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Darré T, Djiwa T, Ladekpo KJO, M’Bortche BK, Douaguibe B, Aboubakari AS, Ekouévi DK, Saka B. Factors Associated With Precancerous Cervical Lesions in Human Immunodeficiency Virus-Infected Women: A Cross-Sectional Survey in Togo. Clin Med Insights Oncol 2024; 18:11795549241234620. [PMID: 38510316 PMCID: PMC10953098 DOI: 10.1177/11795549241234620] [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: 10/09/2023] [Accepted: 02/05/2024] [Indexed: 03/22/2024] Open
Abstract
Background The burden of human immunodeficiency virus (HIV) in cervical cancer remains a major public health challenge in developing countries, like Togo. Precancerous lesions include all cellular abnormalities that have malignant potential that can develop into cancer. The objective of this study was to determine the prevalence and factors associated with precancerous cervical lesions in HIV-infected women in our context. Methods A cross-sectional descriptive study was carried out from November 31, 2022, to January 31, 2023, in an HIV care center in Lomé (Non-Governmental Organization Espoir Vie Togo [NGO EVT] Grand-Lomé-Togo). Results A total of 271 women were included with a mean age of 47.0 years and a standard deviation of 10.0 years, among whom 20.7% do not have any scholar education. Only 6.7% of them had previously performed cervical smear examinations. The prevalence of precancerous cervical lesions observed in people living with human immunodeficiency virus (PLHIV) was 11.4% with a 95% confidence interval (CI) of 5.0 to 15.4. Cytological abnormalities were marked by low-grade squamous intraepithelial lesion (LSIL) (5.1%), followed by the presence of atypical squamous cells of undetermined significance (ASCUS) (3.5%). A statistically significant association was found between parity and the presence of precancerous lesions (P = .014). Conclusions In this study, more than 1 out of 10 women living with HIV had precancerous cervical lesions, and parity was the factor associated. The implementation of a systematic screening program for precancerous cervical lesions and human papillomavirus (HPV) infection integrated into HIV care is necessary for early treatment.
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Affiliation(s)
- Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
- Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Toukilnan Djiwa
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | | | - Bingo K M’Bortche
- Department of Gynecology and Obstetrics, University Teaching Hospital of Lomé, Lomé, Togo
| | - Baguilane Douaguibe
- Department of Gynecology and Obstetrics, University Teaching Hospital of Lomé, Lomé, Togo
| | | | | | - Bayaki Saka
- Department of Dermatology and Venereology, University Teaching Hospital of Lomé, Lomé, Togo
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Konstantinidis I, Crothers K, Kunisaki KM, Drummond MB, Benfield T, Zar HJ, Huang L, Morris A. HIV-associated lung disease. Nat Rev Dis Primers 2023; 9:39. [PMID: 37500684 PMCID: PMC11146142 DOI: 10.1038/s41572-023-00450-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
Lung disease encompasses acute, infectious processes and chronic, non-infectious processes such as chronic obstructive pulmonary disease, asthma and lung cancer. People living with HIV are at increased risk of both acute and chronic lung diseases. Although the use of effective antiretroviral therapy has diminished the burden of infectious lung disease, people living with HIV experience growing morbidity and mortality from chronic lung diseases. A key risk factor for HIV-associated lung disease is cigarette smoking, which is more prevalent in people living with HIV than in uninfected people. Other risk factors include older age, history of bacterial pneumonia, Pneumocystis pneumonia, pulmonary tuberculosis and immunosuppression. Mechanistic investigations support roles for aberrant innate and adaptive immunity, local and systemic inflammation, oxidative stress, altered lung and gut microbiota, and environmental exposures such as biomass fuel burning in the development of HIV-associated lung disease. Assessment, prevention and treatment strategies are largely extrapolated from data from HIV-uninfected people. Smoking cessation is essential. Data on the long-term consequences of HIV-associated lung disease are limited. Efforts to continue quantifying the effects of HIV infection on the lung, especially in low-income and middle-income countries, are essential to advance our knowledge and optimize respiratory care in people living with HIV.
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Affiliation(s)
- Ioannis Konstantinidis
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristina Crothers
- Veterans Affairs Puget Sound Healthcare System and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ken M Kunisaki
- Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Heather J Zar
- Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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3
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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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4
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Sengayi-Muchengeti M, Singh E, Chen WC, Bradshaw D, de Villiers CB, Newton R, Waterboer T, Mathew CG, Sitas F. Thirteen cancers associated with HIV infection in a Black South African cancer patient population (1995-2016). Int J Cancer 2023; 152:183-194. [PMID: 36054877 DOI: 10.1002/ijc.34236] [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: 06/14/2021] [Revised: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 11/11/2022]
Abstract
South Africa's HIV epidemic has evolved over time in terms of numbers of people living with HIV, access to antiretroviral treatment (ART) and age. These changes have profoundly influenced local cancer patterns. The Johannesburg Cancer Study has, over a period of 22 years (1995-2016), recruited over 20 000 incident black cancer patients who consented to provide answers to a questionnaire and blood samples (serum, DNA). This has presented a unique opportunity to examine the evolving association of HIV with cancer in Africa. We used logistic regression models to explore case-control associations between specific cancers and HIV, using participants with non-infection related cancers as controls. Using data of 20 835 cancer patients with confirmed HIV status, we found the following cancers to be associated with HIV: Kaposi's sarcoma (ORadj ; 95%CI): (99.1;72.6-135.1), non-Hodgkin lymphoma (11.3;9.3-13.6), cervical cancer (2.7;2.4-3.0), Hodgkin lymphoma (3.1;2.4-4.2), cancer of the eye/conjunctiva (18.7;10.1-34.7), anogenital cancers (anus [2.1;1.4-3.2], penis [5.4;2.7-10.5], vulva [4.8;3.5-6.4], vagina [5.5;3.0-10.2]), oropharyngeal cancer (1.6;1.3-1.9), squamous cell carcinoma of the skin (3.5;2.4-4.9), melanoma (2.0;1.2-3.5) and cancer of the larynx (1.7;1.3-2.4). Kaposi's sarcoma odds ratios increased from the pre-ART (1995-2004) to the early ART (2005-2009) period but declined in the late ART (2010-2016) period. Odds ratios for cancers of the eye/conjunctiva, cervix, penis and vulva continued to increase in recent ART periods. Our study confirms the spectrum of HIV-associated cancers found in other African settings. The odds ratios of conjunctival and HPV-related cancers continue to rise in the ART era as the HIV positive population ages.
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Affiliation(s)
- Mazvita Sengayi-Muchengeti
- National Cancer Registry, 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
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York, UK
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christopher G Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Freddy Sitas
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- 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
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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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Wan Q, Anugwom C, Desalegn H, Debes JD. Hepatocellular carcinoma in Hepatitis B and Human Immunodeficiency Virus coinfection in Africa: a focus on surveillance. HEPATOMA RESEARCH 2022; 8:39. [PMID: 36277115 PMCID: PMC9583937 DOI: 10.20517/2394-5079.2022.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Human immunodeficiency virus (HIV) and hepatitis-B virus (HBV) infections are weighty public health challenges, especially in the African continent. The direct carcinogenic effect of HBV means that it remains a potent cause of early-onset hepatocellular carcinoma (HCC) in Sub-Saharan Africa (SSA), where it causes significant morbidity and mortality. The presence of HIV infection in HBV-infected patients poses a complicating factor, as coinfection has been shown to hasten the progression of liver disease to cirrhosis and HCC, and often resulting in early-age hepatocarcinogenesis with consequent late diagnosis and lower survival. In this review, we discuss this unique conundrum, the epidemiology of HIV-HBV coinfection in SSA, its effect on liver disease and development of HCC, as well as practices and barriers to HCC surveillance in this distinct population. We propose a way forward to curb this considerable health burden focusing on reduction of disease stigma, the need for easy-to-measure biomarkers, and implementation of large prospective studies in this population.
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Affiliation(s)
- Qian Wan
- Department of Medicine, Division of Infectious Disease and International Medicine & Division of Gastroenterology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Chimaobi Anugwom
- Department of Medicine, Division of Infectious Disease and International Medicine & Division of Gastroenterology, University of Minnesota, Minneapolis, MN 55455, USA.,Health Partners Digestive Care, Minneapolis, MN 55455, USA
| | | | - Jose D. Debes
- Department of Medicine, Division of Infectious Disease and International Medicine & Division of Gastroenterology, University of Minnesota, Minneapolis, MN 55455, USA.,Arusha Lutheran Medical Centre, Arusha, Tanzania
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7
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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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8
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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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9
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McMahon DE, Semeere A, Laker-Oketta M, Byakwaga H, Mugglin C, Duda SN, Azwa I, Jaquet A, Cardoso SW, Nash D, Wester CW, Freeman EE. Global Disparities in Skin Cancer Services at HIV Treatment Centers across 29 Countries. J Invest Dermatol 2021; 141:2533-2536.e2. [PMID: 33864771 DOI: 10.1016/j.jid.2021.02.758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aggrey Semeere
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Miriam Laker-Oketta
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Helen Byakwaga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catrina Mugglin
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - Stephany N Duda
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Iskandar Azwa
- Infectious Diseases Unit, Faculty of Medicine, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Antoine Jaquet
- French National Research Institute for Sustainable Development (IRD), University of Bordeaux, Bordeaux, France
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas (Evandro Chagas National Institute of Infectious Diseases), Rio de Janeiro, Brazil
| | - Denis Nash
- Department of Epidemiology and Biostatistics, The City University of New York, New York, New York, USA
| | | | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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10
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Tchounga B, Horo A, Boni S, Tanon A, Folquet MA, Garrigue I, Leroy V, Dabis F, Ekouevi D, Jaquet A. Human papilloma viruses infection among adolescent females perinatally infected with HIV in Côte d'Ivoire. Sex Transm Infect 2020; 97:238-243. [PMID: 32661070 DOI: 10.1136/sextrans-2019-054420] [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: 12/26/2019] [Revised: 04/24/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer prevention strategies recommend human papilloma virus (HPV) vaccination for female adolescents prior to their sexual debut. While HIV is a major risk factor for HPV infection in women of childbearing age, its prevalence among HIV-infected adolescent female is mostly unknown. This study aimed to describe the HPV prevalence and correlates among perinatally HIV-infected adolescent females prior to HPV immunisation. METHODS A cross-sectional survey was conducted from January to June 2016, in the four major paediatric HIV clinics of Abidjan, Côte d'Ivoire. All HIV-infected females aged 11-16 years were approached to participate in the study. A questionnaire assessing sexual behaviours and genital hygiene practices was administered to participants completed with a systematic vaginal swab collection. HPV genotyping was performed using the Anyplex II HPV28 Detection (Seegene). A logistic regression analysis was performed to identify factors associated with the presence of HPV infection. HPV immunisation was proposed free of charge to all participants. RESULTS A total of 250 participants were included, with a median age of 13 years (IQR 11-14). Among them, 237 (94.8%) were on antiretroviral treatment with a median CD4 count of 660 (IQR 439-914) cells/mm3. The overall prevalence of at least one HPV was 3.6% (95% CI 1.6 to 6.7) and the prevalence of at least one carcinogenic HPV was 2.8% (95% CI 0.7 to 4.8). Vaginal cleansing was reported by 75 (30%) of participants, with a median age at initiation of 12 years (IQR 10-13). Sexual activity was self-reported by 12 (4.8%) participants with a median age at sexual debut of 11 years (IQR 10-14). HPV infection was associated with vaginal cleansing (adjusted OR=7.0 (95% CI 1.4 to 31.6)). CONCLUSION The reported low prevalence of carcinogenic HPV infections supports the appropriateness of HPV immunisation in this population. The reported association between cleansing practices and HPV infection deserves further prospective longitudinal studies.
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Affiliation(s)
- Boris Tchounga
- Programme PACCI, site de recherche ANRS, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Simon Boni
- Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire
| | | | | | - Valeriane Leroy
- Université de Toulouse, Centre INSERM U1027, Toulouse, France
| | - François Dabis
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR 1219, Bordeaux, France
| | - Didier Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR 1219, Bordeaux, France.,Université de Lomé, Département des Sciences Fondamentales et Santé Publique, Lome, Togo
| | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR 1219, Bordeaux, France
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11
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Wright CY, du Preez DJ, Millar DA, Norval M. The Epidemiology of Skin Cancer and Public Health Strategies for Its Prevention in Southern Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031017. [PMID: 32041101 PMCID: PMC7037230 DOI: 10.3390/ijerph17031017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 12/24/2022]
Abstract
Skin cancer is a non-communicable disease that has been underexplored in Africa, including Southern Africa. Exposure to solar ultraviolet radiation (UVR) is an important, potentially modifiable risk factor for skin cancer. The countries which comprise Southern Africa are Botswana, Lesotho, Namibia, South Africa, and Swaziland. They differ in population size and composition and experience different levels of solar UVR. Here, the epidemiology and prevalence of skin cancer in Southern African countries are outlined. Information is provided on skin cancer prevention campaigns in these countries, and evidence sought to support recommendations for skin cancer prevention, especially for people with fair skin, or oculocutaneous albinism or HIV-AIDS who are at the greatest risk. Consideration is given to the possible impacts of climate change on skin cancer in Southern Africa and the need for adaptation and human behavioural change is emphasized.
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Affiliation(s)
- Caradee Y. Wright
- Environment and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa;
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0002, South Africa;
- Correspondence: ; Tel.: +27-12-339-8543
| | - D. Jean du Preez
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0002, South Africa;
- LACy, Laboratoire de l’Atmosphère et des Cyclones (UMR 8105 CNRS, Université de La Réunion, Météo-France), 97744 Saint-Denis de La Réunion, France
| | - Danielle A. Millar
- Environment and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa;
| | - Mary Norval
- Biomedical Sciences, University of Edinburgh Medical School, Edinburgh EH8 9AG UK;
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12
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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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13
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Boni S, Tchounga B, Comoe K, Guie P, Adié M, Horo A, Messou E, Ekouévi DK, Dabis F, Adoubi I, Jaquet A. Assessment of the scale-up of cervical cancer screening in Abidjan stratified by HIV status. Int J Gynaecol Obstet 2019; 147:246-251. [PMID: 31482577 DOI: 10.1002/ijgo.12959] [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] [Received: 11/02/2018] [Revised: 05/30/2019] [Accepted: 08/14/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To report the successes and challenges of scaling up a population-based cervical cancer (CC) screening program from HIV clinics to various healthcare facilities in Abidjan, Côte d'Ivoire. METHOD A retrospective analysis of characteristics, outcomes, and follow-up of women attending an initial CC screening visit in Abidjan between January 2010 and December 2014. Data were collected via forms that were systematically completed during CC screening visits. Data from the 2014 population census were used to estimate screening coverage. RESULTS Among 16 169 women attending an initial CC screening, 1616 (10.0%) had a positive VIA test. Among 848 women eligible for immediate cryotherapy, 618 (72.9%) underwent the "see-and-treat" approach. The 1-year follow-up rate after cryotherapy was 23.1% (143/618), and was higher among women with HIV (111/362, 30.7%) than among other women (32/256, 12.5%) (P=0.001). The estimated coverage of CC screening in Abidjan was 1.2% (95% confidence interval, 0.6-3.1). CONCLUSION Despite successful expansion of CC screening from HIV clinics to other facilities, the estimated screening coverage of the targeted population remained low. Follow-up of positively screened and treated women is a major challenge, especially outside HIV clinics, and would benefit from an innovative information system proving unique identification and tracking systems.
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Affiliation(s)
- Simon Boni
- Programme PACCI site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire
| | - Boris Tchounga
- Programme PACCI site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Kouassi Comoe
- Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire.,Service de cancérologie CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Privat Guie
- Service de Gynécologie obstétrique, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Mesmin Adié
- Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de Gynécologie obstétrique, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Centre de Prise en charge, de Recherche et de Formation (CePReF), Abidjan, Côte d'Ivoire
| | - Didier K Ekouévi
- Programme PACCI site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Département des Sciences Fondamentales et Santé Publique, Université de Lomé, Lomé, Togo.,Centre Inserm 1219 & Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, France
| | - François Dabis
- Centre Inserm 1219 & Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, France.,Agence Nationale de Recherche sur le VIH et Les Hépatites Virale, Paris, France
| | - Innocent Adoubi
- Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire.,Service de cancérologie CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Antoine Jaquet
- Centre Inserm 1219 & Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, France
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14
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Cancer incidence in Cotonou (Benin), 2014-2016: First results from the cancer Registry of Cotonou. Cancer Epidemiol 2019; 59:46-50. [PMID: 30685574 DOI: 10.1016/j.canep.2019.01.006] [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] [Received: 09/19/2018] [Revised: 01/02/2019] [Accepted: 01/11/2019] [Indexed: 11/23/2022]
Abstract
Incidence data from the population cancer registry of Cotonou (Benin) for the three year period 2014-2016 are presented. 1086 cancer cases were recorded, 608 cases (56.0%) in women (corresponding to an age standardized incidence rate (ASR) of 78.4 per 100,000) and 478 cases (44.0%) in men (ASR 91.8 per 100,000). Breast and cervical cancer accounted for 49.2% of all cancers in women. Breast cancer (ASR 22.6 per 100,000) was more common than cervical cancer (ASR 14.9 per 100,000) and the mean age of cases was lower. The incidence of prostate cancer (one quarter of all cancers in men), 30.5 per 100,000, was similar to that in other West African registries. Cancers of the liver and digestive tract were also relatively common in both sexes. These are the first data on cancer incidence in Benin, and will be invaluable for the development and evaluation of the National Cancer Control plan.
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15
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McCormack VA, Febvey-Combes O, Ginsburg O, Dos-Santos-Silva I. Breast cancer in women living with HIV: A first global estimate. Int J Cancer 2018; 143:2732-2740. [PMID: 29992553 DOI: 10.1002/ijc.31722] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022]
Abstract
There is a growing population of older women living with HIV/AIDS (WLWHA). Breast cancer is a common cancer in women worldwide, but the global number of breast cancers in WLWHA is not known. We estimated, for each UN sub-region, the number and age distribution of WLWHA who were diagnosed with breast cancer in 2012, by combining IARC-GLOBOCAN estimates of age-country specific breast cancer incidence with corresponding UNAIDS HIV prevalence. Primary analyses assumed no HIV-breast cancer association, and a breast cancer risk reduction scenario was also considered. Among 16.0 million WLWHA aged 15+ years, an estimated 6,325 WLWHA were diagnosed with breast cancer in 2012, 74% of whom were in sub-Saharan Africa, equally distributed between Eastern, Southern and Western Africa. In most areas, 70% of HIV-positive breast cancers were diagnosed under age 50. Among all breast cancers (regardless of HIV status), HIV-positive women constituted less than 1% of the clinical burden, except in Eastern, Western and Middle Africa where they comprised 4-6% of under age 50 year old breast cancer patients, and in Southern Africa where this patient subgroup constituted 26 and 8% of breast cancers diagnosed under and over age 50 respectively. If a deficit of breast cancer occurs in WLWHA, the global estimate would reduce to 3,600. In conclusion, worldwide, the number of HIV-positive women diagnosed with breast cancer was already substantial in 2012 and with an expected increase within the next decade, early detection and treatment research targeted to this population are needed.
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Affiliation(s)
- Valerie A McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Olivia Febvey-Combes
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
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16
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Mpunga T, Znaor A, Uwizeye FR, Uwase A, Munyanshongore C, Franceschi S, Clifford GM. A case-control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda. Int J Cancer 2018; 143:1348-1355. [PMID: 29663358 PMCID: PMC6099235 DOI: 10.1002/ijc.31537] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 12/24/2022]
Abstract
The aim of this study was to assess the association between HIV infection and cancer risk in Rwanda approximately a decade after the introduction of antiretroviral therapy (cART). All persons seeking cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda from 2012 to 2016 were routinely screened for HIV, prior to being confirmed with or without cancer (cases and controls, respectively). Cases were coded according to ICD-O-3 and converted to ICD10. Associations between individual cancer types and HIV were estimated using adjusted unconditional logistic regression. 2,656 cases and 1,196 controls differed by gender (80.3% vs. 70.8% female), age (mean 45.5 vs. 37.7 years), place of residence and proportion of diagnoses made by histopathology (87.5% vs. 67.4%). After adjustment for these variables, HIV was significantly associated with Kaposi Sarcoma (n = 60; OR = 110.3, 95%CI 46.8-259.6), non-Hodgkin lymphoma (NHL) (n = 265; OR = 2.5, 1.4-4.6), Hodgkin lymphoma (HL) (n = 76; OR = 5.2, 2.3-11.6) and cancers of the cervix (n = 560; OR = 5.9, 3.8-9.2), vulva (n = 23; OR = 17.8, 6.3-50.1), penis (n = 29; OR = 8.3, 2.5-27.4) and eye (n = 17; OR = 4.7, 1.0-25.0). Associations varied by NHL/HL subtype, with that for NHL being limited to DLBCL (n = 56; OR = 6.6, 3.1-14.1), particularly plasmablastic lymphoma (n = 6, OR = 106, 12.1-921). No significant associations were seen with other commonly diagnosed cancers, including female breast cancer (n = 559), head and neck (n = 116) and colorectal cancer (n = 106). In conclusion, in the era of cART in Rwanda, HIV is associated with increased risk of a range of infection-related cancers, and accounts for an important fraction of cancers presenting to a referral hospital.
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Affiliation(s)
- Tharcisse Mpunga
- Butaro Cancer Centre of Excellence, Ministry of HealthButaroRwanda
| | - Ariana Znaor
- International Agency for Research on CancerLyonFrance
| | | | - Aline Uwase
- Butaro Cancer Centre of Excellence, Ministry of HealthButaroRwanda
| | | | - Silvia Franceschi
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCSAvianoItaly
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17
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Abstract
Pulmonary complications remain among the most frequent causes of morbidity and mortality for individuals with HIV despite the advent of antiretroviral therapy (ART) and improvement in its efficacy and availability. The prevalence of non-infectious pulmonary diseases is rising in this population, reflecting both an increase in smoking and the independent risk associated with HIV. The unique mechanisms of pulmonary disease in these patients remain poorly understood, and direct effects of HIV, genetic predisposition, inflammatory pathways, and co-infections have all been implicated. Lung cancer, chronic obstructive pulmonary disease (COPD), and pulmonary hypertension are the most prevalent non-infectious pulmonary diseases in persons with HIV, and the risk of each of these diseases is higher among HIV-infected (HIV+) persons than in the general population. This review discusses the latest advances in the literature on these important complications of HIV infection.
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Affiliation(s)
- M Triplette
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - K Crothers
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA
| | - E F Attia
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA
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18
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Jedy-Agba EE, Dareng EO, Adebamowo SN, Odutola M, Oga EA, Igbinoba F, Otu T, Ezeome E, Bray F, Hassan R, Adebamowo CA. The burden of HPV associated cancers in two regions in Nigeria 2012-2014. Cancer Epidemiol 2016; 45:91-97. [PMID: 27780076 PMCID: PMC5124511 DOI: 10.1016/j.canep.2016.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/09/2016] [Accepted: 10/16/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION HPV attributable cancers are the second most common infection-related cancers worldwide, with much higher burden in less developed regions. There are currently no country-specific estimates of the burden of these cancers in Nigeria just like many other low and middle income countries. METHODS In this study, we quantified the proportion of the cancer burden in Nigeria that is attributable to HPV infection from 2012 to 2014 using HPV prevalence estimated from previous studies and data from two population based cancer registries (PBCR) in Nigeria. We considered cancer sites for which there is strong evidence of an association with HPV infection based on the International Agency for Research on Cancer (IARC) classification. We obtained age and sex-specific estimates of incident cancers and using the World Standard Population, we derived age standardized incidence (ASR) rates for each cancer type by categories of sex, and estimated the population attributable fractions (PAF). RESULTS The two PBCR reported 4336 new cancer cases from 2012 to 2014. Of these, 1627 (37.5%) were in males and 2709 (62.5%) in females. Some 11% (488/4336) of these cancers were HPV associated; 2% (38/1627) in men and 17% (450/2709) in women. Of the HPV associated cancers, 7.8% occurred in men and 92.2% in women. The ASRs for HPV associated cancers was 33.5 per 100,000; 2.3 and 31.2 per 100,000 in men and women respectively. The proportion of all cancers attributable to HPV infection ranged from 10.2 to 10.4% (442-453 of 4336) while the proportion of HPV associated cancers attributable to HPV infection ranged from 90.6% to 92.8% (442-453 of the 488 cases). In men, 55.3% to 68.4% of HPV associated cancers were attributable to HPV infection compared to 93.6% to 94.8% in women. The combined ASR for HPV attributable cancers ranged from 31.0 to 31.7 per 100,000. This was 1.4 to 1.7 per 100,000 in men and 29.6 to 30.0 per 100,000 in women. In women, cervical cancer (n=392, ASR 28.3 per 100,000) was the commonest HPV attributable cancer, while anal cancer (n=21, ASR 1.2 per 100,000) was the commonest in men. CONCLUSIONS HPV attributable cancers constitute a substantial cancer burden in Nigerian women, much less so in men. A significant proportion of cancers in Nigerian women would be prevented if strategies such as HPV DNA based screening and HPV vaccination are implemented.
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Affiliation(s)
- E E Jedy-Agba
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - E O Dareng
- Center for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - S N Adebamowo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD, USA
| | - M Odutola
- Institute of Human Virology, Abuja, Nigeria
| | - E A Oga
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, USA
| | | | - T Otu
- University of Abuja Teaching Hospital Gwagwalada, Nigeria
| | - E Ezeome
- University of Nigeria Teaching Hospital Enugu, Nigeria
| | - F Bray
- International Agency for Research on Cancer, Lyon, France
| | - R Hassan
- Federal Ministry of Health, Abuja, Nigeria
| | - C A Adebamowo
- Institute of Human Virology, Abuja, Nigeria; Department of Epidemiology and Public Health, University of Maryland, Baltimore, USA; Marlene and Stewart Greenbaum Comprehensive Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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19
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Odutola M, Jedy-Agba EE, Dareng EO, Oga EA, Igbinoba F, Otu T, Ezeome E, Hassan R, Adebamowo CA. Burden of Cancers Attributable to Infectious Agents in Nigeria: 2012-2014. Front Oncol 2016; 6:216. [PMID: 27822455 PMCID: PMC5075533 DOI: 10.3389/fonc.2016.00216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/28/2016] [Indexed: 01/08/2023] Open
Abstract
Introduction Infections by certain viruses, bacteria, and parasites have been identified as risk factors for some cancers. In Nigeria, like many other developing countries, infections remain a leading cause of morbidity and mortality. While there are data on the incidence of different cancers in Nigeria, there has been no study of cancers attributable to infections. This study was carried out to determine the burden of cancers attributable to infections using data from two population-based cancer registries (PBCRs) in Nigeria. Methods We obtained data on cancers associated with EBV, human papillomavirus (HPV), hepatitis B and C, HIV, HHV8, Helicobacter pylori, and Schistosoma spp. from the databases of Abuja and Enugu cancer registries in Nigeria. We used population-attributable fraction for infections-associated cancers in developing countries that are based on prevalence data and relative risk estimates from previous studies. Results The PBCRs reported 4,336 incident cancer cases [age standardized incidence rate (ASR) 113.9 per 100,000] from 2012 to 2014, of which 1,627 (37.5%) were in males and 2,709 (62.5%) were in females. Some 1,030 (23.8%) of these cancers were associated with infections (ASR 44.4 per 100,000), while 951 (22.0%) were attributable to infections (ASR 41.6 per 100,000). Cancers of the cervix (n = 392, ASR 28.3 per 100,000) and liver (n = 145, ASR 3.4 per 100,000); and non-Hodgkin’s lymphoma (n = 110, ASR 2.5 per 100,000) were the commonest infections-associated cancers overall. The commonest infectious agents associated with cancers in this population were HPV, EBV, hepatitis B and C, HIV, and HHV8. Conclusion Our results suggest that 23.8% of incident cancer cases in this population were associated with infections, while 22.0% were attributable to infections. The infections attributable cancers are potentially preventable with strategies, such as vaccination, risk factor modification, or anti-infective treatment.
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Affiliation(s)
| | - Elima E Jedy-Agba
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine , London , UK
| | - Eileen O Dareng
- Department of Public Health and Primary Care, Center for Cancer Genetic Epidemiology, University of Cambridge , Cambridge , UK
| | | | | | - Theresa Otu
- University of Abuja Teaching Hospital Gwagwalada , Gwagwalada , Nigeria
| | - Emmanuel Ezeome
- University of Nigeria Teaching Hospital Enugu , Enugu , Nigeria
| | | | - Clement A Adebamowo
- Institute of Human Virology, Abuja, Nigeria; Department of Epidemiology and Public Health, Marlene and Stewart Greenebaum Comprehensive Cancer Center, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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20
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Capo-Chichi CD, Aguida B, Chabi NW, Acapko-Ezin J, Sossah-Hiffo J, Agossou VK, Anagbla T, Zannou M, Houngbé F, Sanni A. Diversity of high risk human papilloma viruses in women treated with antiretroviral and in healthy controls and discordance with cervical dysplasia in the South of Benin. Infect Agent Cancer 2016; 11:43. [PMID: 27528886 PMCID: PMC4983786 DOI: 10.1186/s13027-016-0090-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/28/2016] [Indexed: 11/14/2022] Open
Abstract
Background High risk oncologic Human Papilloma Virus (HPV) is one of the leading causes of cervical cancer worldwide. We investigated HPV genotypes among women living or not with Human Immuno-deficiency Virus (HIV) in two major hospitals in the south of the republic of BENIN in the city of Cotonou. Our objective is to investigate the association of high risk-HPV to cervical dysplasia among women under stringent anti-retroviral (ARV) treatment and in controls without HIV. Methods The investigation was carried out within 1 year period in two groups of adult women: one group with HIV1 infection and under ARV therapy in the National University Hospital (CNHU-HKM) designated as CH group (n = 86); and one control group without HIV infection and attending the hospital Mènontin for routine gynecologic checkup and designated as ME group (n = 86). Cells derived from cervical uterine smears (CUS) were used for this investigation. The samples in ME group were selected to have similar lamin A/C profile with CH group. HPV genotypes were assessed by polymerase chain reaction (PCR) while lamin A/C expression profile was assessed by western blotting to corroborate the risk of cervical dysplasia. Results HPV56 is dominant in CH group while HPV66 is dominant in ME group. 31 % of women in CH group are infected with HPV compared to 23 % in ME group. Quadruple and quintuple HPV infections are more observed among CH group but not in ME group making HPV counts of 43 in CH group and 27 in ME group. Cervical dysplasia are present in 5 % (4/86) of women in CH group and in 1 % (1/86) of women in ME group at the time of CUS collection. The adjustment of the risk to develop cervical cancer in the future related to HPV infection and the total loss of lamin A/C is not significantly different in both groups. Conclusion Women living with HIV are more sensitive to multiple HPV infection but not all HPV infections generated cervical dysplasia. The effectiveness of antiretroviral therapy in CH group may reduce significantly the frequency of cervical dysplasia.
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Affiliation(s)
- Callinice D Capo-Chichi
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
| | - Blanche Aguida
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
| | - Nicodème W Chabi
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
| | | | - Jonas Sossah-Hiffo
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
| | | | | | - Marcel Zannou
- National University Hospital (CNHU-HKM), Cotonou, Benin
| | | | - Ambaliou Sanni
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
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Esposito S, Bonanni P, Maggi S, Tan L, Ansaldi F, Lopalco PL, Dagan R, Michel JP, van Damme P, Gaillat J, Prymula R, Vesikari T, Mussini C, Frank U, Osterhaus A, Celentano LP, Rossi M, Guercio V, Gavazzi G. Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid). Hum Vaccin Immunother 2016; 12:1777-94. [PMID: 27135390 PMCID: PMC4964839 DOI: 10.1080/21645515.2016.1150396] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/19/2016] [Accepted: 02/01/2016] [Indexed: 12/27/2022] Open
Abstract
Rapid population aging has become a major challenge in the industrialized world and progressive aging is a key reason for making improvement in vaccination a cornerstone of public health strategy. An increase in age-related disorders and conditions is likely to be seen in the near future, and these are risk factors for the occurrence of a number of vaccine-preventable diseases. An improvement in infectious diseases prevention specifically aimed at adults and the elderly can therefore also decrease the burden of these chronic conditions by reducing morbidity, disability, hospital admissions, health costs, mortality rates and, perhaps most importantly, by improving the quality of life. Among adults, it is necessary to identify groups at increased risk of vaccine-preventable diseases and highlight the epidemiological impact and benefits of vaccinations using an evidence-based approach. This document provides clinical practice guidance on immunization for adults in order to provide recommendations for decision makers and healthcare workers in Europe. Although immunization is considered one of the most impactful and cost-effective public health measures that can be undertaken, vaccination coverage rates among adults are largely lower than the stated goal of ≥ 95% among adults, and stronger efforts are needed to increase coverage in this population. Active surveillance of adult vaccine-preventable diseases, determining the effectiveness of the vaccines approved for marketing in the last 5 y, the efficacy and safety of vaccines in immunocompromised patients, as well as in pregnant women, represent the priorities for future research.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Stefania Maggi
- CNR - Institute of Neuroscience, Aging Branch Center for Research, Padua, Italy
| | - Litjan Tan
- Immunization Action Coalition, St Paul, MN, USA
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, IRCCS San Martino-IST University Teaching Hospital, Genoa, Italy
| | | | - Ron Dagan
- Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | | | - Pierre van Damme
- Vaccine & Infectious Disease Institute, Antwerp University, Wilrijk, Belgium
| | | | - Roman Prymula
- Department of Social Medicine, Faculty of Medicine, Charles University, Sokolska, Hradec Kralove, Czech Republic
| | - Timo Vesikari
- Vaccine Research Center, Tampere University Hospital, Tampere, Finland
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Uwe Frank
- Division of Infection Control and Hospital Epidemiology, Department of Infectious Diseases, Heidelberg University, Heidelberg, Germany
| | | | | | - Marta Rossi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Valentina Guercio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Gaetan Gavazzi
- University Clinic of Geriatric Medicine, University Hospital of Grenoble, and GREPI University of Grenoble-Alpes, Grenoble, France
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