage
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul M. Lieberman
- Wistar Institute, Philadelphia, Pennsylvania, United States of America
| | - John T. West
- Nebraska Center for Virology and the Department of Biochemistry, University of Nebraska, Lincoln, Nebraska, United States of America
| | - Charles Wood
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska, Lincoln, Nebraska, United States of America
- Nebraska Center for Virology and the Department of Biochemistry, University of Nebraska, Lincoln, Nebraska, United States of America
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16
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Horner MJ, Salima A, Chilima C, Mukatipa M, Kumwenda W, Kampani C, Chimzimu F, Mukunda B, Tomoka T, Mulenga M, Nyasosela R, Chasimpha S, Dzamalala C, Gopal S. Frequent HIV and Young Age Among Individuals With Diverse Cancers at a National Teaching Hospital in Malawi. J Glob Oncol 2019; 4:1-11. [PMID: 30085887 PMCID: PMC6223526 DOI: 10.1200/jgo.17.00174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Cancer surveillance provides a critical evidence base to guide cancer control efforts, yet population-based coverage in Africa is sparse. Hospital-based registries may help fill this need by providing local epidemiologic data to guide policy and forecast local health care needs. We report the epidemiology of patients with cancer recorded by a de novo hospital-based cancer registry at Kamuzu Central Hospital, Malawi, the sole provider of comprehensive oncology services for half the country and location of a high-volume pathology laboratory. Methods We conducted active case finding across all hospital departments and the pathology laboratory from June 2014 to March 2016. Patient demographics, tumor characteristics, treatment, and HIV status were collected. We describe epidemiology of the cancer caseload, registry design, and costs associated with registry operations. Results Among 1,446 registered patients, Kaposi sarcoma and cervical cancer were the most common cancers among men and women, respectively. Burkitt lymphoma was most common cancer among children. The current rate of pathology confirmation is 65%, a vast improvement in the diagnostic capacity for cancer through the hospital’s pathology laboratory. Among leading cancer types, an alarming proportion occurred at young ages; 50% of Kaposi sarcoma and 25% of esophageal, breast, and cervical cancers were diagnosed among those younger than 40 years of age. A systematic, cross-sectional assessment of HIV status reveals a prevalence of 58% among adults and 18% among children. Conclusion We report a high caseload among typically young patients and a significant burden of HIV infection among patients with cancer. In low- and middle-income countries with intermittent, sparse, or nonexistent cancer surveillance, hospital-based cancer registries can provide important local epidemiologic data while efforts to expand population-based registration continue.
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Affiliation(s)
- Marie-Josèphe Horner
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Ande Salima
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Chrissie Chilima
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Matthews Mukatipa
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Wiza Kumwenda
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Coxcilly Kampani
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Fred Chimzimu
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Bal Mukunda
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Tamiwe Tomoka
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Maurice Mulenga
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Richard Nyasosela
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Steady Chasimpha
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Charles Dzamalala
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Satish Gopal
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
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17
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Horner MJ, Chasimpha S, Spoerri A, Edwards J, Bohlius J, Tweya H, Tembo P, Nkhambule F, Phiri EM, Miller WC, Malisita K, Phiri S, Dzamalala C, Olshan AF, Gopal S. High Cancer Burden Among Antiretroviral Therapy Users in Malawi: A Record Linkage Study of Observational Human Immunodeficiency Virus Cohorts and Cancer Registry Data. Clin Infect Dis 2019; 69:829-835. [PMID: 30452634 PMCID: PMC6773978 DOI: 10.1093/cid/ciy960] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/13/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND With antiretroviral therapy (ART), AIDS-defining cancer incidence has declined and non-AIDS-defining cancers (NADCs) are now more frequent among human immunodeficiency virus (HIV)-infected populations in high-income countries. In sub-Saharan Africa, limited epidemiological data describe cancer burden among ART users. METHODS We used probabilistic algorithms to link cases from the population-based cancer registry with electronic medical records supporting ART delivery in Malawi's 2 largest HIV cohorts from 2000-2010. Age-adjusted cancer incidence rates (IRs) and 95% confidence intervals were estimated by cancer site, early vs late incidence periods (4-24 and >24 months after ART start), and World Health Organization (WHO) stage among naive ART initiators enrolled for at least 90 days. RESULTS We identified 4346 cancers among 28 576 persons. Most people initiated ART at advanced WHO stages 3 or 4 (60%); 12% of patients had prevalent malignancies at ART initiation, which were predominantly AIDS-defining eligibility criteria for initiating ART. Kaposi sarcoma (KS) had the highest IR (634.7 per 100 000 person-years) followed by cervical cancer (36.6). KS incidence was highest during the early period 4-24 months after ART initiation. NADCs accounted for 6% of new cancers. CONCLUSIONS Under historical ART guidelines, NADCs were observed at low rates and were eclipsed by high KS and cervical cancer burden. Cancer burden among Malawian ART users does not yet mirror that in high-income countries. Integrated cancer screening and management in HIV clinics, especially for KS and cervical cancer, remain important priorities in the current Malawi context.
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Affiliation(s)
- Marie-Josèphe Horner
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- University of North Carolina Project-Malawi, Lilongwe
| | | | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Jessie Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | | | - Petros Tembo
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe
| | | | | | - William C Miller
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus
| | | | - Sam Phiri
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe
- Department of Public Medicine, University of Malawi, Blantyre
- Department of Medicine, University of North Carolina at Chapel Hill, Blantyre
| | - Charles Dzamalala
- Malawi Cancer Registry, Blantyre, Malawi
- University of Malawi College of Medicine, Blantyre
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill Lilongwe, Malawi
| | - Satish Gopal
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- University of North Carolina Project-Malawi, Lilongwe
- University of Malawi College of Medicine, Blantyre
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill Lilongwe, Malawi
- University of North Carolina Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill Lilongwe, Malawi
- Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe, Malawi
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Gonçales JP, Silva Júnior JVJ, Lopes TRR, Tozetto-Mendoza TR, de Farias Guimarães D, de Morais VMS, Coêlho MRCD. Association of polymorphisms in NFκB1 promoter and NFκBIA gene with the development of antibodies against HHV-8 in HIV-infected individuals. Virology 2019; 535:255-260. [PMID: 31344550 DOI: 10.1016/j.virol.2019.07.011] [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: 05/19/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 01/01/2023]
Abstract
Human gammaherpesvirus 8 (HHV-8) is the etiologic agent of Kaposi's sarcoma, multicentric Castleman's disease and primary effusion lymphoma. Like other herpesviruses, the HHV-8 may exhibit latent or lytic cycle, both regulated by viral and host factors. Regarding host factors, we analysed the association of polymorphisms in NFkB1 promoter (NFkB1-94 ins/del ATTG) and NFκBIA gene (NFκBIA 3'UTR A→G) with the development of antibodies against latent or lytic antigens from HHV-8. The ins/del [OR 7.9 (95% CI 3.3-19.1), p < 0.001], AG [OR 12.3 (95% CI 4.3-34.9) p < 0.001], GG [OR 9.4 (95% CI 3.2-27.9), p < 0.001], ins/del + AG [OR 94.5 (95% CI 9.6-924.4), <0.0001], ins/del + GG [OR 50.4 (95% CI 5.2-482.2, p < 0.0001] and G allele [OR 3.3 (95% CI 2.0-5.6), p < 0.001] were strongly related with the presence of antibodies to lytic antigens. This is the first association of polymorphisms in NFκB1 promoter and NFκBIA gene with the development of antibodies against HHV-8.
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Affiliation(s)
- Juliana Prado Gonçales
- Virology Sector, Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Pernambuco, Brazil
| | - José Valter Joaquim Silva Júnior
- Virology Sector, Department of Preventive Veterinary Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Thaísa Regina Rocha Lopes
- Virology Sector, Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Pernambuco, Brazil
| | | | | | | | - Maria Rosangela Cunha Duarte Coêlho
- Virology Sector, Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Pernambuco, Brazil; Department of Physiology and Pharmacology, Center of Biosciences, Federal University of Pernambuco, Pernambuco, Brazil.
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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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de Morais VMS, Gonçales JP, Cahú GGDOM, Tozetto-Mendoza TR, Coêlho MRCD. Mannose-binding lectin concentrations in people living with HIV/AIDS infected by HHV-8. BMC Immunol 2019; 20:1. [PMID: 30606111 PMCID: PMC6318849 DOI: 10.1186/s12865-018-0284-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/18/2018] [Indexed: 12/17/2022] Open
Abstract
Background Mannose-binding lectin (MBL) plays an important role in the innate immune response by activating the complement system via the lectin pathway, and it has been studied in several viral infections; however, the influence of MBL in PLWHA infected with HHV-8 is unknown. The objective of this study was to verify the association of MBL deficient plasma concentrations in HIV/HHV-8 coinfected and HIV monoinfected patients and to correlate these concentrations with HIV viral load and CD4 counts in both groups. Results This was an analytical study of case-controls consisting of PLWHA monitored at the medical outpatient of Infectious and Parasitic Diseases of the clinical hospital in the Federal University of Pernambuco. Plasma concentrations of MBL were obtained by an enzyme-linked immunosorbent assay (ELISA) using a commercial Human Mannose Binding Lectin kit (MyBioSource, Inc.) that was performed according to the manufacturer’s guidelines, with values < 100 ng/ml considered deficient. A total of 245 PLWHA samples were analysed; 118 were HIV/HHV-8 coinfected and 127 were HIV monoinfected; 5.1% (6/118) of the coinfected patients and 3.2% (4/127) of the monoinfected patients (p = 0.445) were considered plasma concentration deficient. The median of the plasma concentrations of MBL in the coinfected patients was 2803 log10 ng/ml and was 2.959 log10 ng/ml in the monoinfected patients (p = 0.001). There was an inverse correlation between the plasma concentrations of MBL and the HIV viral load in both groups, but no correlation with the CD4 count. Conclusions Although the plasma concentrations considered deficient in MBL were not associated with HHV-8 infection in PLWHA, the coinfected patients showed lower MBL concentrations and an inverse correlation with HIV viral load, suggesting that there may be consumption and reduction of MBL due to opsonization of HIV and HHV-8, leading to the reduction of plasma MBL and non-accumulation in the circulation.
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Affiliation(s)
- Viviane Martha Santos de Morais
- Virology Division, Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Juliana Prado Gonçales
- Virology Division, Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Tania Regina Tozetto-Mendoza
- Laboratory of Virology (LIM52), Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Maria Rosângela Cunha Duarte Coêlho
- Virology Division, Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco, Recife, Pernambuco, Brazil. .,Departament of Physiology and Pharmacology, Center of Biological Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. .,Setor de Virologia do Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Cidade Universitária, P.O. Box: Av. Prof. Moraes Rego, 1235, Recife, PE, 50670-901, Brazil.
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21
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de Morais VMS, de Lima ELS, Cahú GGDOM, Lopes TRR, Gonçales JP, Muniz MTC, Coêlho MRCD. MBL2 gene polymorphisms in HHV-8 infection in people living with HIV/AIDS. Retrovirology 2018; 15:75. [PMID: 30482213 PMCID: PMC6260567 DOI: 10.1186/s12977-018-0456-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 11/16/2018] [Indexed: 02/01/2023] Open
Abstract
Background Host genetic factors such as MBL2 gene polymorphisms cause defects in the polymerization of MBL protein and result in a functional deficiency and/or in low serum levels that can influence susceptibility to various viral infections. The aim of this study was to estimate the frequency of alleles, genotypes and haplotypes related to -550, -221 and exon 1 polymorphisms of the MBL2 gene and investigate their association with HHV-8 in people living with HIV/AIDS (PLWHA), as well as the impacts on CD4 cell count and HIV viral load in HIV/HHV-8 coinfected and HIV monoinfected patients. Results A cross sectional study in PLWHA, with and without HHV-8 infection, exploring associations between different factors, was performed in the outpatient infectious and parasitic diseases clinic at a referral hospital. Genomic DNA extractions from leukocytes were performed using a commercial Wizard®Genomic DNA Purification kit (Promega, Madison, WI). The promoter region (-550 and -221) was genotyped with the TaqMan system (Applied TaqMan Biosystems® genotyping Assays), and the structural region (exon1) was genotyped with Express Sybr Greener Supermix kit (Invitrogen, USA). In total, 124 HIV/HHV-8 coinfected and 213 HIV monoinfected patients were analysed. Median TCD4 counts were significantly lower in HIV/HHV-8 coinfected patients, whereas the mean of the first and last viral load of HIV did not present significant difference. There was no difference in frequency between the LL, YY and AA genotypes between the HIV/HHV-8 coinfected or HIV monoinfected patients. However, in a multivariate analysis, coinfected patients with the intermediate expression haplotype of the MBL2 gene had an odds ratio of 3.1-fold (CI = 1.2–7.6) of their last CD4 cell count being below 350 cells/mm3. Among the coinfected individuals, four developed KS and presented the intermediate expression MBL haplotype, with three being HYA/LXA and one being LYA/LYO. Conclusions Host genetic factors, such as -550, -221 and exon 1 polymorphisms, can be related to the may modify coinfections and/or to the development clinical manifestations caused by HHV-8, especially in HIV/HHV-8 coinfected patients who present the intermediate expression haplotypes of MBL.
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Affiliation(s)
- Viviane Martha Santos de Morais
- Virology Division, Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Elker Lene Santos de Lima
- Laboratory of Molecular Biology, Center of Pediatric Oncohematology, Oswaldo Cruz University Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Georgea Gertrudes de Oliveira Mendes Cahú
- Virology Division, Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Thaisa Regina Rocha Lopes
- Virology Division, Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Juliana Prado Gonçales
- Virology Division, Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Maria Tereza Cartaxo Muniz
- Laboratory of Molecular Biology, Center of Pediatric Oncohematology, Oswaldo Cruz University Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Maria Rosângela Cunha Duarte Coêlho
- Virology Division, Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil. .,Departament of Physiology and Pharmacology, Center of Biological Sciences, Federal University of Pernambuco, Recife, PE, Brazil.
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22
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Liu Z, Fang Q, Zuo J, Minhas V, Wood C, Zhang T. The world‐wide incidence of Kaposi's sarcoma in the
HIV
/
AIDS
era. HIV Med 2018; 19:355-364. [DOI: 10.1111/hiv.12584] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Z Liu
- Department of Epidemiology School of Public Health Fudan University Shanghai China
- Key Laboratory of Public Health Safety (Fudan University) Ministry of Education Shanghai China
| | - Q Fang
- Department of Epidemiology School of Public Health Fudan University Shanghai China
- Key Laboratory of Public Health Safety (Fudan University) Ministry of Education Shanghai China
| | - J Zuo
- Department of Epidemiology School of Public Health Fudan University Shanghai China
- Key Laboratory of Public Health Safety (Fudan University) Ministry of Education Shanghai China
| | - V Minhas
- Nebraska Center of Virology and the School of Biological Sciences University of Nebraska‐Lincoln Lincoln NE USA
| | - C Wood
- Nebraska Center of Virology and the School of Biological Sciences University of Nebraska‐Lincoln Lincoln NE USA
| | - T Zhang
- Department of Epidemiology School of Public Health Fudan University Shanghai China
- Key Laboratory of Public Health Safety (Fudan University) Ministry of Education Shanghai China
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23
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Wang X, Zou Z, Deng Z, Liang D, Zhou X, Sun R, Lan K. Male hormones activate EphA2 to facilitate Kaposi's sarcoma-associated herpesvirus infection: Implications for gender disparity in Kaposi's sarcoma. PLoS Pathog 2017; 13:e1006580. [PMID: 28957431 PMCID: PMC5619820 DOI: 10.1371/journal.ppat.1006580] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/14/2017] [Indexed: 12/12/2022] Open
Abstract
There is increasing consensus that males are more vulnerable than females to infection by several pathogens. However, the underlying mechanism needs further investigation. Here, it was showed that knockdown of androgen receptor (AR) expression or pre-treatment with 5α-dihydrotestosterone, the AR agonist, led to a considerably dysregulated Kaposi's sarcoma-associated herpesvirus (KSHV) infection. In endothelial cells, membrane-localized AR promoted the endocytosis and nuclear trafficking of KSHV. The AR interacted with ephrin receptor A2 (EphA2) and increased its phosphorylation at residue Ser897, which was specifically upregulated upon KSHV infection. This phosphorylation resulted from the AR-mediated recruitment of Src, which resulted in the activation of p90 ribosomal S6 kinase 1 (RSK1), which directly phosphorylates EphA2 at Ser897. Finally, the EphA2-mediated entry of KSHV was abolished in a Ser897Asn EphA2 mutant. Taken together, membrane-localized AR was identified as a KSHV entry factor that cooperatively activates Src/RSK1/EphA2 signaling, which subsequently promotes KSHV infection of both endothelial and epithelial cells.
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Affiliation(s)
- Xing Wang
- State Key Laboratory of Virology, College of Life Science, Wuhan University, Wuhan, Hubei Province, China
| | - Zhe Zou
- State Key Laboratory of Virology, College of Life Science, Wuhan University, Wuhan, Hubei Province, China
| | - Zhaohui Deng
- Hospital of Xinjiang Production and Construction Corps, Urumqi, Xinjiang, China
| | - Deguang Liang
- State Key Laboratory of Virology, College of Life Science, Wuhan University, Wuhan, Hubei Province, China
| | - Xin Zhou
- Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Rui Sun
- State Key Laboratory of Virology, College of Life Science, Wuhan University, Wuhan, Hubei Province, China
| | - Ke Lan
- State Key Laboratory of Virology, College of Life Science, Wuhan University, Wuhan, Hubei Province, China
- * E-mail:
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24
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Abstract
Skin tumors are a clinically heterogeneous group of dermatologic conditions that affect both children and adults. Although similar types of skin tumors can affect both children and adults, the epidemiology, pathogenesis, and treatment of these skin neoplasms can vary drastically in children compared with adults. Despite the clear need for literature elucidating the differences of skin tumors in children compared with adults, there is a serious dearth of scientific contributions addressing this area. This contribution highlights the types of differences that can occur between adults and children with skin neoplasms, as well as the special considerations that need to be recognized when managing skin tumors in children by providing a comparative analysis of basal cell carcinoma, squamous cell carcinoma, and Kaposi sarcoma occurring in adults with these same tumors occurring in children. Specifically, we examine the aforementioned tumors with a focus on (1) epidemiology, (2) etiology, (3) clinical presentation, (4) workup, and (5) treatment.
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MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Adolescent
- Adult
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/epidemiology
- Carcinoma, Basal Cell/etiology
- Carcinoma, Basal Cell/therapy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/therapy
- Child
- Child, Preschool
- Humans
- Infant
- Infant, Newborn
- Sarcoma, Kaposi/diagnosis
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/therapy
- Skin Neoplasms/diagnosis
- Skin Neoplasms/epidemiology
- Skin Neoplasms/etiology
- Skin Neoplasms/therapy
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Affiliation(s)
- Reid A Waldman
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT.
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Tozetto‐Mendoza TR, Sumita LM, Palmieri M, Ornaghi M, Canto AM, Braz‐Silva PH. No detectable human herpesvirus‐8 oral shedding in seronegative‐healthy, immunocompetent individuals from non‐endemic regions for Kaposi's sarcoma: A pilot study. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/jicd.12278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Laura M. Sumita
- Institute of Tropical Medicine of São PauloUniversity of São Paulo São Paulo Brazil
| | - Michelle Palmieri
- Department of StomatologySchool of DentistryUniversity of São Paulo São Paulo Brazil
| | - Mariana Ornaghi
- Department of StomatologySchool of DentistryUniversity of São Paulo São Paulo Brazil
| | - Alan M. Canto
- Department of StomatologySchool of DentistryUniversity of São Paulo São Paulo Brazil
| | - Paulo H. Braz‐Silva
- Institute of Tropical Medicine of São PauloUniversity of São Paulo São Paulo Brazil
- Department of StomatologySchool of DentistryUniversity of São Paulo São Paulo Brazil
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Abstract
PURPOSE OF REVIEW To review current knowledge of different cancer states affecting women with HIV infection. RECENT FINDINGS With improved survival of persons with HIV in the post-cART era, the landscape of malignancies in this population has greatly changed with fewer AIDS-defining malignancies (ADM) and a growing number of non-AIDS defining malignancies (NADM). Women, however, continue to represent a vulnerable population at risk for certain ADM and NADM such as cervical, anal, and breast cancer. Human papillomavirus-mediated cancers disproportionately burden women in resource-poor settings such as sub-Saharan Africa. For cancers such as Kaposi's sarcoma, lung cancer, liver cancer, and colorectal cancer, women share a lower burden of disease compared with their male counterparts. However, there remains a dearth of evidence characterizing these disease states specifically among women. SUMMARY Cancer in women with HIV continues to be a major source of morbidity and mortality worldwide, especially in low-income countries. Screening strategies, primary prevention through vaccination against human papillomavirus and viral hepatitis, and treatment for HIV with combined antiviral therapy remain cornerstones in cancer prevention.
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Affiliation(s)
- Nora T. Oliver
- Department of Medicine, Section of Infectious Diseases, Atlanta VA Medical Center, Decatur, GA
| | - Elizabeth Y. Chiao
- Department of Medicine, Section of Infectious Diseases and Health Services Research, Baylor College of Medicine, Houston, TX
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Qin J, Lu C. Infection of KSHV and Interaction with HIV: The Bad Romance. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1018:237-251. [PMID: 29052142 DOI: 10.1007/978-981-10-5765-6_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV), namely, human herpesvirus 8 (HHV-8), is considered as the pathogen of Kaposi's sarcoma (KS), the most frequent cancer in untreated HIV-infected individuals. Patients infected with HIV have a much higher possibility developing KS than average individual. Researchers have found that HIV, which functions as a cofactor of KS, contributes a lot to the development of KS. In this article, we will give a brief introduction of KS and KSHV and how the interaction between KSHV and HIV contributes to the development of KS. Also we will take a glance at the development of treatment in KS, especially AIDS-KS.
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Affiliation(s)
- Jie Qin
- Key Laboratory of Pathogen Biology (Jiangsu Province), Nanjing Medical University, Nanjing, People's Republic of China.,Department of Microbiology, Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Chun Lu
- Key Laboratory of Pathogen Biology (Jiangsu Province), Nanjing Medical University, Nanjing, People's Republic of China. .,Department of Microbiology, Nanjing Medical University, Nanjing, 210029, People's Republic of China.
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