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Dusingize JC, Murenzi G, Muhoza B, Businge L, Remera E, Uwinkindi F, Hagenimana M, Rwibasira G, Nsanzimana S, Castle PE, Anastos K, Clifford GM. Cancer risk among people living with Human Immuodeficiency Virus (HIV) in Rwanda from 2007 to 2018. Int J Cancer 2024. [PMID: 39128948 DOI: 10.1002/ijc.35091] [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: 01/21/2024] [Revised: 05/06/2024] [Accepted: 06/04/2024] [Indexed: 08/13/2024]
Abstract
Assessing the risk of cancer among people living with HIV (PLHIV) in the current era of antiretroviral therapy (ART) is crucial, given their increased susceptibility to many types of cancer and prolonged survival due to ART exposure. Our study aims to compare the association between HIV infection and specific cancer sites in Rwanda. Population-based cancer registry data were used to identify cancer cases in both PLHIV and HIV-negative persons. A probabilistic record linkage approach between the HIV and cancer registries was used to supplement HIV status ascertainment in the cancer registry. Associations between HIV infection and different cancer types were evaluated using unconditional logistic regression models. We performed several sensitivity analyses to assess the robustness of our findings and to evaluate the potential impact of different assumptions on our results. From 2007 to 2018, the cancer registry recorded 17,679 cases, of which 7% were diagnosed among PLHIV. We found significant associations between HIV infection and Kaposi's Sarcoma (KS) (adjusted odds ratio [OR]: 29.1, 95% CI: 23.2-36.6), non-Hodgkin lymphoma (NHL) (1.6, 1.3-2.0), Hodgkin lymphoma (HL) (1.6, 1.1-2.4), cervical (2.3, 2.0-2.7), vulvar (4.0, 2.5-6.5), penile (3.0, 2.0-4.5), and eye cancers (2.2, 1.6-3.0). Men living with HIV had a higher risk of anal cancer (3.1, 1.0-9.5) than men without HIV, but women living with HIV did not have higher risk than women without HIV (1.0, 0.2-4.3). Our study found that in an era of expanded ART coverage in Rwanda, HIV is associated with a broad range of cancers, particularly those linked to viral infections.
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Affiliation(s)
- Jean Claude Dusingize
- Cancer Epidemiology, Prevention & Control Program, Montefiore Einstein Cancer Center, Bronx, New York, USA
| | - Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Benjamin Muhoza
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | | | | | | | | | | | | | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Kathryn Anastos
- Department of Medicine and of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gary M Clifford
- Early Detection Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
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Singini MG, Muchengeti M, Sitas F, Chen WC, Combes JD, Waterboer T, Clifford GM. Antibodies against high-risk human papillomavirus proteins as markers for noncervical HPV-related cancers in a Black South African population, according to HIV status. Int J Cancer 2024; 155:251-260. [PMID: 38577820 DOI: 10.1002/ijc.34919] [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: 11/07/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 04/06/2024]
Abstract
Human papillomavirus (HPV) proteins may elicit antibody responses in the process toward HPV-related malignancy. However, HPV seroepidemiology in noncervical HPV-related cancers remains poorly understood, particularly in populations with a high prevalence of human immunodeficiency virus (HIV). Using a glutathione S-transferase-based multiplex serology assay, antibodies against E6, E7 and L1 proteins of HPV16 and HPV18 were measured in sera of 535 cases of noncervical HPV-related cancers (anal (n = 104), vulval (n = 211), vaginal (n = 49), penile (n = 37) and oropharyngeal (n = 134)) and 6651 non-infection-related cancer controls, from the Johannesburg Cancer Study that recruited Black South African with newly diagnosed cancer between 1995 and 2016. Logistic and Poisson regression models were used to calculate adjusted odds ratios (aOR) and prevalence ratios (aPR) and 95% confidence intervals (CI) in cases versus controls. HPV16 E6 was more strongly associated with noncervical HPV-related cancers than HPV16 L1 or E7, or HPV18 proteins: anal (females (HPV16 E6 aOR = 11.50;95%CI:6.0-22.2), males (aOR = 10.12;95%CI:4.9-20.8), vulval (aOR = 11.69;95%CI:7.9-17.2), vaginal (aOR = 10.26;95%CI:5.0-21), penile (aOR = 18.95;95%CI:8.9-40), and oropharyngeal (females (aOR = 8.95;95%CI:2.9-27.5), males (aOR = 3.49;95%CI:1.8-7.0)) cancers. HPV16-E6 seropositivity ranged from 24.0% to 35.1% in anal, vulval, vaginal and penile cancer but was significantly lower (11.2%) in oropharyngeal cancer. After adjustment for HIV, prevalence of which increased from 22.2% in 1995-2005 to 54.1% in 2010-2016, HPV16 E6 seropositivity increased by period of diagnosis (aPR for 2010-2016 vs. 1995-2006 = 1.84;95%CI:1.1-3.0). Assuming HPV16 E6 seroprevalence reflects HPV attributable fraction, the proportion of certain noncervical-HPV-related cancers caused by HPV is increasing over time in South Africa. This is expected to be driven by the increasing influence of HIV.
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Affiliation(s)
- Mwiza Gideon Singini
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mazvita Muchengeti
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Freddy Sitas
- Center for Primary Health Care and Equity, School of Population Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Menzies Center of Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wenlong Carl Chen
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean-Damien Combes
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gary M Clifford
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
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Ashindoitiang JA, Nwagbara VIC, Ozinko MO, Ugbem TI, Asuquo ME. Multiple carcinomas in a woman with HIV infection: a case report and literature review. J Int Med Res 2024; 52:3000605241245011. [PMID: 38606735 PMCID: PMC11015788 DOI: 10.1177/03000605241245011] [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: 10/24/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Non-acquired immunodeficiency syndrome-defining cancers (NADCs) are malignancies in persons living with human immunodeficiency virus (PLWHIV) and are not primarily due to the host's immunodeficiency. There is renewed clinical interest in long-term morbidities in PLWHIV as well as malignancies that occur in this population. We herein describe a 36-year-old woman with a 2-year history of an anal wound and right breast mass. She had been diagnosed with HIV infection prior to the development of these lesions. Clinical and laboratory evaluations led to diagnoses of breast and anal cancers. Chemotherapy and antiretroviral therapy were begun, but the patient discontinued these treatments early and was lost to follow-up. NADCs will continue to be a major clinical issue as the global population ages. This presentation of two NADCs (breast and anal cancers) in a PLWHIV further highlights the burden of multiple malignancies on the depleted health of HIV-infected patients. Early identification and treatment of HIV upon patients' presentation to cancer care sites and screening for NADCs at HIV/AIDS care sites are recommended for improved outcomes.
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Affiliation(s)
- John Adi Ashindoitiang
- Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Mba Okpan Ozinko
- Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Theophilus Ipeh Ugbem
- Department of Pathology, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Maurice Efana Asuquo
- Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
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Muturi D, Mwanzi SN, Riunga FM, Shah J, Shah R. HIV Prevalence and Characteristics Among Patients With AIDS-Defining and Non-AIDS-Defining Cancers in a Tertiary Hospital in Kenya. JCO Glob Oncol 2023; 9:e2200360. [PMID: 37018633 DOI: 10.1200/go.22.00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
PURPOSE Antiretroviral therapy (ART) has resulted in a higher life expectancy of persons living with HIV. This has led to an aging population at risk for both non-AIDS-defining cancers (NADCs) and AIDS-defining cancers (ADCs). HIV testing among patients with cancer in Kenya is not routinely performed, making its prevalence undefined. The aim of our study was to determine the prevalence of HIV and the spectrum of malignancies among HIV-positive and HIV-negative patients with cancer attending a tertiary hospital in Nairobi, Kenya. MATERIALS AND METHODS We conducted a cross-sectional study between February 2021 and September 2021. Patients with a histologic cancer diagnosis were enrolled. Demographic data and HIV- and cancer-related clinical variables were obtained. HIV pretest counseling and consent were done, and testing was performed using a fourth-generation assay. Positive results were confirmed using a third-generation assay. RESULTS We enrolled 301 patients with cancer; 67.8% (204 of 301) were female; the mean age was 50.7 ± 12.5 years. From our cohort, 10.6% (95% CI, 7.4 to 14.7, n = 32 of 301) of patients were HIV-positive with the prevalence of a new HIV diagnosis of 0.7% (n = 2 of 301). Of the HIV-positive patients, 59.4% (19 of 32) had a NADC. The commonest NADC was breast cancer (18.8%; 6 of 32), whereas non-Hodgkin lymphoma (18.8%; 6 of 32) and cervical cancer (18.8%; 6 of 32) were the most prevalent ADCs among HIV-positive patients. CONCLUSION The prevalence of HIV infection among patients with cancer was twice the Kenya national HIV prevalence. NADCs comprised a larger percentage of the cancer burden. Universal opt-out HIV testing of patients attending for cancer care regardless of cancer type may facilitate early recognition of HIV-infected patients and aid in appropriate selection of ART and cancer therapies and preventive strategies.
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Affiliation(s)
- Diana Muturi
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Sitna N Mwanzi
- Department of Haemato-Oncology, Aga Khan University, Nairobi, Kenya
| | - Felix M Riunga
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
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Cancer in patients with and without HIV infection in the national cancer registry of Rwanda. AIDS 2023; 37:83-90. [PMID: 36172844 DOI: 10.1097/qad.0000000000003396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE As antiretroviral therapy (ART) has been widely scaled up in Rwanda, life expectancies among people with HIV (PWH) have increased. With increasing viral suppression, AIDS-defining cancers (ADCs) typically decrease; however, as the PWH population ages, non-AIDS-defining cancers (NADCs) will be expected to increase. The aim of this study was to compare cancer diagnoses between PWH and patients without HIV in Rwanda and to describe the changes in the number and types of cancer over time. DESIGN Retrospective cohort study. METHODS Rwanda National Cancer Registry (RNCR) recorded the HIV status, primary site, and morphological description for cancer diagnoses from 2007 to 2018. Descriptive analyses were carried out by cancer group (HIV+ and HIV-). A portion of patients whose HIV status was unknown (63%) were excluded from the present analysis. RESULTS Among the 20 258 cases registered in the Registry, there were 1048 PWH and 6359 HIV- individuals. The proportion of ADCs were significantly higher in the PWH group compared to those without HIV ( P < 0.001). Among PWH, there was a longitudinal increase in NADCs and a decrease in ADCs ( P < 0.001) over time. Among the ADCs in the PWH group, there was a significant decline in Kaposi sarcoma cases over time. CONCLUSIONS The study demonstrates a decreasing frequency of ADCs driven by declines in Kaposi sarcoma diagnoses and an increased frequency of NADCs among PWH in Rwanda over time. These findings support a need for focusing early detection and management efforts on NADCs, as they begin to play a larger role in the disease processes that affect the aging PWH population.
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Deng L, Si Y, Wu Q, Cao Y, Lian S, Li L. Higher Neutrophil-to-Lymphocyte Ratio (NLR) Is a Preoperative Inflammation Biomarker of Poor Prognosis in HIV-Infected Patients with Colorectal Cancer: A Retrospective Study. Can J Gastroenterol Hepatol 2023; 2023:7966625. [PMID: 36923659 PMCID: PMC10010889 DOI: 10.1155/2023/7966625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
Background The serum systemic inflammation biomarkers are known predictors of colorectal cancer (CRC) patient prognosis. However, their significance in human immunodeficiency virus (HIV)-infected patients with CRC has not been studied. To address this gap, we conducted a retrospective study to evaluate the prognostic value of preoperative systemic inflammation biomarkers in HIV-infected patients with CRC. Methods The study enrolled 57 patients with colorectal cancer (CRC) and HIV who underwent surgery at the Shanghai Public Health Clinical Center between January 2015 and December 2021. Preoperative tests were conducted, and systemic inflammation biomarkers were measured. The patients were categorized into two groups using the optimal cut-off value. The Kaplan-Meier method and the log-rank test were used to determine overall survival (OS) and progression-free survival (PFS). Multivariate analysis was performed using the Cox proportional regression model. A time-dependent receiver operating characteristic (t-ROC) was used to compare the prognostic abilities of the biomarkers. Results The study included 57 HIV-infected CRC patients, with a median age of 60 and a follow-up time ranging from 3 to 86 months. Of the patients, 49 were male and 8 were female. The cumulative three-year OS and PFS rates were 55.0% and 45.0%, respectively. The optimal cut-off value for preoperative NLR was found to be 2.8, which was significantly correlated with lower CD8+ T and CD3+ T lymphocyte counts. Multivariate Cox regression analysis revealed that a low NLR was an independent predictor of better OS and PFS (OS: HR = 0.094, 95% CI: 0.02-0.45, P=0.003; PFS: HR = 0.265, 95% CI: 0.088-0.8, P=0.019). The time-dependent receiver operating characteristic (t-ROC) analysis showed that NLR was a superior systemic inflammation biomarker for predicting the prognosis of HIV-infected CRC patients throughout the observation period. Conclusion The preoperative neutrophil-to-lymphocyte ratio (NLR), an easily measurable immune biomarker, may provide useful prognostic information in HIV-infected colorectal cancer (CRC) patients.
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Affiliation(s)
- Li Deng
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yanhui Si
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Qian Wu
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ye Cao
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Shixian Lian
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lei Li
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Habimana S, Biracyaza E, Mpunga T, Nsabimana E, Kayitesi F, Nzamwita P, Jansen S. Prevalence and associated factors of depression and anxiety among patients with cancer seeking treatment at the Butaro Cancer Center of Excellence in Rwanda. Front Public Health 2023; 11:972360. [PMID: 36875374 PMCID: PMC9978744 DOI: 10.3389/fpubh.2023.972360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Background Depression and anxiety are psychological and physiological disturbances persisting in cancer patients with high prevalence worldwide, particularly in low- and middle-income countries, due to complexities of determinants of health including biological, individual, socio-cultural, and treatment-related characteristics. Although depression and anxiety have an enormous impact on adherence, length of stay at the hospital, quality of life, and treatment outcomes, studies on psychiatric disorders remain limited. Thus, this study determined the prevalence and factors of depression and anxiety among patients with cancer in Rwanda. Methods A cross-sectional study was conducted among 425 patients with cancer from the Butaro Cancer Center of Excellence. We administered socio-demographic questionnaires and psychometric instruments. Bivariate logistic regressions were computed to identify significant factors to be exported into the multivariate logistic models. Then, odds ratios and their 95% confidence intervals were applied, and statistical significance at p < 0.05 were considered to confirm significant associations. Results The prevalence of depression and anxiety was 42.6 and 40.9%, respectively. Patients with cancer initiated to chemotherapy had a greater likelihood of being depressed [AOR = 2.06; 95% CI (1.11-3.79)] than those initiated to chemotherapy and counseling. Breast cancer was significantly associated with a greater risk of depression [AOR = 2.07, 95% CI (1.01-4.22)] than Hodgikins's Lymphoma cancer. Furthermore, patients with depression had greater odds of developing anxiety [AOR = 1.76, 95% CI (1.01-3.05)] than those with no depression. Those suffering from depression were almost two times more likely to experience anxiety [AOR = 1.76; 95% CI (1.01-3.05)] than their counterparts. Conclusion Our results revealed that depressive and anxious symptomatology is a health threat in clinical settings that requires enhancement of clinical monitoring and prioritization of mental health in cancer health facilities. Designing biopsychosocial interventions to address associated factors needs special attention to promote the health and wellbeing of patients with cancer.
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Affiliation(s)
- Samuel Habimana
- Department of Social work and Social Ecology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, United States.,Rwanda Resilience and Grounding Organization, Kigali, Rwanda
| | - Emmanuel Biracyaza
- Rwanda Resilience and Grounding Organization, Kigali, Rwanda.,Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
| | | | | | - Florence Kayitesi
- Acquired Immunodeficiency Syndrome Health Care Foundation, Kigali, Rwanda
| | - Pascal Nzamwita
- Acquired Immunodeficiency Syndrome Health Care Foundation, Kigali, Rwanda
| | - Stefan Jansen
- Center for Research and Innovation, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Yuan T, Hu Y, Zhou X, Yang L, Wang H, Li L, Wang J, Qian HZ, Clifford GM, Zou H. Incidence and mortality of non-AIDS-defining cancers among people living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101613. [PMID: 35990580 PMCID: PMC9386399 DOI: 10.1016/j.eclinm.2022.101613] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-AIDS-defining cancers (NADCs) are now becoming a rising cause of morbidity among people living with HIV (PLHIV) in the highly active antiretroviral therapy (HAART) era. We conducted a systematic review and meta-analysis to estimate the summary risk of incidence and mortality of a wide range of NADCs among PLHIV compared with the general population. Methods This systematic review and meta-analysis was registered in the PROSPERO (registration number CRD42020222020). We searched PubMed, EMBASE, Cochrane library, and Web of Science for relevant studies published before Jan 24, 2022. Cohort or registry linkage studies comparing the incidence or mortality of individual NADCs in PLHIV with that in the general population were included. Studies simply reporting outcomes of cancer precursor lesions or combined NADCs were excluded. We calculated pooled standardised incidence (SIRs) and standardised mortality ratios (SMRs) and their 95% confidence intervals (CIs) using random-effects models, and used robust variance estimation to account for non-independence in study-level effect sizes. Findings We identified 92 publications arising from 46 independent studies including 7 articles out of 7 studies from developing countries. Among the 40 types of NADCs investigated, all of the 20 infection-related NADCs, cancers related with human papillomavirus infection in particular, and half of the 20 non-infection-related NADCs occurred in excess in PLHIV compared with the general population. This risk pattern was consistent in most WHO regions and in both high-income and low-and middle-income countries. The increased SIRs for various NADCs were more evident among PLHIV with advanced immunodeficiency, and was explored by HIV transmission route, and use of HAART. PLHIV had increased mortality for anal cancer (SMR 124·07, 95% CI 27·31-563·72), Hodgkin lymphoma (41·03, 2·91-577·88), liver cancer (8·36, 3·86-18·11), lung cancer (3·95, 1·52-10·26), and skin melanoma (3·95, 1·28-12·2). Interpretation PLHIV had increased incidence and mortality for a wide spectrum of NADCs. Primary prevention and effective treatment for NADCs in this population is urgently needed. Funding Natural Science Foundation of China Excellent Young Scientists Fund, Natural Science Foundation of China International/Regional Research Collaboration Project, National Science and Technology Major Project of China, Sanming Project of Medicine in Shenzhen, High Level Project of Medicine in Longhua, Shenzhen, Shenzhen Science and Technology Innovation Commission Basic Research Program, Special Support Plan for High-Level Talents of Guangdong Province, the Guangzhou Basic Research Program on People's Livelihood Science and Technology, the National Natural Science Foundation of China.
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Affiliation(s)
- Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuqing Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xinyi Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Luoyao Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- National Clinical Research Center for Infectious Diseases, Shenzhen, China
- The Third People's Hospital of Shenzhen, Shenzhen, China
- The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou, China
- Guangzhou Medical University, Guangzhou, China
| | - Junfeng Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT USA
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, the University of New South Wales, Sydney, Australia
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Ibrahim Khalil A, Franceschi S, de Martel C, Bray F, Clifford GM. Burden of Kaposi sarcoma according to HIV status: A systematic review and global analysis. Int J Cancer 2022; 150:1948-1957. [PMID: 35085400 DOI: 10.1002/ijc.33951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 11/09/2022]
Abstract
In 2020, over 34 000 cases of Kaposi sarcoma (KS) were estimated globally, all attributable to KS herpesvirus (KSHV). Prior to the HIV epidemic, KS already existed in KSHV endemic regions, notably in sub-Saharan Africa (SSA). The HIV epidemic has vastly increased the KS burden. We developed a methodology to provide global estimates of KS burden according to HIV status. A systematic review identified studies reporting HIV prevalence in consecutive KS series. Pooled estimates of HIV prevalence, by country or UN subregion, were used to calculate population-attributable fraction (PAF) and these were applied to IARC's GLOBOCAN 2020 to estimate burden and incidence of HIV-attributable and non-HIV-attributable KS. We identified 55 eligible studies, reporting HIV prevalence ranging from ≤5% to ≥95%. Approximately 80% of KS in SSA was estimated attributable to HIV, vs ~50% in the rest of the world. By applying PAFs to national GLOBOCAN estimates, an estimated 19 560 KS cases attributable to HIV were diagnosed in SSA in 2020 (~80% of the worldwide burden), vs 5064 cases of non-HIV-attributable KS (~60% of the worldwide burden). Incidence of HIV-attributable KS was highest in Southern Africa (6.0 cases per 100 000) and Eastern Africa (3.4), which were also the world regions with highest incidence of non-HIV-attributable KS (0.4 and 1.0 cases per 100 000, respectively). This first systematic effort to produce a global picture of KS burden stratified by HIV status highlights the continuing important burden of HIV-attributable KS in SSA, even in the era of combined antiretroviral therapy.
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Affiliation(s)
- Ahmadaye Ibrahim Khalil
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | | | - Catherine de Martel
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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Ramogola-Masire D, Grover S, Mathoma A, Monare B, Gabaitiri L, Bazzett-Matabele L, Hofmeyr GJ, Morroni C, Luckett R. Support for lowering cervical cancer screening age to 25 for women living with HIV: retrospective cross-sectional programmatic data from Botswana. BMC Womens Health 2022; 22:100. [PMID: 35366863 PMCID: PMC8976959 DOI: 10.1186/s12905-022-01680-7] [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: 08/24/2021] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Women living with human immunodeficiency virus (HIV) tend to develop cervical cancer at a younger age than women without HIV. The World Health Organization's (WHO) 2021 guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention include a conditional recommendation for initiating screening at age 25 for women living with HIV (WLWH). This recommendation is based on low-certainty evidence, and WHO calls for additional data. We describe the association of age and HIV status with visual inspection with acetic acid (VIA) positivity and cervical intraepithelial neoplasia grade two or higher (CIN2+) in Botswana. METHODS This was a retrospective cross-sectional study of 5714 participants aged 25 to 49 years who underwent VIA screening in a clinic mainly serving WLWH. VIA-positive women received cryotherapy if eligible or were referred for colposcopy and excisional treatment. Known cervical cancer risk factors, screening outcome, and histological results were extracted from the program database. We compared the proportions and association of VIA positivity and CIN2+ by age and HIV status. RESULTS The median age was 35 years [IQR 31-39], and 18% of the women were aged 25-29. Ninety percent were WLWH; median CD4 count was 250 cells/µL [IQR 150-428], and 34.2% were on anti-retroviral treatment (ART). VIA-positivity was associated with younger age (OR 1.48, CI 1.28, 1.72 for 25-29 years vs. 30-49 years), and HIV-positivity (OR 1.85, CI 1.51, 2.28). CIN2+ was only associated with HIV-positivity (OR 6.12, CI 3.39, 11.10), and proportions of CIN2+ were similar for both age groups in WLWH (69.1% vs. 68.3%). CONCLUSIONS Younger WLWH in Botswana had a significant burden of CIN2+. This finding further supports lowering the screening age for WLWH from 30 to 25.
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Affiliation(s)
- Doreen Ramogola-Masire
- grid.7621.20000 0004 0635 5486Department of Obstetrics and Gynecology and Office of Research and Graduate Studies, University of Botswana, Corner of Notwane and Mabuto Road, Gaborone, Botswana
| | - Surbhi Grover
- grid.25879.310000 0004 1936 8972Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA ,Botswana U-Penn Partnership, Gaborone, Botswana
| | - Anikie Mathoma
- grid.7621.20000 0004 0635 5486Office of Research, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Lesego Gabaitiri
- grid.7621.20000 0004 0635 5486Department of Statistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Lisa Bazzett-Matabele
- grid.7621.20000 0004 0635 5486Department of Obstetrics and Gynecology and Office of Research and Graduate Studies, University of Botswana, Corner of Notwane and Mabuto Road, Gaborone, Botswana
| | - GJustus Hofmeyr
- grid.7621.20000 0004 0635 5486Department of Obstetrics and Gynecology and Office of Research and Graduate Studies, University of Botswana, Corner of Notwane and Mabuto Road, Gaborone, Botswana
| | - Chelsea Morroni
- grid.462829.3Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana ,grid.4305.20000 0004 1936 7988MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Rebecca Luckett
- grid.7621.20000 0004 0635 5486Department of Obstetrics and Gynecology and Office of Research and Graduate Studies, University of Botswana, Corner of Notwane and Mabuto Road, Gaborone, Botswana ,grid.462829.3Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana ,grid.239395.70000 0000 9011 8547Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
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11
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Wagner A, Skof AS, Sehouli J, Richter R, Henrich W, von Weizsäcker K, Siedentopf JP, Chekerov R, Kaufmann AM, Rohr I. Genotype-specific high-risk human papillomavirus infections and risk factors for cervical dysplasia in women with human immunodeficiency virus in Germany: results from a single-center cross-sectional study. Int J Gynecol Cancer 2022; 32:716-723. [PMID: 35354606 DOI: 10.1136/ijgc-2021-003327] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Women living with HIV have an increased risk of human papillomavirus (HPV) infection and cervical cancer. Little is known about genotype-specific HPV prevalence, the impact of antiretroviral therapy, immunological status, and additional risk factors in women living with HIV in Germany. The goal of this study was to characterize the risk profile for cervical dysplasia in these women. METHODS Patients with HIV infection presenting at Charité-Universitätsmedizin Berlin from October 2017 to September 2020 were included and underwent gynecological examination, colposcopy, cervical cytology and HPV genotype testing. HPV genotypes were stratified by carcinogenicity. Atypical squamous cells of undetermined significance or higher were considered abnormal cytology. Data were analyzed by SPSS software (version 26, 2019). A two-tailed p-value ≤0.05 was considered statistically significant. RESULTS A total of 84 women were evaluated. The majority (95.2%) received antiretroviral therapy. Median CD4 cell count was 564 cells/µl (range 20-1969). 95.2% were previously screened for cervical cancer. High-risk HPV prevalence was 44%. High-high-risk HPV subtypes (16, 18, 31, 33, 45, 52, 58) were significantly associated with abnormal cytology (p<0.001). HPV16 was the most common genotype (23%), was significantly associated with abnormal cytology (p=0.002) and was the main risk factor for abnormal cytology (OR 8.55, 95% CI 2.15 to 34.13, p=0.002), followed by age <35 years (OR 4.96, 95% CI 1.23 to 19.61, p=0.033) and cigarette smoking (OR 3.944, 95% CI 0.98 to 15.88, p=0.053). CONCLUSIONS Antiretroviral therapy and adherence to cervical cancer screening was high. High-high-risk HPV, especially HPV16, coincided with high incidence of cytological abnormalities. Women living with HIV in Germany have adequate immune status and are often pre-screened for cervical cancer, and therefore have a different risk profile for cervical dysplasia than in low-income or medium-income countries. Adapted screening programs should be defined.
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Affiliation(s)
- Alexandra Wagner
- Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- Department of Obstetrics, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Anna Sophie Skof
- Department of Gynecology with Center for Oncological Surgery, Laboratory for Gynecological Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Katharina von Weizsäcker
- Department of Obstetrics, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Jan-Peter Siedentopf
- Department of Obstetrics, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Radoslav Chekerov
- Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Andreas M Kaufmann
- Department of Gynecology with Center for Oncological Surgery, Laboratory for Gynecological Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Irena Rohr
- Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- Department of Obstetrics, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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12
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Malmström S, Wagner P, Yilmaz A, Svedhem V, Carlander C. Failure to restore CD4+ cell count associated with infection-related and noninfection-related cancer. AIDS 2022; 36:447-457. [PMID: 34711738 DOI: 10.1097/qad.0000000000003117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess incidence and relative risk of cancer in Sweden, by HIV status, from 1988 to 2017. DESIGN Population-based register study. METHODS From the Swedish Total Population Register, all people born between 1940 and 2000 (n = 8 587 629), and resident in Sweden sometime 1983-2017 were identified and linked to National HIV Register InfCareHIV, National Cancer Register, and LISA database. We present incidence and adjusted hazard ratios (adjHR) of infection and noninfection-related cancer for three periods between 1988 and 2017. RESULTS Incidence and relative risk of infection-related cancer decreased but remained higher in people with HIV (PWH) than in HIV-negative. The proportion attributable to infection remained higher in PWH than in HIV-negative (44 vs. 9%). Women with HIV had lower risk of infection-related cancer than men with HIV [adjusted hazard ratio (adjHR) 0.6, 95% CI 0.4-0.9], mainly driven by lower incidence of Kaposi's sarcoma (adjHR 0.1, 95% CI 0.0-0.4). Current viral suppression (adjHR 0.3, 95% CI 0.2-0.5) was associated with lower risk of infection-related cancer. Current CD4+ cell count less than 200 cells/μl was associated with both infection-related (adjHR 15.3, 95% CI 10.7-21.8) and noninfection-related cancer (adjHR 2.5, 95% CI 1.5-4.1), as was CD4+ cell count increases less than 100 cells/μl post antiretroviral therapy (ART) (infection-related cancer adjHR 6.6, 95% CI 4.2-10.6, noninfection-related cancer adjHR 2.0, 95% CI 1.2-3.3). CONCLUSION Current CD4+ cell count and failure to restore CD4+ cell count both associated with infection and noninfection-related cancer. Viral suppression associated with lower risk of infection-related cancer. Early HIV detection and early adherent ART remain essential for cancer prevention.
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Affiliation(s)
- Stina Malmström
- Department of Infectious Diseases, Västmanland County Hospital Västerås
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
| | - Philippe Wagner
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | | | - Christina Carlander
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
- Department of Medicine Huddinge
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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13
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Ibrahim Khalil A, Mpunga T, Wei F, Baussano I, de Martel C, Bray F, Stelzle D, Dryden‐Peterson S, Jaquet A, Horner M, Awolude OA, Trejo MJ, Mudini W, Soliman AS, Sengayi‐Muchengeti M, Coghill AE, van Aardt MC, De Vuyst H, Hawes SE, Broutet N, Dalal S, Clifford GM. Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa. Int J Cancer 2022; 150:761-772. [PMID: 34626498 PMCID: PMC8732304 DOI: 10.1002/ijc.33841] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 01/28/2023]
Abstract
HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in sub-Saharan Africa (SSA). We estimated HIV- and age-stratified cervical cancer burden at a country, regional and global level in 2020. Proportions of cervical cancer (a) diagnosed in women living with HIV (WLHIV), and (b) attributable to HIV, were calculated using age-specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to age-specific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV-attributable fraction decreased from 86% in women ≤34 years to only 12% in women ≥55 years. The absolute burden of HIV-attributable cervical cancer (approximately 28 000 cases globally) also shifted toward younger women: in Southern Africa, 63% of 5341 HIV-attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non-HIV-attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV-targeted vs general population approaches to cervical screening, and impact of HIV prevention.
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Affiliation(s)
- Ahmadaye Ibrahim Khalil
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Tharcisse Mpunga
- Butaro Cancer Centre of Excellence, Ministry of HealthButaroRwanda
| | - Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Iacopo Baussano
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Catherine de Martel
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Dominik Stelzle
- Center for Global Health, Department of Neurology, Faculty of MedicineTechnical University of MunichMunichGermany,Chair of Epidemiology, Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - Scott Dryden‐Peterson
- Division of Infectious DiseasesBrigham and Women's HospitalBostonMassachusettsUSA,Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA,Botswana Harvard AIDS Institute PartnershipGaboroneBotswana
| | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR 1219BordeauxFrance
| | - Marie‐Josèphe Horner
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMarylandUSA
| | - Olutosin A. Awolude
- Department of Obstetrics and Gynaecology, College of MedicineUniversity of IbadanIbadanNigeria,Infectious Disease Institute, College of MedicineUniversity of IbadanIbadanNigeria
| | - Mario Jesus Trejo
- Department of Epidemiology and BiostatisticsUniversity of ArizonaTucsonArizonaUSA
| | - Washington Mudini
- Division of Anatomical Pathology, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Amr S. Soliman
- Community Health and Social Medicine Department, CUNY School of MedicineThe City College of New YorkNew York CityNew YorkUSA
| | - Mazvita Sengayi‐Muchengeti
- National Cancer Registry, National Health Laboratory ServiceJohannesburgSouth Africa,School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa,South African DSI‐NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA)Stellenbosch UniversityStellenboschSouth Africa
| | - Anna E. Coghill
- Cancer Epidemiology Program, Division of Population ScienceH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Matthys C. van Aardt
- Gynaecologic Oncology Unit, Department of Obstetrics and GynaecologyUniversity of PretoriaPretoriaSouth Africa
| | - Hugo De Vuyst
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Stephen E. Hawes
- Departments of Epidemiology, Health Services, and Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health OrganizationGenevaSwitzerland
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health OrganizationGenevaSwitzerland
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
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14
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Mpunga T, Clifford GM, Morgan EA, Milner DA, de Martel C, Munyanshongore C, Muvugabigwi G, Combes JD. Epstein-Barr virus prevalence among subtypes of malignant lymphoma in Rwanda, 2012 to 2018. Int J Cancer 2022; 150:753-760. [PMID: 34626122 DOI: 10.1002/ijc.33840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022]
Abstract
Few data exist on Epstein-Barr virus (EBV) prevalence across the full spectrum of lymphoma subtypes, particularly in sub-Saharan Africa. The objective of our study was to test the presence of EBV in a nationally representative sample of malignant lymphomas diagnosed in the Butaro Cancer Center of Excellence (BCCOE) in Rwanda. Of 102 Hodgkin (HL) and 378 non-Hodgkin lymphomas (NHL) diagnosed in BCCOE between 2012 and 2018, 52 HL and 207 NHL were successfully tested by EBV-encoding RNA in situ hybridization. EBV prevalence was 54% in HL, being detected in all classical HL subtypes: mixed-cellularity (n = 3/8), nodular-sclerosis (n = 7/17) and lymphocyte-rich (n = 2/3). EBV prevalence was 9% in NHL, being 10% among 158 B-cell NHL, 3% among 35 T-cell NHL and the single NK-cell NHL was EBV-positive. Among B-cell NHL, EBV was present in the majority of Burkitt (n = 8/13), and was also rarely detected in follicular (n = 1/4) and acute B-cell lymphoblastic (n = 1/45) lymphomas. Five of the 45 (11%) diffuse large B-cell lymphomas (DLBCLs) were EBV-positive, including three out of five plasmablastic lymphoma (PBL). Of 39 HL and 163 NHL of known human immunodeficiency virus (HIV) status, 2 (5%) and 14 (9%) were HIV-positive, respectively, of which only four were also EBV-positive (2 PBL, 2 HL). In summary, we report rare regional-level data on the association of EBV with classical HL, Burkitt and DLBCLs, and report sporadic detection in other subtypes possibly related to EBV. Such data inform the burden of disease caused by EBV and can help guide application of future advances in EBV-specific prevention and therapeutics.
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Affiliation(s)
- Tharcisse Mpunga
- Butaro Cancer Center of Excellence, Ministry of Health, Butaro, Rwanda
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Elizabeth A Morgan
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois, USA
| | - Catherine de Martel
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | | | | | - Jean-Damien Combes
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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15
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Dhokotera T, Asangbeh S, Bohlius J, Singh E, Egger M, Rohner E, Ncayiyana J, Clifford GM, Olago V, Sengayi-Muchengeti M. Cervical cancer in women living in South Africa: a record linkage study of the National Health Laboratory Service and the National Cancer Registry. Ecancermedicalscience 2022; 16:1348. [PMID: 35242229 PMCID: PMC8831110 DOI: 10.3332/ecancer.2022.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION In countries with high HIV prevalence, it is important to understand the cervical cancer (CC) patterns by HIV status to ensure targeted prevention measures. We aimed to determine the factors associated with CC compared to non-infection related cancer in women living in South Africa. METHODS This was a cross-sectional study of women aged 15 years and older diagnosed with CC and non-infection related cancer in the South African public health sector from 2004 to 2014. The National Cancer Registry provided data on cancer, whilst HIV status was determined from routinely collected HIV related data from the National Health Laboratory Service. We explored the association of HIV infection, age, ethnicity and calendar period with CC compared to non-infection related cancer. RESULTS From 2004 to 2014, 49,599 women were diagnosed with CC, whilst 78,687 women had non-infection related cancer. About 40% (n = 20,063) of those with CC and 28% (n = 5,667) of those with non-infection related cancer had a known HIV status. The median age at CC diagnosis was 44 years (interquartile range (IQR): 37-52) and 54 years (IQR: 46-64) for HIV positive and negative women, respectively, and for non-infection related cancer, 45 years (IQR: 47-55) and 56 years (IQR: 47-66) for HIV negative and positive women, respectively. Diagnosis of CC was associated with HIV positivity, Black ethnicity, earlier calendar period (2004-2006) and the ages 30-49 years. In comparison with Black women, the odds of CC were 44% less in Coloured women, 50% less in Asian women and 51% less in White women. CONCLUSIONS HIV positive women presented a decade earlier with CC compared to HIV negative women. A large proportion of women with CC were unaware of their HIV status with a disproportionate burden of CC in Black women. We recommend women attending CC screening facilities to be offered HIV testing so that recommendations for their follow-up visits are given according to their HIV status.
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Affiliation(s)
- Tafadzwa Dhokotera
- National Cancer Registry, National Health Laboratory Science, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Uni Mittelstrasse, Mittelstrasse 43, CH-3012 Bern, Switzerland
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel Land, Switzerland
| | - Serra Asangbeh
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Uni Mittelstrasse, Mittelstrasse 43, CH-3012 Bern, Switzerland
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel Land, Switzerland
| | - Julia Bohlius
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel Land, Switzerland
- University of Basel, Peterspl. 1, 4001 Basel, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Science, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Beacon House, Queens Road, Bristol BS8 1QU, UK
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Falmouth Rd, Observatory, Cape Town 7925, South Africa
| | - Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Jabulani Ncayiyana
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, George Campbell Building, 2nd Floor, Rm 226, 238 Mazisi Kunene Rd, Glenwood, Durban 4041, South Africa
| | - Gary M Clifford
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, (IARC/WHO), 150 cours Albert Thomas, 69372 Lyon, Cedex 08, France
| | - Victor Olago
- National Cancer Registry, National Health Laboratory Science, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
| | - Mazvita Sengayi-Muchengeti
- National Cancer Registry, National Health Laboratory Science, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, 19 Jonkershoek Road, Stellenbosch 7600, South Africa
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16
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New Insights into the Epidemiology of Vulvar Cancer: Systematic Literature Review for an Update of Incidence and Risk Factors. Cancers (Basel) 2022; 14:cancers14020389. [PMID: 35053552 PMCID: PMC8773873 DOI: 10.3390/cancers14020389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Vulvar cancer incidence data were sought from official sources (WHO Cancer Incidence in Five Continents) and studies reporting comparable data. With respect to risk factors, a systematic PubMed search of articles published since 1980 identified 69 original cohort and case-control studies. Information was extracted using a PRISMA predesigned data collection form. Recent advances have provided further evidence in support of the carcinogenic model centred on human papillomavirus infection with different defects of the immune function. Conversely, the model centred on the role of vulvar lichen sclerosus and the often-associated differentiated vulva intraepithelial neoplasia has continued to be understudied. Abstract The aim of this review was an update of vulvar cancer incidence rates and trends and of all known and putative risk factors for the disease. The most recent incidence data were sought from official sources (WHO Cancer Incidence in Five Continents). To obtain an estimate of time trends in some areas, we compared data from Cancer Incidence in Five Continents with the few available studies that measured incidence using comparable methods. With respect to risk factors, a systematic PubMed search identified 1585 relevant articles published between 1980 and 2021. Abstracts and full texts were screened. Sixty-nine eligible original cohort and case-control studies were selected. Information was extracted using a PRISMA predesigned form. Nineteen risk factors, or risk factor categories, were investigated by two or more original studies. Solitary, unreplicated studies addressed the putative role of eight more factors. Recent advances have provided further evidence supporting the carcinogenic model centred on human papillomavirus infection with different defects of the immune function. Conversely, the model centred on the role of vulvar lichen sclerosus and the often associated differentiated vulvar intraepithelial neoplasia has continued to be epidemiologically understudied. More research on the association between these two conditions and vulvar cancer is a priority.
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17
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Mori H, Fukatsu M, Ohkawara H, Oka Y, Kataoka Y, Taito S, Ikezoe T. Heterogeneity in the diagnosis of plasmablastic lymphoma, plasmablastic myeloma, and plasmablastic neoplasm: a scoping review. Int J Hematol 2021; 114:639-652. [PMID: 34462886 DOI: 10.1007/s12185-021-03211-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/19/2022]
Abstract
The diagnosis of plasmablastic lymphoma (PBL), plasmablastic myeloma (PBM), and plasmablastic neoplasm (PBN) may be arbitrary in some cases because these entities can be indistinct. We conducted this scoping review to investigate heterogeneity in diagnostic criteria used in previous studies and validate the diagnostic results of previous diagnostic algorithms and the algorithm we developed, which also includes diagnosis of PBN. Using the PRISMA Extension for Scoping Reviews, we analyzed literature published between September 2017 and April 2020. We identified a total of 163 cases (128 PBL, 32 PBM, and 3 PBN) from 77 case reports and 8 case series. We found that diagnostic criteria in the literature varied for PBL but were consistent for PBM. Our algorithm was the first attempt to include PBN in a complete structure. The results of the three diagnostic algorithms varied significantly. Hematologists and pathologists should pay more attention to the differential diagnosis of PBL, PBM, and PBN.
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Affiliation(s)
- Hirotaka Mori
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 9601295, Japan.
| | - Masahiko Fukatsu
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 9601295, Japan
| | - Hiroshi Ohkawara
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 9601295, Japan
| | - Yuka Oka
- Department of Diagnostic Pathology, Fukushima Medical University, Fukushima, Japan
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Shunsuke Taito
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 9601295, Japan
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18
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Somdyala NIM, Bradshaw D, Dhansay MA, Stefan DC. Increasing Cervical Cancer Incidence in Rural Eastern Cape Province of South Africa From 1998 to 2012: A Population-Based Cancer Registry Study. JCO Glob Oncol 2021; 6:1-8. [PMID: 32031436 PMCID: PMC7000228 DOI: 10.1200/jgo.19.00198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE In this study, we aimed to investigate trends in the age-standardized and age-specific incidence rates in two distinct regions (the northern and southern areas) of South Africa covered by a population-based cancer registry. In addition, trends in coverage of the cervical cancer screening program were assessed using routine health service data. METHODS Occurrences (topography C53.0-C53.9) for the period 1998-2012 were extracted from a cancer registry database from which basic descriptive statistics and frequencies were analyzed for all variables using CanReg4. Trends over time were estimated using a direct standardization method and world standard population as a reference. Screening coverage annualized figures for women age ≥ 30 years by sub–health district were extracted from the District Health Information System. RESULTS In the northern area, annual age-standardized incidence rates per 100,000 women increased from 24.0 (95% CI, 21.1 to 27.0) in 1998-2002 to 39.0 (95% CI, 35.6 to 42.5) in 2008-2012, with a screening coverage rate of 15% by 2012. In contrast, no increase was observed in incidence in the southern area, with rates of 20.0 (95% CI, 18.5 to 21.4) in 1998-2002 and 18.8 (95% CI, 16.2 to 21.4) in 2008-2012, and the southern area had a higher screening coverage of 41% in 2012. Overall, the percentage distribution of stage at diagnosis showed that 28.5% of occurrences were diagnosed at disease stages I and II and 35%, at III and IV; 36% had with missing stage information (2003-2012). In 77% of occurrences, a histologically verified diagnosis was made, compared with only 12.3% by cytology. CONCLUSION This study has demonstrated an almost two-fold increase in the incidence rate in the northern area but little change in the southern area of the cancer registry.
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Affiliation(s)
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Muhammad A Dhansay
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Division of Human Nutrition and Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Daniela C Stefan
- African Organisation for Research and Training in Cancer, Mowbray, South Africa
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19
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Jaquet A, Boni SP, Boidy K, Tine J, Tchounga B, Touré SA, Koffi JJ, Dial C, Monnereau A, Diomande I, Tanon A, Seydi M, Dabis F, Diop S, Koffi G. Chronic viral hepatitis, HIV infection and Non-Hodgkin lymphomas in West Africa, a case-control study. Int J Cancer 2021; 149:1536-1543. [PMID: 34124779 DOI: 10.1002/ijc.33709] [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: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/09/2022]
Abstract
Non-Hodgkin lymphomas (NHL) are underestimated causes of cancer in West Africa where chronic viral hepatitis and HIV are endemic. While the association with HIV infection has already been characterized, limited information is available on the association between chronic viral hepatitis and NHL in sub-Saharan Africa. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire) and Dakar (Senegal). Cases of NHL were matched with controls on age, gender and participating site. The diagnosis of NHL relied on local pathological examination completed with immunohistochemistry. HIV, HBV and HCV serology tests were systematically performed. A conditional logistic regression model estimated the associations by the Odds Ratio (OR) with their 95% confidence interval (CI). A total of 117 NHL cases (Abidjan n = 97, Dakar n = 20) and their 234 matched controls were enrolled. Cases were predominantly men (68.4%) and had a median age of 50 years (IQR 37-57). While Diffuse Large B-cell lymphoma were the most reported morphological type (n = 35) among mature B-cell NHL, the proportion mature T-cell NHL (30%) was high. The prevalence figures of HBV, HCV and HIV infection were 12.8%, 7.7% and 14.5%, respectively among cases of NHL. In multivariate analysis, HBV, HCV and HIV were independently associated with NHL with OR of 2.23 (CI 1.05-4.75), 4.82 (CI 1.52-15.29) and 3.32 (CI 1.54-7.16), respectively. Chronic viral hepatitis B and C were significantly associated with NHL in West Africa. Timely preventive measures against HBV infection and access to curative anti-HCV treatment might prevent a significant number of NHL.
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Affiliation(s)
- Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Simon P Boni
- Programme National de Lutte Contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire.,Programme PACCI/Site ANRS Abidjan, Abidjan, Côte d'Ivoire
| | - Kouakou Boidy
- Service d'hématologie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Judicaël Tine
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Boris Tchounga
- Programme PACCI/Site ANRS Abidjan, Abidjan, Côte d'Ivoire.,Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Sokhna A Touré
- Service d'hématologie, Centre National de Transfusion Sanguine, Dakar, Senegal
| | | | - Cherif Dial
- Service Anatomopathologie, Hôpital de Grand Yoff, Dakar, Senegal
| | - Alain Monnereau
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Isidore Diomande
- Service Anatomopathologie, Centre Hospitalier Universitaire Cocody, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - François Dabis
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Saliou Diop
- Service d'hématologie, Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Gustave Koffi
- Service d'hématologie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
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20
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Chiao EY, Coghill A, Kizub D, Fink V, Ndlovu N, Mazul A, Sigel K. The effect of non-AIDS-defining cancers on people living with HIV. Lancet Oncol 2021; 22:e240-e253. [PMID: 34087151 PMCID: PMC8628366 DOI: 10.1016/s1470-2045(21)00137-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
Non-AIDS-defining cancers are a growing source of morbidity for people with HIV globally. Although people living with HIV have a disproportionately increased risk of developing virally mediated cancers, cancer burden for common non-AIDS-defining cancers that are not virally associated and are linked to ageing, such as prostate cancer, is becoming higher than for virally mediated cancers. Ageing, behavioural, and HIV-specific factors drive the incidence and affect the outcomes of non-AIDS-defining cancers, presenting different challenges for addressing global morbidity and mortality from non-AIDS-defining cancer. Although large population-based studies have shown that people living with HIV with non-AIDS-defining cancers have poorer cancer outcomes than do people without HIV, current guidelines emphasise that people living with HIV with non-AIDS-defining cancers should receive standard, guideline-based treatment, and infectious disease and oncology providers should work closely to address potential drug interactions between antiretroviral therapy and antineoplastic treatment. Most trials target preventive measures focusing on non-AIDS-defining cancers. However, treatment trials for the optimal management of people living with HIV and non-AIDS-defining cancer, including interventions such as immunotherapies, are needed to improve non-AIDS-defining cancer outcomes.
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Affiliation(s)
- Elizabeth Y Chiao
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Anna Coghill
- Cancer Epidemiology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Center for Immunization and Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Darya Kizub
- Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valeria Fink
- Clinical Research, Fundación Huésped, Buenos Aires, Argentina
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Angela Mazul
- Department of Otolaryngology, Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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21
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Jaquet A, Boni S, Tchounga B, Comoe K, Tanon A, Horo A, Diomandé I, Didi-Kouko Coulibaly J, Ekouevi DK, Adoubi I. Changes in HIV-Related Cervical Cancer Over a Decade in Côte d'Ivoire. JCO Glob Oncol 2021; 7:782-789. [PMID: 34043415 PMCID: PMC8457855 DOI: 10.1200/go.21.00006] [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: 01/05/2021] [Revised: 02/22/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Major improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire. METHODS A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model. RESULTS During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% (P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% (P < 10-4) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm3 (P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]). CONCLUSION Despite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities.
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Affiliation(s)
- Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Simon Boni
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Programme PACCI /site ANRS Abidjan, Abidjan, Cote d'Ivoire
| | - Boris Tchounga
- Programme PACCI /site ANRS Abidjan, Abidjan, Cote d'Ivoire
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Kouassi Comoe
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de Gynécologie obstétrique, CHU de Yopougon, Université Félix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - Isidore Diomandé
- Service anatomopathologie, Centre Hospitalier Universitaire (CHU) Cocody, Abidjan, Cote d'Ivoire
| | | | - Didier K. Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
- Université de Lomé, Département de Santé Publique, Lomé, Togo
| | - Innocent Adoubi
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
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22
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Murenzi G, Kanyabwisha F, Murangwa A, Kubwimana G, Mutesa L, Burk RD, Anastos K, Castle PE. Twelve-Year Trend in the Prevalence of High-Risk Human Papillomavirus Infection Among Rwandan Women Living With HIV. J Infect Dis 2021; 222:74-81. [PMID: 32050023 DOI: 10.1093/infdis/jiaa065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/07/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We examined the trend in prevalence of high-risk human papillomavirus (hrHPV) cervical infection among Rwandan women living with HIV (WLWH) over 12 years. METHODS Prevalence of cervical hrHPV DNA was measured in 3 studies at 3 different time periods in 3 different groups of WLWH using 3 different but comparable hrHPV tests: a MY09/MY11 PCR test in 2005 (RWISA; n = 497), careHPV in 2009-2010 (HPV Demonstration; n = 1242), and Xpert HPV test in 2016-2018 (U54; n = 4734). Prevalences were adjusted for age and CD4 cell count. RESULTS HrHPV prevalence decreased over time from 42.5% to 32.2% to 26.5% (P < .001). CD4 cell counts improved over time (Ptrend <.001) so that the percentage of WLWH with CD4 counts of ≥500 cells/μL increased from 7.7% in 2005 to 42.2% in 2009-2010 and 61.1% in 2016-2018. Thus, after adjustment for differences in CD4 counts and age, hrHPV prevalences were more similar over time: 32.6% for RWISA, 30.6% for HPV Demonstration, and 27.1% for U54 (P = .007). CONCLUSIONS Prevalence of hrHPV among WLWH has decreased over the past decade, most likely the result of improved immune reconstitution due to better HIV care and management in Rwanda.
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Affiliation(s)
| | | | | | | | - Leon Mutesa
- Center for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Robert D Burk
- Albert Einstein College of Medicine, Bronx, New York, USA
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23
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Stelzle D, Tanaka LF, Lee KK, Ibrahim Khalil A, Baussano I, Shah ASV, McAllister DA, Gottlieb SL, Klug SJ, Winkler AS, Bray F, Baggaley R, Clifford GM, Broutet N, Dalal S. Estimates of the global burden of cervical cancer associated with HIV. LANCET GLOBAL HEALTH 2020; 9:e161-e169. [PMID: 33212031 PMCID: PMC7815633 DOI: 10.1016/s2214-109x(20)30459-9] [Citation(s) in RCA: 301] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/27/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Background HIV enhances human papillomavirus (HPV)-induced carcinogenesis. However, the contribution of HIV to cervical cancer burden at a population level has not been quantified. We aimed to investigate cervical cancer risk among women living with HIV and to estimate the global cervical cancer burden associated with HIV. Methods We did a systematic literature search and meta-analysis of five databases (PubMed, Embase, Global Health [CABI.org], Web of Science, and Global Index Medicus) to identify studies analysing the association between HIV infection and cervical cancer. We estimated the pooled risk of cervical cancer among women living with HIV across four continents (Africa, Asia, Europe, and North America). The risk ratio (RR) was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer to calculate the proportion of women living with HIV among women with cervical cancer and population attributable fractions and age-standardised incidence rates (ASIRs) of HIV-attributable cervical cancer. Findings 24 studies met our inclusion criteria, which included 236 127 women living with HIV. The pooled risk of cervical cancer was increased in women living with HIV (RR 6·07, 95% CI 4·40–8·37). Globally, 5·8% (95% CI 4·6–7·3) of new cervical cancer cases in 2018 (33 000 new cases, 95% CI 26 000–42 000) were diagnosed in women living with HIV and 4·9% (95% CI 3·6–6·4) were attributable to HIV infection (28 000 new cases, 20 000–36 000). The most affected regions were southern Africa and eastern Africa. In southern Africa, 63·8% (95% CI 58·9–68·1) of women with cervical cancer (9200 new cases, 95% CI 8500–9800) were living with HIV, as were 27·4% (23·7–31·7) of women in eastern Africa (14 000 new cases, 12 000–17 000). ASIRs of HIV-attributable cervical cancer were more than 20 per 100 000 in six countries, all in southern Africa and eastern Africa. Interpretation Women living with HIV have a significantly increased risk of cervical cancer. HPV vaccination and cervical cancer screening for women living with HIV are especially important for countries in southern Africa and eastern Africa, where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden. Funding WHO, US Agency for International Development, and US President's Emergency Plan for AIDS Relief.
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Affiliation(s)
- Dominik Stelzle
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Munich, Germany; Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Luana F Tanaka
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Kuan Ken Lee
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | | | - Anoop S V Shah
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sami L Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Stefanie J Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Andrea S Winkler
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Munich, Germany; Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Rachel Baggaley
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | | | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland.
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24
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Shindiapina P, Ahmed EH, Mozhenkova A, Abebe T, Baiocchi RA. Immunology of EBV-Related Lymphoproliferative Disease in HIV-Positive Individuals. Front Oncol 2020; 10:1723. [PMID: 33102204 PMCID: PMC7556212 DOI: 10.3389/fonc.2020.01723] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022] Open
Abstract
Epstein-Bar virus (EBV) can directly cause lymphoproliferative disease (LPD), including AIDS-defining lymphomas such as Burkitt’s lymphoma and other non-Hodgkin lymphomas (NHL), as well as human immunodeficiency virus (HIV)-related Hodgkin lymphoma (HL). The prevalence of EBV in HL and NHL is elevated in HIV-positive individuals compared with the general population. Rates of incidence of AIDS-defining cancers have been declining in HIV-infected individuals since initiation of combination anti-retroviral therapy (cART) use in 1996. However, HIV-infected persons remain at an increased risk of cancers related to infections with oncogenic viruses. Proposed pathogenic mechanisms of HIV-related cancers include decreased immune surveillance, decreased ability to suppress infection-related oncogenic processes and a state of chronic inflammation marked by alteration of the cytokine profile and expanded numbers of cytotoxic T lymphocytes with down-regulated co-stimulatory molecules and increased expression of markers of senescence in the setting of treated HIV infection. Here we discuss the cooperation of EBV-infected B cell- and environment-associated factors that may contribute to EBV-related lymphomagenesis in HIV-infected individuals. Environment-derived lymphomagenic factors include impaired host adaptive and innate immune surveillance, cytokine dysregulation and a pro-inflammatory state observed in the setting of chronic, cART-treated HIV infection. B cell factors include distinctive EBV latency patterns and host protein expression in HIV-associated LPD, as well as B cell-stimulating factors derived from HIV infection. We review the future directions for expanding therapeutic approaches in targeting the viral and immune components of EBV LPD pathogenesis.
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Affiliation(s)
- Polina Shindiapina
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States.,Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, United States
| | - Elshafa H Ahmed
- Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, United States
| | - Anna Mozhenkova
- Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, United States
| | - Tamrat Abebe
- Department of Microbiology, Immunology, and Parasitology, School of Medicine Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robert A Baiocchi
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States.,Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, United States
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25
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Kimani SM, Painschab MS, Horner MJ, Muchengeti M, Fedoriw Y, Shiels MS, Gopal S. Epidemiology of haematological malignancies in people living with HIV. Lancet HIV 2020; 7:e641-e651. [PMID: 32791045 PMCID: PMC10199168 DOI: 10.1016/s2352-3018(20)30118-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022]
Abstract
People living with HIV or AIDS are at increased risk of Hodgkin and non-Hodgkin lymphoma compared with HIV-negative individuals. Data on the risk of multiple myeloma or leukaemia are inconsistent and of low quality but the risk does not seem to be increased. Specific haematological malignancies occur in different contexts of age, CD4 cell count, HIV control, viral co-infections, or chronic inflammation, and the expansion of combination antiretroviral therapy has led to varied demographic and epidemiological shifts among people with HIV. Increased use of combination antiretroviral therapy has substantially reduced the risks of diffuse large B-cell lymphoma, Burkitt lymphoma, and primary CNS lymphoma, and to a lesser extent, Hodgkin lymphoma. There is no effect of combination antiretroviral therapy use on multiple myeloma or leukaemia. Although many cases of HIV are in low-income and middle-income countries, high-quality epidemiological data for haematological malignancies from these regions are scarce. Closing this gap is an essential first step in decreasing mortality from HIV-associated haematological malignancies worldwide. Finally, although multicentric Castleman disease is not a neoplastic condition, it is an emerging precursor to neoplastic high-grade B-cell lymphoproliferation among people with HIV, especially for individuals on long-term combination antiretroviral therapy with well controlled HIV.
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Affiliation(s)
- Stephen M Kimani
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Matthew S Painschab
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Marie-Josèphe Horner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Yuri Fedoriw
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Satish Gopal
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi.
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Nietz S, O'Neil DS, Ayeni O, Chen WC, Joffe M, Jacobson JS, Neugut AI, Ruff P, Mapanga W, Buccimazza I, Singh U, Čačala S, Stopforth L, Phakathi B, Chirwa T, Cubasch H. A comparison of complete pathologic response rates following neoadjuvant chemotherapy among South African breast cancer patients with and without concurrent HIV infection. Breast Cancer Res Treat 2020; 184:861-872. [PMID: 32875480 DOI: 10.1007/s10549-020-05889-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Among patients diagnosed with breast cancer (BC), women also living with HIV (WLWH) have worse survival than women without HIV. Chronic HIV infection may interfere with the effectiveness of BC treatment, contributing to this disparity. We attempted to determine the impact of HIV infection on response to neoadjuvant chemotherapy (NACT) among South African women with BC. METHODS We evaluated women from the South African Breast Cancer and HIV Outcomes cohort study who had stage I-III disease, initiated NACT, underwent definitive breast surgery, and had available surgical pathology reports. We compared pathologic complete response (pCR) rates among women with and without HIV infection, using multivariable logistic regression to control for differences in tumor characteristics. We also evaluated the impact of HIV infection on pCR within subgroups based on patient and tumor factors. RESULTS Of 715 women, the 173 (24.2%) WLWH were less likely to achieve pCR than women without HIV (8.7% vs 16.4%, [odds ratio (OR) 0.48, 95% confidence interval (95% CI) 0.27-0.86]). WLWH continued to have lower likelihood of achieving pCR on multivariable analysis (OR 0.52, 95% CI 0.28-0.98). A similar pattern was seen within subgroups, although HIV infection appeared to affect pCR more in ER/PR-positive BC (OR 0.24, 95% CI 0.08-0.71) than in ER/PR-negative BC (OR 0.94, 95% CI 0.39-2.29). CONCLUSION WLWH were less like to achieve pCR following NACT for BC than women without HIV. This reduced response to systemic therapy may contribute to the poorer BC outcomes seen in WLWH.
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Affiliation(s)
- Sarah Nietz
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Daniel S O'Neil
- Sylvester Comprehensive Cancer Center, University of Miami Health System, 1121 NW 14th Street, SMOB, Rm 245B, Miami, FL, 33150, USA. .,Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, USA.
| | - Oluwatosin Ayeni
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
| | - Wenlong Carl Chen
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa.,National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.,Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, 9 Jubilee Road, Parktown, Johannesburg, 2193, South Africa
| | - Maureen Joffe
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa.,South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, South Africa
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, Room 732, New York, NY, 10032, USA
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, Room 732, New York, NY, 10032, USA.,Division of Medical Oncology, Columbia University Medical Center, 722 W 168th Street, Room 725, New York, NY, 10032, USA
| | - Paul Ruff
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Witness Mapanga
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
| | - Ines Buccimazza
- Departments of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Private Bag X03, Mayville, Durban, 4058, South Africa
| | - Urishka Singh
- Departments of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Private Bag X03, Mayville, Durban, 4058, South Africa
| | - Sharon Čačala
- Departments of Surgery and Oncology, Grey's Hospital, University of KwaZulu Natal, Townbush Road, Pietermaritzburg, 3100, KZN, South Africa.,Department of Surgery, Ngwelezana Hospital, Thanduyise Road, Empangeni, 3880, KZN, South Africa
| | - Laura Stopforth
- Departments of Surgery and Oncology, Grey's Hospital, University of KwaZulu Natal, Townbush Road, Pietermaritzburg, 3100, KZN, South Africa
| | - Boitumelo Phakathi
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Tobias Chirwa
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, Gauteng, South Africa.,Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa
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27
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Sun D, Cao M, Li H, Ren J, Shi J, Li N, Chen W. Risk of prostate cancer in men with HIV/AIDS: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2020; 24:24-34. [PMID: 32801354 DOI: 10.1038/s41391-020-00268-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although previous studies have shown a decreased incidence of prostate cancer in men with HIV/AIDS, the consensus has not been reached. Our aim is to conduct a systematic review and meta-analysis to assess the risk of prostate cancer among people with HIV/AIDS. METHODS We systematically searched PubMed, Web of Science, Embase, and Cochrane Library until March 2020. Cohort studies were included if they compared the prostate cancer risk between people with HIV/AIDS and uninfected controls or the general population. The summary standardized incidence ratio (SIR) and 95% confidence interval (CI) were calculated using a random-effects model. RESULTS A total of 27 studies were included for analysis, with more than 2780 males with HIV/AIDS developing prostate cancer. The results showed that HIV infection was associated with a decreased risk of prostate cancer incidence (SIR, 0.76; 95% CI, 0.64-0.91; P = 0.003), with significant heterogeneity (P < 0.001; I2 = 91.6%). A range of sensitivity analyzes did not significantly change the results. CONCLUSIONS Our study shows that people with HIV/AIDS have a lower incidence of prostate cancer compared with the general population. However, significant heterogeneity exists among the included studies. Further prospective studies with better designs are needed to elucidate the association between HIV infection and prostate cancer.
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Affiliation(s)
- Dianqin Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Maomao Cao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - He Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Jiansong Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Jufang Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Ni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
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Parkin DM, Hämmerl L, Ferlay J, Kantelhardt EJ. Cancer in Africa 2018: The role of infections. Int J Cancer 2020; 146:2089-2103. [PMID: 31254479 DOI: 10.1002/ijc.32538] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022]
Abstract
We estimate the fractions of cancer attributed to infections in Africa in 2018. The number of new cancer cases occurring was taken from Globocan2018 with some additional estimations based on data from African population-based registries. Population attributable fractions were calculated using prevalence of infection and relative risk in exposed vs. nonexposed. The greatest share of infection-associated cancers is due to the human papillomaviruses (12.1% of all cancers in Africa and 15.4% in sub-Saharan Africa [SSA]); of these, cervical cancer is by far the most common. Kaposi sarcoma-associated herpesvirus is responsible for 3.1% of all cancers in Africa, the hepatitis viruses (B and C) for 2.9% and Helicobacter pylori for 2.7% (non-Cardia Gastric cancer and primary gastric lymphomas). Two percent of cancers are attributable to the Epstein-Barr virus, Schistosoma haematobium increases the risk of bladder cancer resulting in 1.0% of all cancers. HIV-related NHL and squamous cell carcinoma of the conjunctiva account for 0.6% of cancers. Altogether 24.5% of cancers in Africa and 28.7% in SSA are due to infectious agents. Infections are by far the most common cancer risk factor for cancer in Africa-the traditional risk factors (smoking, alcohol and unhealthy diet) probably cause only one in eight cancers in Africa. Prevention should focus on those infectious diseases preventable through vaccination (HPV and hepatitis B) which could reduce two-thirds of the burden. Helicobacter pylori and schistosomiasis are treatable with antibiotics and praziquantel, with a potential reduction of one in eight infection-associated cancers.
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Affiliation(s)
- Donald M Parkin
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- African Cancer Registry Network, Oxford, United Kingdom
| | - Lucia Hämmerl
- Institute for Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Eva J Kantelhardt
- Institute for Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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29
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Mpunga T, Chantal Umulisa M, Tenet V, Rugwizangoga B, Milner Jr DA, Munyanshongore C, Heideman DA, Bleeker MC, Tommasino M, Franceschi S, Baussano I, Gheit T, Sayinzoga F, Clifford GM. Human papillomavirus genotypes in cervical and other HPV-related anogenital cancer in Rwanda, according to HIV status. Int J Cancer 2020; 146:1514-1522. [PMID: 31173641 PMCID: PMC7003740 DOI: 10.1002/ijc.32491] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/22/2019] [Accepted: 05/27/2019] [Indexed: 12/22/2022]
Abstract
The study aim was to describe human papillomavirus (HPV)-attributable cancer burden in Rwanda, according to anogenital cancer site, HPV type, age and HIV status. Tissue specimens of cervical, vulvar, vaginal, penile and anal cancer diagnosed in 2012-2018 were retrieved from three cancer referral hospitals and tested for high-risk (HR) HPV DNA. Cervical cancer represented the majority of cases (598 of 738), of which 96.0% were HR-HPV positive. HPV-attributable fractions in other cancer sites varied from 53.1% in 81 penile, through 76.7% in 30 vulvar, 83.3% in 24 vaginal, up to 100% in 5 anal cases. HPV16 was the predominant HR-HPV type in cervical cancer (55.0%), followed by HPV18 (16.6%) and HPV45 (13.4%). HPV16 also predominated in other cancer sites (60-80% of HR-HPV-attributable fraction). For cervical cancer, type-specific prevalence varied significantly by histology (higher alpha-9 type prevalence in 509 squamous cell carcinoma vs. higher alpha-7 type prevalence in 80 adenocarcinoma), but not between 501 HIV-negative and 97 HIV-positive cases. With respect to types targeted, and/or cross-protected, by HPV vaccines, HPV16/18 accounted for 73%, HPV31/33/45/52/58 for an additional 22% and other HR-HPV types for 5%, of HPV-attributable cancer burden, with no significant difference by HIV status nor age. These data highlight the preventive potential of the ongoing national HPV vaccination program in Rwanda, and in sub-Saharan Africa as a whole. Importantly for this region, the impact of HIV on the distribution of causal HPV types was relatively minor, confirming type-specific relevance of HPV vaccines, irrespective of HIV status.
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Affiliation(s)
- Tharcisse Mpunga
- Butaro Cancer Centre of ExcellenceMinistry of HealthButaroRwanda
| | - Marie Chantal Umulisa
- Rwanda Biomedical CentreMinistry of Health of RwandaKigaliRwanda
- International Agency for Research on CancerLyonFrance
| | - Vanessa Tenet
- International Agency for Research on CancerLyonFrance
| | - Belson Rugwizangoga
- Department of PathologyUniversity Teaching Hospital of KigaliKigaliRwanda
- University of Rwanda School of Medicine and PharmacyKigaliRwanda
| | | | | | - Daniëlle A.M. Heideman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Maaike C.G. Bleeker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center AmsterdamAmsterdamThe Netherlands
| | | | | | | | - Tarik Gheit
- International Agency for Research on CancerLyonFrance
| | - Felix Sayinzoga
- Rwanda Biomedical CentreMinistry of Health of RwandaKigaliRwanda
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Cañas-Ruano E, Martín-Castillo M, Raventós B, Burgos J, Curran A, Navarro J, García J, Suanzes P, Ribera E, Falcó V. Incidence of malignancy in a Spanish cohort of patients infected by the human immunodeficiency virus. Med Clin (Barc) 2020; 155:288-294. [PMID: 32005558 DOI: 10.1016/j.medcli.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION A higher incidence of malignancies has been described in patients with HIV infection compared to the general population. PATIENTS AND METHODS Observational retrospective study in patients with HIV infection followed up at the Vall d'Hebron University Hospital (Barcelona, Spain) between 2009 and 2017. The objective of this research was to estimate the incidence of malignancies in HIV patients and their surveillance. Age and sex-adjusted incidence was compared to the incidence calculated by the Spanish Cancer Registry network (REDECAN) in 2015. RESULTS We included 2,773 patients (41,238 patients-year). Two hundred and eleven malignancies were diagnosed in 182 patients. Non-AIDS defining cancers accounted for 78.2% of the malignancies. The global incidence of cancer was 485 cases per 100,000 person-years. Twenty-year mortality rate was 31.2% in patients with cancer and 7.8% in patients without cancer. In men, adjusted for age, the incidence of malignancies was higher than the incidence in the general population (978.4 vs. 641 cases per 100,000 person-years, P<.001). The most common malignancies in men were lung cancer, Kaposi sarcoma and Hodgkin lymphoma. In women, the incidence of malignancies was not higher than in the general population (340.6 vs. 404.7 cases per 100,000 person-years, P=.27). The most common malignancies among women were lung cancer, head and neck cancer, cervical cancer and Hodgkin's lymphoma. CONCLUSIONS Men with HIV infection showed a statistically significant higher incidence of malignancies compared to the general Spanish population. Lung cancer was the most common non-AIDS defining cancer.
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Affiliation(s)
- Esperanza Cañas-Ruano
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | | | | | - Joaquín Burgos
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Adrià Curran
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Jordi Navarro
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Jorge García
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Paula Suanzes
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Esteban Ribera
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Vicenç Falcó
- Vall d'Hebron Institut de Recerca, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
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Cancer spectrum in HIV-infected patients: A zonal hospital experience in Tanzania. Cancer Treat Res Commun 2020; 25:100213. [PMID: 33038569 PMCID: PMC9887343 DOI: 10.1016/j.ctarc.2020.100213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although the burden of human immunodeficiency virus (HIV) infection in Tanzania is high, limited data are available on cancers in HIV-infected patients. We aimed to determine the spectrum and prevalence of cancers in HIV-infected patients attending care at a zonal hospital in Tanzania. MATERIALS AND METHODS Clinical records of HIV-infected patients from 2009 to 2019 were identified and retrospectively reviewed. RESULTS A total of 3398 HIV-infected patients were recruited with median age of 37 years. Cancer was diagnosed in 9% of the patients after enrollment into HIV clinical care, with an increasing prevalence from 7.2% between years 2009 and 2013 to 8.6% between years 2017 and 2019 (p-value <0.0001). Majority (89.2%) were on antiretroviral therapy (ART) during the time of cancer diagnosis. The proportions of acquired immunodeficiency syndrome (AIDS)-defining cancers and non-AIDS defining cancers were 28% and 72% respectively. Kaposi's sarcoma was the most common (13.2%) AIDS-defining cancer while esophageal cancer was the most common (11.1%) non-AIDS defining cancer. The median duration of time from HIV infection to cancer diagnosis was 715 days (IQR: 98-2570). The median CD4+T-cell count was 318(IQR 159-690) cells/µl at the time of cancer diagnosis and 40.7% of the patients had advanced immunosuppression with CD4 count less than 200 cells/µl at the time of cancer diagnosis. CONCLUSION Non-AIDS defining cancers were much more common than AIDS-defining cancers suggesting increased longevity due to ART access. The prevalence of cancer among HIV-infected patients was 9% with an increasing trend over time; highlighting the importance of promoting cancer screening in this vulnerable population and implementation of vaccinations programs for liver and cervical cancers as well as tobacco control policies for smoking-related cancers.
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