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Gutiérrez F, Padilla S, García-Abellán J, Gutiérrez-Ortiz de la Tabla A, Ledesma C, Masiá M. Cancer screening in people with HIV: Implementation in clinical practice and barriers perceived by medical specialists in Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00013-3. [PMID: 38262880 DOI: 10.1016/j.eimce.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To assess the degree of implementation of cancer screening recommendations in people living with HIV (PLHIV) in Spain. METHODS A self-administered questionnaire was designed on the strategies used for early detection of the main types of cancer in PLHIV. The survey was distributed electronically to HIV physicians participating in the Spanish CoRIS cohort. RESULTS 106 questionnaires were received from 12 different Spanish Autonomous Communities, with an overall response rate among those who accessed the questionnaire of 60.2%. The majority responded that they followed the CPGs recommendations for the early detection of liver (94.3%), cervical (93.2%) and breast (85.8%) cancers. In colorectal and anal cancer, the proportion was 68.9% and 63.2%, and in prostate and lung cancer of 46.2% and 19.8%, respectively. In hospitals with a greater number of beds, a tendency to perform more cancer screening and greater participation of the Infectious Diseases/HIV Services in the screening programmes was observed. Significant differences were observed in the frequency of colorectal and anal cancer screening among the different Autonomous Communities. The most frequent reasons for not performing screening were the scarcity of material and/or human resources and not being aware of what is recommended in the CPGs. CONCLUSIONS There are barriers and opportunities to expand cancer screening programmes in PLHIV, especially in colorectal, anal and lung cancers. It is necessary to allocate resources for the early detection of cancer in PLHIV, but also to disseminate CPGs screening recommendations among medical specialists.
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Affiliation(s)
- Félix Gutiérrez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Sergio Padilla
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier García-Abellán
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Christian Ledesma
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Mar Masiá
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Masiá M, Gutiérrez‐Ortiz de la Tabla A, Gutiérrez F. Cancer screening in people living with HIV. Cancer Med 2023; 12:20590-20603. [PMID: 37877338 PMCID: PMC10660116 DOI: 10.1002/cam4.6585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Cancer is the leading cause of mortality in people living with HIV (PWH) and is expected to account for a growing fraction of deaths as PWH age. METHODS In this literature review, we have compiled the most recent developments in cancer screening and screening performance in PWH, which are currently primarily implemented in well-resourced settings. This includes an assessment of the associated benefits, harms, and cost-effectiveness. The article also addresses unmet needs and potential strategies for tailored screening in the HIV population. FINDINGS Incidence and mortality due to screenable cancer are higher in PWH than in the general population, and diagnosis is frequently made at younger ages and/or at more advanced stages, the latter amenable to improved screening. Adequate evidence on the benefits of screening is lacking for most cancers in the HIV population, in whom standard practice may be suboptimal. While cancer surveillance has helped reduce mortality in the general population, and interest in risk-based strategies is growing, implementation of screening programs in the HIV care settings remains low. INTERPRETATION Given the devastating consequences of a late diagnosis, enhancing early detection of cancer is essential for improving patient outcomes. There is an urgent need to extend the investigation in cancer screening performance to PWH, evaluating whether personalized measures according to individual risk could result in higher efficiency and improve patient outcomes.
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Affiliation(s)
- Mar Masiá
- Infectious Diseases DivisionHospital General Universitario de ElcheElcheSpain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos IIIMadridSpain
| | | | - Félix Gutiérrez
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos IIIMadridSpain
- Department of Clinical MedicineMiguel Hernández UniversitySan Juan de AlicanteSpain
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Abstract
PURPOSE OF REVIEW As people living with human immunodeficiency virus (HIV, PLWH) age, aging-related comorbidities have come into focus as major challenges to their overall health. In this review, an in-depth overview of the two most commonly encountered chronic lung diseases in PLWH, chronic obstructive pulmonary disease (COPD) and lung cancer, is provided. RECENT FINDINGS The risk for both COPD and lung cancer remains significantly higher in PLWH compared to the HIV-uninfected population, although fortunately rates of lung cancer appear to be declining over the last two decades. Outcomes for PLWH with these conditions, though, continue to be poor with worse survival rates in comparison to the general population. PLWH still face major barriers in accessing care for these conditions, including a higher likelihood of being underdiagnosed with COPD and a lower likelihood of being referred for lung cancer screening or treatment. A lack of evidence for optimal treatment strategies for both COPD and lung cancer still hampers the care of PLWH with these conditions. SUMMARY COPD and lung cancer represent substantial burdens of disease in PLWH. Improved access to standard-of-care screening and treatment and greater investigation into therapeutic responses specifically in this population are recommended.
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Affiliation(s)
- Janice M Leung
- Division of Respiratory Medicine, Department of Medicine
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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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: 33] [Impact Index Per Article: 16.5] [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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Masiá M, Padilla S, Estañ G, Portu J, Silva A, Rivero A, González-Cordón A, García-Fraile L, Martínez O, Bernal E, Galera C, Boix Martínez V, Macias J, Montero M, García-Rosado D, Vivancos-Gallego MJ, Llenas-García J, Torralba M, García JA, Agulló V, Fernández-González M, Gutiérrez F, Martínez E. Impact of an enhanced screening program on the detection of non-AIDS neoplasias in patients with human immunodeficiency virus infection. Trials 2021; 22:851. [PMID: 34838115 PMCID: PMC8626748 DOI: 10.1186/s13063-021-05777-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of non-AIDS defining cancer (NADC) is higher in people living with HIV (PLWH) than in the general population, and it is already one of the leading causes of death in the HIV-infected population. It is estimated that the situation will be aggravated by the progressive aging of PLWH. Early diagnosis through intensive cancer screening may improve the ability for therapeutic interventions and could be critical in reducing mortality, but it might also increase expenditure and harms associated with adverse events. The aim of this study is to evaluate an enhanced screening program for early diagnosis of cancer in PLWH compared to standard practice. The specific objectives are (1) to compare the frequency of cancer diagnosed at an early stage, (2) to analyze safety of the enhanced program: adverse events and unnecessary interventions, (3) to analyze the cost-utility of the program, and (4) to estimate the overall and site-specific incidence of NADC in PLWH. METHODS We will conduct a multicenter, non-blinded, randomized, controlled trial, comparing two parallel arms: conventional vs enhanced screening. Data will be recorded in an electronic data collection notebook. Conventional intervention group will follow the standard of care screening in the participating centers, according to the European AIDS Clinical Society recommendations, and the enhanced intervention group will follow an expanded screening aimed to early detection of lung, liver, anal, cervical, breast, prostate, colorectal, and skin cancer. The trial will be conducted within the framework of the Spanish AIDS Research Network Cohort (CoRIS). DISCUSSION The trial will evaluate the efficacy, safety, and efficiency of an enhanced screening program for the early diagnosis of cancer in HIV patients compared to standard of care practice. The information provided will be relevant since there are currently no studies on expanded cancer screening strategies in patients with HIV, and available data estimating cost effectiveness or cost-utility of such as programs are scarce. An enhanced program for NADC screening in patients with HIV could lead to early diagnosis and improve the prognosis of these patients, with an acceptable rate of unnecessary interventions, but it is critical to demonstrate that the benefits clearly outweigh the harms, before the strategy could be implemented. TRIAL REGISTRATION ClinicalTrials.gov NCT04735445. Registered on 25 June 2019.
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Affiliation(s)
- M Masiá
- Hospital General Universitario de Elche and Universidad Miguel Hernández de Elche, Elche, Spain
| | - S Padilla
- Hospital General Universitario de Elche and Universidad Miguel Hernández de Elche, Elche, Spain
| | - G Estañ
- Hospital General Universitario de Elche, Elche, Spain
| | - J Portu
- Hospital Universitario Araba, Vitoria-Gasteiz, Spain
| | - A Silva
- Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - A Rivero
- Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) and Universidad de Córdoba, Córdoba, Spain
| | - A González-Cordón
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - O Martínez
- Hospital General Universitario Santa Lucía de Cartagena, Murcia, Spain
| | - E Bernal
- Hospital General Universitario Reina Sofía de Murcia, Murcia, Spain
| | - C Galera
- Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - J Macias
- Hospital Universitario de Valme, Seville, Spain
| | | | - D García-Rosado
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - M J Vivancos-Gallego
- Hospital Ramon y Cajal and Ramon y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | | | - M Torralba
- Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - J A García
- Hospital General Universitario de Elche, Elche, Spain
| | - V Agulló
- Hospital General Universitario de Elche, Elche, Spain
| | | | - F Gutiérrez
- Hospital General Universitario de Elche and Universidad Miguel Hernández de Elche, Elche, Spain.
| | - E Martínez
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Leadebal ODCP, Pereira RR, Nóbrega LMB, Oliveira JAMD, Chaves RB, Medeiros LBD, Monroe AA, Nogueira JDA. Prevalência do alto risco de complicações clínicas associadas ao óbito por Aids. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Investigar a prevalência do alto risco entre casos de óbitos a partir da classificação de risco de complicações clínicas associadas a aids e sua relação com variáveis sociodemográficas e terapêuticas. Métodos: Estudo epidemiológico, retrospectivo, envolvendo 80 casos de óbito por aids ocorridos entre 2007 e 2015 em um Estado do Nordeste brasileiro. A estratificação do risco considerou indicadores de acompanhamento obtidos no diagnóstico da infecção, atribuindo-se valores de 1,2 para carga viral, e 1,2 e 3 aos indicadores de linfócitos T CD4+, quantidade de doenças oportunistas, manifestações clínicas e doenças crónicas, com escore variando entre 5 e 14. Quanto maior esse escore, maior o risco para complicações clínicas. Os dados foram analisados estimando a prevalência e razão de prevalência para o alto risco, seguido do método de Weight of Evidence e estatística D de Somers. Resultados: Dos 80 casos estudados, 51,2% foram alocados no estrato de alto risco. O registro de antecedentes psiquiátricos aumentou em 2 vezes a prevalência para o alto risco e a faixa etária apresentou forte relação com esse estrato. A contagem de linfócitos T-CD4+, doenças oportunistas e manifestações clínicas foram os indicadores que apresentaram maior força de associação com a estratificação de risco. Conclusão: O estudo mostrou a prevalência do alto risco para o desenvolvimento de complicações clínicas, maior força associativa nos indicadores LT-CD4+, doenças oportunistas e manifestações clínicas com escore de risco proposto. Estes resultados sugerem a necessidade de atenção especial dos serviços de atenção especializada aos indivíduos acompanhados em nível ambulatorial.
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Grabar S, Hleyhel M, Belot A, Bouvier AM, Tattevin P, Pacanowski J, Genet P, Pradier C, Salmon D, Simon A, Pourcher V, Spano JP, Poizot-Martin I, Costagliola D. Invasive cervical cancer in HIV-infected women: risk and survival relative to those of the general population in France. Results from the French Hospital Database on HIV (FHDH)-Agence Nationale de Recherches sur le SIDA et les Hépatites Virales (ANRS) CO4 cohort study. HIV Med 2019; 20:222-229. [PMID: 30693646 DOI: 10.1111/hiv.12703] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We examined trends in the incidence rates of invasive cervical cancer (ICC) and in the rate of survival after ICC among women living with HIV (WLHIV) in France and compared them to those of the general population. METHODS Histologically validated incident cases of ICC in the period 1992-2009 from the French Hospital Database on HIV (FHDH-ANRS CO4) were included in the study. Age-standardized incidence rates were estimated for FHDH and the general population in France for 1992-1996 [pre-combination antiretroviral therapy (cART) period], 1997-2000 (early cART period), 2001-2004 (intermediate cART period), and 2005-2009 (late cART period). Age-standardized incidence ratios (SIRs) were calculated. Five-year survival was compared with that of the general population for ICC diagnosed in 2005-2009 after standardization for age. RESULTS Among 28 977 WLHIV, 60 incident ICCs were histologically validated. There was a nonsignificant decreasing trend for the incidence across the cART periods (P = 0.07), from 60 to 36/100 000 person-years. The risk of ICC was consistently significantly higher in WLHIV than in the general population; the SIR was 5.4 [95% confidence interval (CI) 3.0-8.9] during the pre-cART period and 3.3 (95% CI 2.2-4.7) in 2005-2009. Survival after ICC did not improve across periods (log-rank P = 0.14), with overall estimated 5-year survival of 78% (95% CI 0.67-0.89%). Five-year survival was similar for WLHIV and the general population for women diagnosed with ICC in 2005-2009, after standardization (P = 0.45). CONCLUSIONS ICC risk is still more than three times higher in WLHIV than in the general population. Survival after ICC did not improve over time and was similar to that of the general population during the most recent period. Such results call for promotion of the uptake of screening in WLHIV.
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Affiliation(s)
- S Grabar
- Sorbonne University, INSERM, IPLESP (Pierre Louis Institute of Public Health), Paris, France.,Unit of Biostatistic and Epidemiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Centre University Hospitals, Paris Descartes University, Paris, France
| | - M Hleyhel
- CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon.,INSPECT-LB, National Public Health Institute, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - A Belot
- Department of Biostatistics, Hospices Civils de Lyon, Lyon, France.,Department of Chronical Diseases and Trauma, Institute de Veille Sanitaire, Saint-Maurice, France.,Laboratory of Biometry and Evolutive Biology, Health-Biostatistics team, CNRS, UMR 5558, Villeurbanne, France.,Department of Non-Communicable Disease Epidemiology, London, School of Hygiene and Tropical Medicine, Cancer Survival Group, Faculty of Epidemiology and Population Health, London, UK
| | - A-M Bouvier
- INSERM UMR 1231, Burgundy Digestive Cancer Registry, FRANCIM, Dijon University Hospital, Dijon, France
| | - P Tattevin
- Department of Infectious Diseases and Medical Reanimation, Rennes University Hospital, Pontchaillou Hospital, Rennes, France
| | - J Pacanowski
- Department of Infectious Diseases, AP-HP, Saint Antoine University Hospital, Paris, France
| | - P Genet
- Hematology and AIDS Department, Argenteuil Hospital, Argenteuil, France
| | - C Pradier
- Department of Public Health, Nice University Hospital, L'Archet Hospital, Nice, France
| | - D Salmon
- Unit of Infectious Diseases, Paris Centre University Hospitals, AP-HP, Paris Descartes University, Paris, France
| | - A Simon
- Department of Infectious Diseases, Pitié Salpêtrière University Hospital, AP-HP, Paris, France
| | - V Pourcher
- INSERM U1136, AP-HP Department of Infectious Diseases, Pitié Salpêtrière - Charles Foix University Hospital, Sorbonne University, Paris, France
| | - J-P Spano
- Medical Oncology Department, Pitié Salpêtrière University Hospital, AP-HP, IPLESP, Sorbonne University, INSERM, Paris, France
| | - I Poizot-Martin
- Clinical Immuno-Hematology Department, Aix-Marseille University, Sainte-Marguerite University Hospital, Marseille, France.,Inserm U912 (SESSTIM-Health Economic and Social Sciences and Medical Informatics), Marseille, France
| | - D Costagliola
- Sorbonne University, INSERM, IPLESP (Pierre Louis Institute of Public Health), Paris, France
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