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Ahn SM, Lee YS, Han M, Lee JA, Seong JE, Baek YJ, Hyun J, Kim JH, Ahn JY, Oh DH, Jeong SJ, Baek JH, Ku NS, Choi HK, Park Y, Chin B, Kim YK, Yeom JS, Choi YH, Choi JY. Epidemiological and Clinical Characteristics of Women Living with HIV in Korea. Infect Chemother 2024; 56:369-377. [PMID: 39370122 PMCID: PMC11458499 DOI: 10.3947/ic.2024.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/07/2024] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND While Korea maintains a low prevalence of human immunodeficiency virus (HIV), the number of newly diagnosed cases has been steadily rising, reaching approximately 1,000 annually in recent years. The 2022 annual report from the Korea Disease Control and Prevention Agency revealed that women living with HIV (WLWH) constitute 6.4% of the total confirmed people living with the HIV population, totaling 1,219 individuals. Despite this, only a few studies have focused on WLWH in Korea. This study aims to analyze the epidemiological and clinical characteristics of WLWH in Korea. MATERIALS AND METHODS We retrospectively collected data by reviewing the medical records of all WLWH who visited 10 urban referral hospitals across Korea between January 2005 and May 2023. RESULTS A total of 443 WLWH were enrolled in this study. The predominant risk exposure was heterosexual contact, with 235 (53%) participants either married or cohabiting with a male partner at their initial clinic visit. Among the participants, 334 (77.7%) were Korean, 27 (6.1%) were Southeast Asian, and 19 (4.3%) were African. Antiretroviral therapy was initiated by 404 WLWH (91.2%). We observed 118 pregnancies in WLWH following their HIV diagnosis, resulting in 78 live births (66.1%), 18 induced abortions (15.2%), 10 pre-viable fetal losses (8.5%), and four stillbirths (3.4%). Over a cumulative follow-up duration of 3,202.1 years, the incidence rates of breast and cervical cancers were both 2.18 per 1,000 person-years. Additionally, the incidence rates of pelvic inflammatory disease, cervical intraepithelial neoplasm (above grade II), and osteoporosis were 4.67, 11.21, and 13.39 per 1,000 patient-years, respectively. CONCLUSION This is the first multicenter study to investigate the clinical and epidemiological characteristics of WLWH in Korea. The incidence and prevalence of diseases in women, including breast cancer, cervical cancer, and chronic comorbidities, are high in WLWH in Korea; therefore, further research and efforts are needed to manage these diseases.
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Affiliation(s)
- Sang Min Ahn
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seop Lee
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Han
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ah Lee
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Eun Seong
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yae Jee Baek
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - JongHoon Hyun
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jung Ho Kim
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Ahn
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyun Oh
- Division of Infectious Diseases, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Nam Su Ku
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Kyoung Choi
- Division of Infectious Diseases, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yoonseon Park
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Young Keun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Joon Sup Yeom
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Firnhaber C, Simoncini G, Mayer C, Armon C, Ewing AC, Tedaldi E, Battalora L, Carlson K, Chagaris K, Buchacz K, Li J. Mammogram and Pap Smear Uptake Among Women in the HIV Outpatient Study USA, 2010-2021. AIDS Patient Care STDS 2024; 38:151-154. [PMID: 38656216 DOI: 10.1089/apc.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- Cynthia Firnhaber
- Vivent Health, Department of Research, Denver, Colorado, USA
- University of Colorado, Department of Medicine, Division of Infectious Disease, Anschutz Medical Center, Aurora, Colorado, USA
| | - Gina Simoncini
- Department of Internal Medicine, AIDS Healthcare Foundation, Philadelphia, Pennsylvania, USA
| | - Cynthia Mayer
- Department of Internal Medicine, Division of Infectious Disease, St. Joseph's Comprehensive Research Institute, Tampa, Florida, USA
| | - Carl Armon
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
| | - Alexander C Ewing
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ellen Tedaldi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Linda Battalora
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
- Petroleum Engineering Department, Colorado School of Mines, Golden, Colorado, USA
| | - Kimberly Carlson
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
| | - Kalliope Chagaris
- Department of Life Science, Cerner Corporation, Kansas City, Missouri, USA
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Li
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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3
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Yuan T, Hu Y, Zhou X, Yang L, Wang H, Li L, Wang J, Qian HZ, Clifford GM, Zou H. Incidence and mortality of non-AIDS-defining cancers among people living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101613. [PMID: 35990580 PMCID: PMC9386399 DOI: 10.1016/j.eclinm.2022.101613] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-AIDS-defining cancers (NADCs) are now becoming a rising cause of morbidity among people living with HIV (PLHIV) in the highly active antiretroviral therapy (HAART) era. We conducted a systematic review and meta-analysis to estimate the summary risk of incidence and mortality of a wide range of NADCs among PLHIV compared with the general population. Methods This systematic review and meta-analysis was registered in the PROSPERO (registration number CRD42020222020). We searched PubMed, EMBASE, Cochrane library, and Web of Science for relevant studies published before Jan 24, 2022. Cohort or registry linkage studies comparing the incidence or mortality of individual NADCs in PLHIV with that in the general population were included. Studies simply reporting outcomes of cancer precursor lesions or combined NADCs were excluded. We calculated pooled standardised incidence (SIRs) and standardised mortality ratios (SMRs) and their 95% confidence intervals (CIs) using random-effects models, and used robust variance estimation to account for non-independence in study-level effect sizes. Findings We identified 92 publications arising from 46 independent studies including 7 articles out of 7 studies from developing countries. Among the 40 types of NADCs investigated, all of the 20 infection-related NADCs, cancers related with human papillomavirus infection in particular, and half of the 20 non-infection-related NADCs occurred in excess in PLHIV compared with the general population. This risk pattern was consistent in most WHO regions and in both high-income and low-and middle-income countries. The increased SIRs for various NADCs were more evident among PLHIV with advanced immunodeficiency, and was explored by HIV transmission route, and use of HAART. PLHIV had increased mortality for anal cancer (SMR 124·07, 95% CI 27·31-563·72), Hodgkin lymphoma (41·03, 2·91-577·88), liver cancer (8·36, 3·86-18·11), lung cancer (3·95, 1·52-10·26), and skin melanoma (3·95, 1·28-12·2). Interpretation PLHIV had increased incidence and mortality for a wide spectrum of NADCs. Primary prevention and effective treatment for NADCs in this population is urgently needed. Funding Natural Science Foundation of China Excellent Young Scientists Fund, Natural Science Foundation of China International/Regional Research Collaboration Project, National Science and Technology Major Project of China, Sanming Project of Medicine in Shenzhen, High Level Project of Medicine in Longhua, Shenzhen, Shenzhen Science and Technology Innovation Commission Basic Research Program, Special Support Plan for High-Level Talents of Guangdong Province, the Guangzhou Basic Research Program on People's Livelihood Science and Technology, the National Natural Science Foundation of China.
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Affiliation(s)
- Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuqing Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xinyi Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Luoyao Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- National Clinical Research Center for Infectious Diseases, Shenzhen, China
- The Third People's Hospital of Shenzhen, Shenzhen, China
- The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou, China
- Guangzhou Medical University, Guangzhou, China
| | - Junfeng Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT USA
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, the University of New South Wales, Sydney, Australia
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4
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Coburn SB, Dionne-Odom J, Alcaide ML, Moran CA, Rahangdale L, Golub ET, Massad LS, Seidman D, Michel KG, Minkoff H, Murphy K, Brown TT, Visvanathan K, Lau B, Althoff KN. The Association Between HIV Status, Estradiol, and Sex Hormone Binding Globulin Among Premenopausal Women in the Women's Interagency HIV Study. J Womens Health (Larchmt) 2022; 31:183-193. [PMID: 35041528 PMCID: PMC8864429 DOI: 10.1089/jwh.2021.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Characterizing estradiol among women with HIV may have implications for breast cancer and cardiovascular disease risk but has not been adequately explored. We quantified differences in total (E2), free (FE2) estradiol, and sex hormone binding globulin (SHBG) by HIV and viral suppression status. Methods: Women from a substudy (2003-2006) within the Women's Interagency HIV Study (IRB approved at each participating site) were included if they reported: a period in the last six months, were not pregnant/breastfeeding, no oophorectomy, and no exogenous hormone use in the prior year. Serum was collected on days 2-4 of the menstrual cycle. We assessed differences in biomarkers at 25th, 50th, and 75th percentiles by HIV and viral suppression status using weighted quantile regression. Results: Among 643 women (68% with HIV) median age was 37 years. All E2 percentiles were significantly (p < 0.05) lower in women with suppressed viral load versus women without HIV (4-10 pg/mL). The 25th and 50th percentile of E2 were 4-5 pg/mL lower in women with unsuppressed viral load compared to women without HIV (p < 0.05). The 25th and 50th percentile of SHBG was significantly higher in women with unsuppressed viral load compared to women without HIV (10 and 12 nmol/L, respectively). There were no consistent differences in estradiol or SHBG by suppression status. Conclusions: There were no differences in FE2 but significantly lower E2 and higher SHBG among women with HIV versus without HIV. Further research is merited in a large contemporary sample to clarify the clinical implications of these findings.
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Affiliation(s)
- Sally B. Coburn
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.,Address correspondence to: Sally B. Coburn, PhD, MPH, Department of Epidemiology, Johns Hopkins University, 615 N Wolfe Street, No. E7008, Baltimore, MD 21205, USA
| | - Jodie Dionne-Odom
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maria L. Alcaide
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Caitlin A. Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lisa Rahangdale
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leslie Stewart Massad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Katherine G. Michel
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Georgetown University Medical Center, Georgetown University, Washington, District of Columbia, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Downstate, Brooklyn, New York, USA
| | - Kerry Murphy
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
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5
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Emens LA, Adams S, Cimino-Mathews A, Disis ML, Gatti-Mays ME, Ho AY, Kalinsky K, McArthur HL, Mittendorf EA, Nanda R, Page DB, Rugo HS, Rubin KM, Soliman H, Spears PA, Tolaney SM, Litton JK. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of breast cancer. J Immunother Cancer 2021; 9:e002597. [PMID: 34389617 PMCID: PMC8365813 DOI: 10.1136/jitc-2021-002597] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Breast cancer has historically been a disease for which immunotherapy was largely unavailable. Recently, the use of immune checkpoint inhibitors (ICIs) in combination with chemotherapy for the treatment of advanced/metastatic triple-negative breast cancer (TNBC) has demonstrated efficacy, including longer progression-free survival and increased overall survival in subsets of patients. Based on clinical benefit in randomized trials, ICIs in combination with chemotherapy for the treatment of some patients with advanced/metastatic TNBC have been approved by the United States (US) Food and Drug Administration (FDA), expanding options for patients. Ongoing questions remain, however, about the optimal chemotherapy backbone for immunotherapy, appropriate biomarker-based selection of patients for treatment, the optimal strategy for immunotherapy treatment in earlier stage disease, and potential use in histological subtypes other than TNBC. To provide guidance to the oncology community on these and other important concerns, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew upon the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for breast cancer, including diagnostic testing, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence-based and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with breast cancer.
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Affiliation(s)
- Leisha A Emens
- Department of Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University Langone, New York, New York, USA
| | - Ashley Cimino-Mathews
- Department of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary L Disis
- Cancer Vaccine Institute, University of Washington, Seattle, Washington, USA
| | - Margaret E Gatti-Mays
- Pelotonia Institute for Immuno-Oncology, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Alice Y Ho
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin Kalinsky
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rita Nanda
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois, USA
| | - David B Page
- Earle A Chiles Research Institute, Portland, Oregon, USA
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Krista M Rubin
- Center for Melanoma, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Hatem Soliman
- Department of Breast Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Patricia A Spears
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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6
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Chiao EY, Coghill A, Kizub D, Fink V, Ndlovu N, Mazul A, Sigel K. The effect of non-AIDS-defining cancers on people living with HIV. Lancet Oncol 2021; 22:e240-e253. [PMID: 34087151 PMCID: PMC8628366 DOI: 10.1016/s1470-2045(21)00137-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
Non-AIDS-defining cancers are a growing source of morbidity for people with HIV globally. Although people living with HIV have a disproportionately increased risk of developing virally mediated cancers, cancer burden for common non-AIDS-defining cancers that are not virally associated and are linked to ageing, such as prostate cancer, is becoming higher than for virally mediated cancers. Ageing, behavioural, and HIV-specific factors drive the incidence and affect the outcomes of non-AIDS-defining cancers, presenting different challenges for addressing global morbidity and mortality from non-AIDS-defining cancer. Although large population-based studies have shown that people living with HIV with non-AIDS-defining cancers have poorer cancer outcomes than do people without HIV, current guidelines emphasise that people living with HIV with non-AIDS-defining cancers should receive standard, guideline-based treatment, and infectious disease and oncology providers should work closely to address potential drug interactions between antiretroviral therapy and antineoplastic treatment. Most trials target preventive measures focusing on non-AIDS-defining cancers. However, treatment trials for the optimal management of people living with HIV and non-AIDS-defining cancer, including interventions such as immunotherapies, are needed to improve non-AIDS-defining cancer outcomes.
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Affiliation(s)
- Elizabeth Y Chiao
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Anna Coghill
- Cancer Epidemiology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Center for Immunization and Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Darya Kizub
- Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valeria Fink
- Clinical Research, Fundación Huésped, Buenos Aires, Argentina
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Angela Mazul
- Department of Otolaryngology, Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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Coburn SB, Shiels MS, Silverberg MJ, Horberg MA, Gill MJ, Brown TT, Visvanathan K, Connor AE, Napravnik S, Marcus JL, Moore RD, Mathews WC, Mayor AM, Sterling TR, Li J, Rabkin CS, D’Souza G, Lau B, Althoff KN. Secular Trends in Breast Cancer Risk Among Women With HIV Initiating ART in North America. J Acquir Immune Defic Syndr 2021; 87:663-670. [PMID: 33492023 PMCID: PMC8026587 DOI: 10.1097/qai.0000000000002627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies suggest lower risk of breast cancer in women with HIV versus without HIV. These estimates may be biased by lower life expectancy and younger age distribution of women with HIV. Our analysis evaluated this bias and characterized secular trends in breast cancer among women with HIV initiating antiretroviral therapy. We hypothesized breast cancer risk would increase over time as mortality decreased. SETTING Women with HIV prescribed antiretroviral therapy in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 1997 through 2016. METHODS We estimated breast cancer hazard (cause-specific hazard ratios) and cumulative incidence accounting for competing risks (subdistribution hazard ratios) to assess changes in breast cancer risk over time. This was assessed overall (1997-2016) and within/across calendar periods. Analyses were adjusted for race/ethnicity and inverse probability weighted for cohort. Cumulative incidence was graphically assessed by calendar period and race/ethnicity. RESULTS We observed 11,587 women during 1997-2016, contributing 63 incident breast cancer diagnoses and 1,353 deaths [73,445 person-years (median follow-up = 4.5 years)]. Breast cancer cumulative incidence was 3.2% for 1997-2016. We observed no secular trends in breast cancer hazard or cumulative incidence. There were annual declines in the hazard and cumulative incidence of death (cause-specific hazard ratios and subdistribution hazard ratios: 0.89, 95% confidence interval: 0.87 to 0.91) which remained within and across calendar periods. CONCLUSIONS These findings contradict the hypothesis of increasing breast cancer risk with declining mortality over time among women with HIV, suggesting limited impact of changing mortality on breast cancer risk. Additional inquiry is merited as survival improves among women with HIV.
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Affiliation(s)
- Sally B. Coburn
- Department of Epidemiology, Johns Hopkins University,
Baltimore, Maryland, USA
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, Infections
and Immunoepidemiology Branch, National Cancer Institute, NIH, Rockville, Maryland,
USA
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern
California, Oakland, California, USA
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser
Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary,
Alberta, Canada
| | - Todd T. Brown
- Department of Epidemiology, Johns Hopkins University,
Baltimore, Maryland, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins University,
Baltimore, Maryland, USA
| | - Avonne E. Connor
- Department of Epidemiology, Johns Hopkins University,
Baltimore, Maryland, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julia L. Marcus
- Department of Population Medicine, Harvard University,
Cambridge, Massachusetts, USA
| | - Richard D. Moore
- Department of Epidemiology, Johns Hopkins University,
Baltimore, Maryland, USA
| | - W. Chris Mathews
- Department of Medicine, University of California San Diego,
San Diego, California, USA
| | - Angel Mauricio Mayor
- Department of Medicine, Universidad Central del Caribe,
Bayamón, Puerto Rico, USA
| | - Timothy R. Sterling
- Department of Medicine, Division of Infectious Diseases,
Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, USA
| | - Charles S. Rabkin
- Division of Cancer Epidemiology and Genetics, Infections
and Immunoepidemiology Branch, National Cancer Institute, NIH, Rockville, Maryland,
USA
| | - Gyspyamber D’Souza
- Department of Epidemiology, Johns Hopkins University,
Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University,
Baltimore, Maryland, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University,
Baltimore, Maryland, USA
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8
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Lurain K, Mbulaiteye SM. Does HIV undermine breast cancer outcomes in women? AIDS 2021; 35:689-690. [PMID: 33620873 PMCID: PMC7905782 DOI: 10.1097/qad.0000000000002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research,
National Cancer Institute, Bethesda, MD, USA
| | - Sam M. Mbulaiteye
- Infections and Immunoepidemiology Branch, Division of
Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland,
USA
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9
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Spence AB, Levy ME, Monroe A, Castel A, Timpone J, Horberg M, Adams-Campbell L, Kumar P. Cancer Incidence and Cancer Screening Practices Among a Cohort of Persons Receiving HIV Care in Washington, DC. J Community Health 2021; 46:75-85. [PMID: 32424501 PMCID: PMC8370184 DOI: 10.1007/s10900-020-00844-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In this era of effective combination antiretroviral therapy the incidence of AIDS defining cancers (ADCs) is projected to decline while the incidence of certain non-AIDS defining cancers (NADCs) increases. Some of these NADCs are potentially preventable with appropriate cancer screening. We examined cancer incidence, screening eligibility, and receipt of screening among persons actively enrolled in the DC Cohort, a longitudinal observational cohort of PLWH, between 2011 and 2017. Cancer screening eligibility was determined based on age, sex, smoking history and co-morbidity data available and published national guidelines. The incidence rate of NADCs was 12.1 (95% CI 10.7, 13.8) and ADCs 1.6 (95% CI 0.6, 4.6) per 1000 person-years. The most common incident NADCs were breast 2.6 (95% CI 0.5,1 2.1), prostate 2.3 (95% CI 1.2, 4.3), and non-melanoma skin 1.2 (95% CI 0.6, 2.3) incident diagnoses/cases per 1000 person-years. Among cohort sites where receipt of cancer screening was assessed, less than 60% of eligible participants had any ascertained anal HPV, breast, cervical, colorectal, hepatocellular carcinoma, or lung cancer screening. In this cohort of PLWH, there were more incident NADCs versus ADCs in contrast to earlier cohort studies where ADCs predominated. Despite a large eligible population there were low rates of screening. Implementation of cancer screening is an important component of care among PLWH.
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Affiliation(s)
- Amanda Blair Spence
- Georgetown University Medical Center, 3800 Reservoir Road NW, 5th Floor PHC, Washington, DC, 20008, USA.
| | - Matthew E Levy
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Anne Monroe
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Amanda Castel
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Joseph Timpone
- Georgetown University Medical Center, 3800 Reservoir Road NW, 5th Floor PHC, Washington, DC, 20008, USA
| | - Michael Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | | | - Princy Kumar
- Georgetown University Medical Center, 3800 Reservoir Road NW, 5th Floor PHC, Washington, DC, 20008, USA
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Chhatre S, Schapira M, Metzger DS, Jayadevappa R. Association between HIV infection and outcomes of care among medicare enrollees with breast cancer. EClinicalMedicine 2019; 17:100205. [PMID: 31891138 PMCID: PMC6933147 DOI: 10.1016/j.eclinm.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To assess the interaction of breast cancer, HIV infection, Medicare disability status, cancer stage and its implications for outcomes, after accounting for competing risks among female, fee-for-service Medicare enrollees. METHODS We used data from Surveillance, Epidemiology and End Results (SEER) -Medicare (2000-2013). From primary female breast cancer cases diagnosed between 2001 and 2011, we identified those with HIV infection. We used Generalized Linear Model for phase-specific incremental cost of HIV, Cox regression for association between HIV and all-cause mortality, and Fine and Gray competing risk models to assess hazard of breast cancer-specific mortality by HIV status. We also studied this association for subgroups of cancer stage and disability status. FINDINGS Of 164,080 eligible cases of breast cancer, 176 had HIV infection. Compared to HIV-uninfected patients, HIV infected patients had 16% higher cost in initial phase, and 80% higher cost in interim stage of care, and at least two times higher mortality (all-cause and breast cancer-specific), after accounting for competing risk. Among disabled enrollees, HIV-infected patients had higher risk of all-cause and breast cancer-specific mortality, compared to HIV-uninfected patients. INTERPRETATION Female fee-for-service Medicare enrollees with breast cancer experience higher initial and interim phase cost and worse survival in the presence of HIV. This association was also significant among disabled Medicare enrollees. Medicare is the single largest source of federal financing for HIV care. Burden on Medicare will grow exponentially due to higher proportion of disabled among HIV-infected enrollees, longer survival among HIV- infected persons, increased HIV incidence in older adults, and increased age related risk of breast cancer. Future research can identify the pathways via which HIV infection affects cost and mortality, and develop integrated strategies for effective management of concomitant breast cancer and HIV and inform survivorship guidelines. FUNDING National Institute on Aging, National Institutes of Health, Grant # R21AG34870-1A1.
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Affiliation(s)
- Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corresponding author.
| | - Marilyn Schapira
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, United States
| | - David S. Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ravishankar Jayadevappa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, United States
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania United States
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Coghill AE, Engels EA, Schymura MJ, Mahale P, Shiels MS. Risk of Breast, Prostate, and Colorectal Cancer Diagnoses Among HIV-Infected Individuals in the United States. J Natl Cancer Inst 2019. [PMID: 29529223 DOI: 10.1093/jnci/djy010] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Although people living with HIV or AIDS (PLWHA) are at higher risk for many cancers, breast, prostate, and colorectal cancer rates are lower in this patient population. Because these tumors are often screen-detected, these inverse associations could be driven by HIV-related differences in utilization of cancer screening. Methods We ascertained incident breast, prostate, and colorectal cancer in PLWHA using data from the HIV/AIDS Cancer Match Study (1996-2012). Comparisons with general population cancer rates were made using standardized incidence ratios (SIRs), overall and stratified by tumor stage/size, breast cancer estrogen receptor status, and colorectal site. We also examined the potential effect of study design and unmeasured confounding on inverse standardized incidence ratios. Results Compared with the general population, PLWHA had lower rates of invasive breast (SIR = 0.63, 95% confidence interval [CI] = 0.58 to 0.68), prostate (SIR = 0.48, 95% CI = 0.46 to 0.51), proximal colon (SIR = 0.67, 95% CI = 0.59 to 0.75), distal colon (SIR = 0.51, 95% CI = 0.43 to 0.59), and rectal cancers (SIR = 0.69, 95% CI = 0.61 to 0.77). Reduced risk persisted across tumor stage/size for prostate and colorectal cancers. Although distant-stage breast cancer rates were not reduced (SIR = 0.94, 95% CI = 0.73 to 1.20), HIV-infected women had lower rates of large (>5 cm) breast tumors (SIR = 0.65, 95% CI = 0.50 to 0.83). The magnitude of these inverse standardized incidence ratios could not plausibly be attributed to case underascertainment, out-migration, or unmeasured confounding. Conclusions Breast, prostate, and colorectal cancer rates are markedly lower among PLWHA, including rates of distant-stage/large tumors that are not generally screen-detected. This set of inverse HIV-cancer associations is therefore unlikely to be due primarily to differential screening and may instead represent biological relationships requiring future investigation.
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Affiliation(s)
- Anna E Coghill
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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Smith AJB, Varma S, Rositch AF, Levinson K. Gynecologic cancer in HIV-positive women: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221:194-207.e5. [PMID: 30771344 DOI: 10.1016/j.ajog.2019.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/17/2019] [Accepted: 02/07/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND While there is a significant body of literature on cervical cancer in HIV-positive women, little is known about other gynecologic cancers in this population. OBJECTIVE The objective of this systematic review and meta-analysis is to describe the incidence, presentation, treatment, and outcomes for HIV-positive women with non-acquired immunodeficiency syndrome-defining gynecologic cancers. STUDY DESIGN We searched MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for English-language studies published from 2000 to May 1, 2017. Studies containing 1 or more HIV-positive women with endometrial, ovarian, or vulvovaginal cancer and reporting incidence, treatment regimen, or survival were included. Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality (details of the review protocol were registered as PROSPERO-CRD42017064525). Pooled estimates of incidence were calculated using random-effects models. Pooled estimates of cancer presentation and outcomes were averaged from case studies. RESULTS Of 5744 abstracts screened, we identified 70 articles on 58 studies on 292,202 women with HIV and 528 women with HIV and gynecologic cancer for inclusion. Most articles (53%) focused on incidence, and only 3, 4, and 20 articles focused on treatment and outcomes of endometrial, ovarian, and vulvovaginal cancers, respectively. The standardized incidence ratios for endometrial, ovarian, and vulvovaginal cancers were 4.38 (95% confidence interval 0.26-8.49) for endometrial cancer, 3.21 (95% confidence interval 2.29-4.13) for ovarian cancer, and 21.93 (95% confidence interval 13.50-30.35) for vulvovaginal cancer. Fifty-seven percent of women were diagnosed at an early stage, and all received cancer treatment. CONCLUSION In women with HIV, the incidence of ovarian and vulvovaginal cancer were higher than the general population, while incidence of endometrial cancer was similar. However, there was a paucity of data on treatment and outcomes for non-acquired immunodeficiency syndrome-defining gynecologic cancers. Given the increased incidence of gynecologic cancer, specific research on this population is essential to improve treatment and outcomes for HIV-positive women.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sanskriti Varma
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kimberly Levinson
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
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13
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Corrigan KL, Wall KC, Bartlett JA, Suneja G. Cancer disparities in people with HIV: A systematic review of screening for non-AIDS-defining malignancies. Cancer 2019; 125:843-853. [PMID: 30645766 DOI: 10.1002/cncr.31838] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/01/2018] [Accepted: 07/23/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with HIV (PWHIV) have improved survival because of the advent of antiretroviral therapy. Consequently, PWHIV experience higher rates of non-acquired immunodeficiency syndrome-defining malignancies (NADMs). Previous studies have demonstrated worsened cancer-specific survival in PWHIV, partly because of advanced cancer stage at diagnosis. The objective of the current systematic review was to evaluate screening disparities for NADMs among PWHIV. METHODS The PubMed, Cochrane, EMBASE, and ClinicalTrials.gov databases were searched from January 1, 1996 through April 10, 2018 to identify studies related to screening disparities for NADMs among PWHIV. Eligibility criteria included any study performed in a high-income country that compared screening for NADMs by HIV status. After title/abstract screening and full-text review, articles that met eligibility criteria were analyzed. RESULTS Of 613 unique articles identified through the search, 9 studies were analyzed. Three studies addressed breast cancer screening, 4 addressed colorectal cancer screening, and 2 addressed prostate cancer screening. Five of the reviewed studies demonstrated that PWHIV were less likely to receive indicated cancer screenings compared with the general population, whereas 3 indicated that screening proportions were higher among PWHIV, and 1 demonstrated that screening proportions were comparable. In most of the studies, PWHIV who had regular access to health care were more likely to undergo cancer screening. CONCLUSIONS The available evidence does not uniformly confirm that PWHIV are less likely to receive cancer screening. Social determinants of health (insurance status, access to health care, education, income level) were associated with the receipt of appropriate cancer screening, suggesting that these barriers need to be addressed to improve cancer screening in PWHIV.
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Affiliation(s)
| | - Kevin C Wall
- Duke University School of Medicine, Durham, North Carolina
| | - John A Bartlett
- Division of Infectious Disease, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Global Health Institute, Durham, North Carolina
| | - Gita Suneja
- Duke Global Health Institute, Durham, North Carolina.,Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
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14
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Chirkut S. Breast cancer, human immunodeficiency virus and highly active antiretroviral treatment; implications for a high-rate seropositive region. Oncol Rev 2019; 13:376. [PMID: 30713605 PMCID: PMC6335972 DOI: 10.4081/oncol.2019.376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Sub-Saharan Africa is the region in the world with the most people infected with the human immunodeficiency virus (HIV). The incidence of breast cancer is also rising in the region. This transcript focusses on the burden of these two diseases when they converge in the same populace. This comprehensive literature review of the topic suggests a trend towards an increasing incidence of breast cancer in the HIV-infected population, and the rationale for such a tendency is hypothesized, especially in the context of the availability of highly active antiretroviral therapy. Besides the age at diagnosis, all other clinical characteristics appear to be similar in HIV-positive and HIV-negative breast cancer populations. Outcomes of the different treatment modalities for breast cancer in HIV-positive patients are also appraised and finally innovative areas of future research are suggested along with plausible recommendations.
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Affiliation(s)
- Subash Chirkut
- King Edward VIII Hospital, Durban; Department of General Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal (UKZN), South Africa
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15
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Abstract
OBJECTIVE To evaluate gynecologic cancer treatments in HIV-infected women for adherence to National Comprehensive Cancer Network (NCCN) guidelines and to describe survival by adherence to guidelines. DESIGN Beyond cervical cancer, there are little data on treatment and outcomes for these women. This is a retrospective cohort study of HIV-infected women with gynecologic cancers. METHODS HIV-infected women with gynecologic cancers from 2000 to 2015 were identified at two urban, comprehensive cancer centers. Chart reviews extracted demographic, HIV, and cancer-related variables. Cancer treatment was evaluated for adherence to NCCN guidelines. Overall survival was compared between those who received NCCN adherent and nonadherent cancer care. RESULTS Fifty-seven women were identified; 15 vulvar (26%), 26 cervical (46%), nine ovarian (16%), and seven endometrial (12%) cancers. Median time from HIV to cancer diagnosis was 8.5 years, and 88% of women were black. Thirty patients (53%) had stage I, and 27 (47%) had stage II-IV disease. Overall, 28 women (49%) received NCCN-adherent care; 22 of 30 stage I (73%) and six of 27 stage II-IV patients (22%). Among 29 women not receiving NCCN-adherent care, 69% were due to patient-related factors or toxicity. Among women with II-IV cancers, 48-month survival was higher in women who received NCCN-adherent care than those who did not (60 versus 28%). CONCLUSION Most HIV-infected women with advanced gynecologic cancers did not receive NCCN-adherent care and had worse survival compared to those who did. Focus on treatment-related toxicities and patient-related barriers to cancer care are necessary in this population.
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16
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Aboulafia DM. Cancer screening in women living with HIV infection. WOMEN'S HEALTH (LONDON, ENGLAND) 2017; 13:68-79. [PMID: 28952428 PMCID: PMC7789029 DOI: 10.1177/1745505717731970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/04/2017] [Accepted: 08/11/2017] [Indexed: 12/18/2022]
Abstract
The number of women living with HIV continues to increase. Thirty years into the AIDS epidemic, we now expect those with access to highly active antiretroviral to survive into their seventh decade of life or beyond. Increasingly, the focus of HIV care is evolving from preventing opportunistic infections and treating AIDS-defining malignancies to strategies that promote longevity. This holistic approach to care includes detection of malignancies that are associated with certain viral infections, with chronic inflammation, and with lifestyle choices. The decision to screen an HIV-infected women for cancer should include an appreciation of the individualized risk of cancer, her life expectancy, and an attempt to balance these concerns with the harms and benefits associated with specific cancer screening tests and their potential outcome. Here, we review cancer screening strategies for women living with HIV/AIDS with a focus on cancers of the lung, breast, cervix, anus, and liver.
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Affiliation(s)
- David M Aboulafia
- Floyd & Delores Jones Cancer
Institute at Virginia Mason Medical Center, Seattle, WA, USA
- Division of Hematology, University of
Washington, Seattle, WA, USA
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Trepka MJ, Auf R, Fennie KP, Sheehan DM, Maddox LM, Niyonsenga T. Deaths Due to Screenable Cancers Among People Living With HIV Infection, Florida, 2000-2014. Am J Prev Med 2017; 53:705-709. [PMID: 28751055 PMCID: PMC5650938 DOI: 10.1016/j.amepre.2017.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/27/2017] [Accepted: 05/22/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Because of antiretroviral therapy, people living with HIV infection are surviving longer and are at higher risk for chronic diseases. This study's objective was to assess the magnitude of deaths due to cancers for which there are screening recommendations for people living with HIV in Florida. METHODS Florida Department of Health Enhanced HIV/AIDS Reporting System data were matched with Department of Health Vital Records and the National Death Index to identify deaths and their causes through 2014. The sex-specific and cause-specific mortality rates and indirect standardized mortality ratios (SMRs, using U.S. mortality rates as a standard) were calculated during 2016 for people reported with HIV infection 2000-2014. RESULTS Despite the competing risk of HIV mortality, among the 25,678 females, there was a higher risk of cervical (SMR=6.32, 95% CI=4.63, 8.44), colorectal (SMR=2.05, 95% CI=1.44, 2.83), liver (SMR=8.96, 95% CI=5.39, 14.03), and lung (SMR=5.82, 95% CI=4.80, 6.96) cancer mortality and lower risk of breast cancer mortality (SMR=0.57, 95% CI=0.42, 0.76). Among 63,493 males, there was a higher risk of liver (SMR=5.50, 95% CI=4.47, 6.70) and lung (4.63, 95% CI=4.11, 5.19) cancer mortality. Among males, the lung cancer SMR significantly declined 2000-2014 (p<0.05), but was still high in 2012-2014 (SMR=3.59, 95% CI=2.87, 4.43). CONCLUSIONS These results indicate the importance of primary and secondary cancer prevention during primary care for people living with HIV infection.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida.
| | - Rehab Auf
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Lorene M Maddox
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, Florida
| | - Theophile Niyonsenga
- School of Population Health, University of South Australia, Adelaide, South Australia, Australia
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Caccuri F, Giordano F, Barone I, Mazzuca P, Giagulli C, Andò S, Caruso A, Marsico S. HIV-1 matrix protein p17 and its variants promote human triple negative breast cancer cell aggressiveness. Infect Agent Cancer 2017; 12:49. [PMID: 29021819 PMCID: PMC5613317 DOI: 10.1186/s13027-017-0160-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022] Open
Abstract
Background The introduction of cART has changed the morbidity and mortality patterns affecting HIV-infected (HIV+) individuals. The risk of breast cancer in HIV+ patients has now approached the general population risk. However, breast cancer has a more aggressive clinical course and poorer outcome in HIV+ patients than in general population, without correlation with the CD4 or virus particles count. These findings suggest a likely influence of HIV-1 proteins on breast cancer aggressiveness and progression. The HIV-1 matrix protein (p17) is expressed in different tissues and organs of successfully cART-treated patients and promotes migration of different cells. Variants of p17 (vp17s), characterized by mutations and amino acid insertions, differently from the prototype p17 (refp17), also promote B-cell proliferation and transformation. Methods Wound-healing assay, matrigel-based invasion assay, and anchorage-independent proliferation assay were employed to compare the biological activity exerted by refp17 and three different vp17s on the triple-negative human breast cancer cell line MDA-MB 231. Intracellular signaling was investigated by western blot analysis. Results Motility and invasiveness increased in cells treated with both refp17 and vp17s compared to untreated cells. The effects of the viral proteins were mediated by binding to the chemokine receptor CXCR2 and activation of the ERK1/2 signaling pathway. However, vp17s promoted MDA-MB 231 cell growth and proliferation in contrast to refp17-treated or not treated cells. Conclusions In the context of the emerging role of the microenvironment in promoting and supporting cancer cell growth and metastatic spreading, here we provide the first evidence that exogenous p17 may play a crucial role in sustaining breast cancer cell migration and invasiveness, whereas some p17 variants may also be involved in cancer cell growth and proliferation.
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Affiliation(s)
- Francesca Caccuri
- Section of Microbiology, Department of Molecular and Translational Medicine, University of Brescia , Brescia, Italy
| | - Francesca Giordano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Italy
| | - Ines Barone
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Italy
| | - Pietro Mazzuca
- Section of Microbiology, Department of Molecular and Translational Medicine, University of Brescia , Brescia, Italy
| | - Cinzia Giagulli
- Section of Microbiology, Department of Molecular and Translational Medicine, University of Brescia , Brescia, Italy
| | - Sebastiano Andò
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Italy
| | - Arnaldo Caruso
- Section of Microbiology, Department of Molecular and Translational Medicine, University of Brescia , Brescia, Italy
| | - Stefania Marsico
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Italy
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Cubasch H, Ruff P, Joffe M, Norris S, Chirwa T, Nietz S, Sharma V, Duarte R, Buccimazza I, Čačala S, Stopforth LW, Tsai WY, Stavsky E, Crew KD, Jacobson JS, Neugut AI. South African Breast Cancer and HIV Outcomes Study: Methods and Baseline Assessment. J Glob Oncol 2017; 3:114-124. [PMID: 28706996 PMCID: PMC5493271 DOI: 10.1200/jgo.2015.002675] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose In low- and middle-income, HIV-endemic regions of sub-Saharan Africa, morbidity and mortality from the common epithelial cancers of the developed world are rising. Even among HIV-infected individuals, access to antiretroviral therapy has enhanced life expectancy, shifting the distribution of cancer diagnoses toward non–AIDS-defining malignancies, including breast cancer. Building on our prior research, we recently initiated the South African Breast Cancer and HIV Outcomes study. Methods We will recruit a cohort of 3,000 women newly diagnosed with breast cancer at hospitals in high (average, 20%) HIV prevalence areas, in Johannesburg, Durban, Pietermaritzburg, and Empangeni. At baseline, we will collect information on demographic, behavioral, clinical, and other factors related to access to health care. Every 3 months in year 1 and every 6 months thereafter, we will collect interview and chart data on treatment, symptoms, cancer progression, comorbidities, and other factors. We will compare survival rates of HIV-infected and uninfected women with newly diagnosed breast cancer and their likelihood of receiving suboptimal anticancer therapy. We will identify determinants of suboptimal therapy and context-specific modifiable factors that future interventions can target to improve outcomes. We will explore molecular mechanisms underlying potentially aggressive breast cancer in both HIV-infected and uninfected patients, as well as the roles of pathogens, states of immune activation, and inflammation in disease progression. Conclusion Our goals are to contribute to development of evidence-based guidelines for the management of breast cancer in HIV-positive women and to improve outcomes for all patients with breast cancer in resource-constrained settings.
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Affiliation(s)
- Herbert Cubasch
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Paul Ruff
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Maureen Joffe
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Shane Norris
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Tobias Chirwa
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Sarah Nietz
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Vinay Sharma
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Raquel Duarte
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Ines Buccimazza
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Sharon Čačala
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Laura W Stopforth
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Wei-Yann Tsai
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Eliezer Stavsky
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Katherine D Crew
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Judith S Jacobson
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
| | - Alfred I Neugut
- Herbert Cubasch, Sarah Nietz, Paul Ruff, Maureen Joffe, Shane Norris, Tobias Chirwa, Vinay Sharma, and Raquel Duarte, University of the Witwatersrand; Sarah Nietz, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg; Herbert Cubasch and Vinay Sharma, Chris Hani Baragwanath Academic Hospital, Soweto; Ines Buccimazza, University of KwaZulu-Natal; Ines Buccimazza, Inkosi Albert Luthuli Central Hospital, Durban; Sharon Čačala and Laura W. Stopforth, Grey's Hospital, Pietermaritzburg, South Africa; and Wei-Yann Tsai, Eliezer Stavsky, Katherine D. Crew, Judith S. Jacobson, and Alfred I. Neugut, Columbia University, New York, NY
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20
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Abstract
PURPOSE OF REVIEW To review current knowledge of different cancer states affecting women with HIV infection. RECENT FINDINGS With improved survival of persons with HIV in the post-cART era, the landscape of malignancies in this population has greatly changed with fewer AIDS-defining malignancies (ADM) and a growing number of non-AIDS defining malignancies (NADM). Women, however, continue to represent a vulnerable population at risk for certain ADM and NADM such as cervical, anal, and breast cancer. Human papillomavirus-mediated cancers disproportionately burden women in resource-poor settings such as sub-Saharan Africa. For cancers such as Kaposi's sarcoma, lung cancer, liver cancer, and colorectal cancer, women share a lower burden of disease compared with their male counterparts. However, there remains a dearth of evidence characterizing these disease states specifically among women. SUMMARY Cancer in women with HIV continues to be a major source of morbidity and mortality worldwide, especially in low-income countries. Screening strategies, primary prevention through vaccination against human papillomavirus and viral hepatitis, and treatment for HIV with combined antiviral therapy remain cornerstones in cancer prevention.
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Affiliation(s)
- Nora T. Oliver
- Department of Medicine, Section of Infectious Diseases, Atlanta VA Medical Center, Decatur, GA
| | - Elizabeth Y. Chiao
- Department of Medicine, Section of Infectious Diseases and Health Services Research, Baylor College of Medicine, Houston, TX
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21
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Ruiz M, Davis H. Breast Cancer in HIV-Infected Patients: A Retrospective Single-Institution Study. ACTA ACUST UNITED AC 2016; 10:30-4. [PMID: 21368012 DOI: 10.1177/1545109710385002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Breast cancer in HIV-positive patients has been reported in some retrospective studies and outcomes are mixed. This paper reviews the experience of an urban HIV outpatient clinic serving with patients infected with HIV infection. METHODS A retrospective study from 2002-2010 was conducted on a total of 2,060 patients with HIV (1361 M, 699 F) who were evaluated and treated in the HIV Outpatient Program clinic at the Medical Center of Louisiana in New Orleans as of March 2010. RESULTS A total of 5 patients were identified. Their average age was 45.6, and 100% were African American. Their average CD4 counts before and after diagnosis of breast cancer were 333 cells/mm(3) and 353.3 cells/mL, respectively. The average number of years with HIV infection was 8.8. The average body mass index (BMI) was 24.8. Eighty (80%) were intraductal carcinoma and 20% were inflammatory cancers. The average survival time for all patients was 5.2 years. DISCUSSION The frequency of breast cancer in our population is low. We did not find any relationship among immunosuppression, obesity, and development of breast cancer. More studies are needed to elucidate the impact of HIV infection in the biology of breast cancer.
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Affiliation(s)
- Marco Ruiz
- Louisiana State University, Health Sciences Center in New Orleans, Department of Medicine, Section of Infectious Diseases, Section of Geriatric Medicine, New Orleans, LA, USA,
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22
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Weinstein ZM, Battaglia TA, Baranoski AS. Factors Associated with Adherence to Routine Screening Mammography in HIV-Infected Women. J Womens Health (Larchmt) 2016; 25:473-9. [PMID: 27168388 DOI: 10.1089/jwh.2015.5430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Both HIV-infected women and minority women have historically lower rates of screening mammography. The objective of this study was to identify factors related to adherence to routine screening mammography in a diverse inner-city cohort of HIV-infected women, to inform future work on targeted interventions to address disparities. MATERIALS AND METHODS This retrospective cohort study reviewed the electronic medical record of HIV-infected women aged 40 and older engaged in care between October 1, 2003 and March 31, 2008 at a large urban safety-net HIV clinic. Analyses included chi square testing and multivariate logistic regression to assess for patient-specific factors associated with adherence to breast cancer screening, defined as obtaining a screening mammogram within 2 years of engaging in care. RESULTS The 292 women were a racially diverse group, with 70% black, 11% Hispanic, and 42% foreign born. There was suboptimal HIV control, with only 33% having an undetectable viral load (VL). One hundred forty-six (50%) were adherent to screening mammography. In multivariate analysis, women who were foreign born (OR 2.65 [CI 1.52-4.64]) had not completed high school (OR 1.77 [CI 1.06-2.95]) or had an undetectable VL (OR 2.51 [CI 1.44-4.40]) had increased odds of obtaining a mammogram. CONCLUSIONS Among a racially diverse urban population of HIV-infected women engaged in care, only half had a mammogram. Foreign-born women had higher odds of undergoing mammography, suggesting that nativity status and social determinants of health are under-recognized drivers of adherence in this population. Future programs targeting screening must be mindful of the multiple predictors of adherence.
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Affiliation(s)
- Zoe M Weinstein
- 1 Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine , Boston, Massachusetts
| | - Tracy A Battaglia
- 2 Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine , Boston, Massachusetts
| | - Amy S Baranoski
- 3 Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine , Philadelphia, Pennsylvania
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23
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Brugnaro P, Morelli E, Cattelan F, Petrucci A, Panese S, Eseme F, Cavinato F, Barelli A, Raise E. Non-acquired immunodeficiency syndrome definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era. World J Virol 2015; 4:209-218. [PMID: 26279983 PMCID: PMC4534813 DOI: 10.5501/wjv.v4.i3.209] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/02/2015] [Accepted: 05/28/2015] [Indexed: 02/05/2023] Open
Abstract
Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection has been widely available in industrialized countries since 1996; its widespread use determined a dramatic decline in acquired immunodeficiency syndrome (AIDS)-related mortality, and consequently, a significant decrease of AIDS-defining cancers. However the increased mean age of HIV-infected patients, prolonged exposure to environmental and lifestyle cancer risk factors, and coinfection with oncogenic viruses contributed to the emergence of other malignancies that are considered non-AIDS-defining cancers (NADCs) as a relevant fraction of morbidity and mortality among HIV-infected people twenty years after HAART introduction. The role of immunosuppression in the pathogenesis of NADCs is not well defined, and future researches should investigate the etiology of NADCs. In the last years there is a growing evidence that intensive chemotherapy regimens and radiotherapy could be safely administrated to HIV-positive patients while continuing HAART. This requires a multidisciplinary approach and a close co-operation of oncologists and HIV-physicians in order to best manage compliance of patients to treatment and to face drug-related side effects. Here we review the main epidemiological features, risk factors and clinical behavior of the more common NADCs, such as lung cancer, hepatocellular carcinoma, colorectal cancer and anal cancer, Hodgkin’s lymphoma and some cutaneous malignancies, focusing also on the current therapeutic approaches and preventive screening strategies.
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24
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Salters KA, Cescon A, Zhang W, Ogilvie G, Murray MCM, Coldman A, Hamm J, Chiu CG, Montaner JSG, Wiseman SM, Money D, Pick N, Hogg RS. Cancer incidence among HIV-positive women in British Columbia, Canada: Heightened risk of virus-related malignancies. HIV Med 2015; 17:188-95. [PMID: 26268461 DOI: 10.1111/hiv.12290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We used population-based data to identify incident cancer cases and correlates of cancer among women living with HIV/AIDS in British Columbia (BC), Canada between 1994 and 2008. METHODS Data were obtained from a retrospective population-based cohort created from linkage of two province-wide databases: (1) the database of the BC Cancer Agency, a province-wide population-based cancer registry, and (2) a database managed by the BC Centre for Excellence in HIV/AIDS, which contains data on all persons treated with antiretroviral therapy in BC. This analysis included women (≥ 19 years old) living with HIV in BC, Canada. Incident cancer diagnoses that occurred after highly active antiretroviral therapy (HAART) initiation were included. We obtained a general population comparison of cancer incidence among women from the BC Cancer Agency. Bivariate analysis (Pearson χ(2) , Fisher's exact or Wilcoxon rank-sum test) compared women with and without incident cancer across relevant clinical and sociodemographic variables. Standardized incidence ratios (SIRs) were calculated for selected cancers compared with the general population sample. RESULTS We identified 2211 women with 12 529 person-years (PY) of follow-up who were at risk of developing cancer after HAART initiation. A total of 77 incident cancers (615/100 000 PY) were identified between 1994 and 2008. HIV-positive women with cancer, in comparison to the general population sample, were more likely to be diagnosed with invasive cervical cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma and Kaposi's sarcoma and less likely to be diagnosed with cancers of the digestive system. CONCLUSIONS This study observed elevated rates of cancer among HIV-positive women compared to a general population sample. HIV-positive women may have an increased risk for cancers of viral-related pathogenesis.
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Affiliation(s)
- K A Salters
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - A Cescon
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Northern Ontario School of Medicine, Sudbury, Canada
| | - W Zhang
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - G Ogilvie
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Centre for Disease Control, Vancouver, Canada
| | - M C M Murray
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Women's Hospital and Health Centre, Vancouver, Canada.,Women's Health Research Institute, Vancouver, Canada
| | | | - J Hamm
- BC Cancer Agency, Vancouver, Canada
| | - C G Chiu
- Department of Surgery, St Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - J S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - S M Wiseman
- Department of Surgery, St Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - D Money
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Women's Hospital and Health Centre, Vancouver, Canada.,Women's Health Research Institute, Vancouver, Canada
| | - N Pick
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Women's Hospital and Health Centre, Vancouver, Canada.,Women's Health Research Institute, Vancouver, Canada
| | - R S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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25
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Traore B, Diane S, Sow MS, Keita M, Conde M, Traore FA, Kourouma T. [HIV infection in patients with breast cancer in Guinea (West Africa)]. Pan Afr Med J 2015; 21:261. [PMID: 26523196 PMCID: PMC4607795 DOI: 10.11604/pamj.2015.21.261.7146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 07/23/2015] [Indexed: 11/11/2022] Open
Abstract
L'objectif était de déterminer la prévalence de l'infection à VIH chez les patientes atteintes de cancer du sein et de comparer les caractéristiques anatomocliques et thérapeutiques de ces cancers du sein par rapports aux patientes non infectées par le VIH. Il s'agissait d'une étude rétrospective et analytique comparant les dossiers de patientes atteintes de cancers du sein histologiquement confirmés, infectées ou non par le VIH à l'unité de chirurgie oncologique de Donka, CHU de Conakry, de 2007 à 2012. Nous avons colligé 278 patientes présentant un cancer du sein dont 14 (5,0%) infectées par le VIH et 264 (95,0%) non infectées par le VIH. Les différences observées entre ces deux groupes de patientes étaient respectivement: âge médian (36,8 vs 49,0 ans), la ménopause (21,4% vs 53,4%), le nombre des patientes traitées (50,0% contre 77,1%) et la survenue de décès (78,6% vs 50,8%). Aucune différence n'a été notée dans la présentation clinique, histologique et le retard de consultation. Dans notre étude, la prévalence de l'infection à VIH chez les patients atteints de cancer du sein est élevée. L’âge jeune des patients, la faible accessibilité au traitement et la mortalité élevée doivent être confirmés par une étude sur un échantillon plus large.
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Affiliation(s)
- Bangaly Traore
- Unité de Chirurgie Oncologique de Donka, CHU de Conakry, Guinée
| | - Solomana Diane
- Unité de Chirurgie Oncologique de Donka, CHU de Conakry, Guinée
| | - Mamadou Saliou Sow
- Service des Maladies Infectieuses et Tropicales de Donka, CHU de Conakry, Guinée
| | - Mamady Keita
- Unité de Chirurgie Oncologique de Donka, CHU de Conakry, Guinée
| | - Mamoudou Conde
- Unité de Chirurgie Oncologique de Donka, CHU de Conakry, Guinée
| | - Fodé Amara Traore
- Service des Maladies Infectieuses et Tropicales de Donka, CHU de Conakry, Guinée
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26
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Sathekge M, Maes A, Van de Wiele C, Dadachova E. Effect of AIDS on women who have sex-determined health issues. Semin Nucl Med 2015; 44:489-98. [PMID: 25362238 DOI: 10.1053/j.semnuclmed.2014.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Worldwide, women account for a growing percentage of human immunodeficiency virus (HIV)-infected patients and more than half of all HIV infections. For many years, morphologic imaging methods were the main approaches employed to investigate HIV and its complications. However, during the past decade, advancements in PET and SPECT imaging technologies opened new possibilities for improved understanding of the pathophysiological processes in HIV. Diagnosis of early HIV-associated neurocognitive disorders (HAND) is important, as many of its symptoms can be caused by other conditions common to people with HIV/AIDS. Presently, there are no PET and SPECT tracers or combination of markers for HAND, hence novel HAND-specific tracers are needed if nuclear medicine is to play a role in solving the problem of the HAND "epidemic." As both highly active antiretroviral therapy (HAART)-induced lipoatrophy and cardiovascular diseases are characterized by ongoing inflammation, FDG-PET/CT imaging may represent an important imaging technique for better understanding the metabolic risk in HIV-infected women on HAART. HIV-infected women are at increased risk for the development of human papilloma virus-associated neoplasms such as cervical and anal carcinomas; these aggressive tumors could be treated better with integration of FDG-PET as part of the standard pretreatment workup. A similar value of FDG-PET may be realized in women with HIV-associated Kaposi sarcoma, as they have more extensive cutaneous disease than men do. In the era of HAART, the incidence and local invasiveness of breast cancer may change, thus creating a need to redefine the pathophysiology of breast cancer in HIV-positive women. Finally, mammary tuberculosis, occasionally the presenting symptom in HIV-infected women, may present with nonspecific clinical, radiological, and histologic findings. In these women, FDG-PET can be of value to detect the lesion for a representative biopsy, staging to exclude pulmonary and other extrapulmonary lesions, and also for therapy monitoring.
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Affiliation(s)
- Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa.
| | - Alex Maes
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa; Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium; Department of Morphology and Medical Imaging, University Hospital Leuven, Leuven, Belgium
| | - Christophe Van de Wiele
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa; Department of Nuclear Medicine and Radiology, University of Ghent, Ghent, Belgium
| | - Ekaterina Dadachova
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa; Department of Radiology, Albert Einstein College of Medicine, Bronx, NY
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27
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Abstract
HIV infection is related to an increased risk of cancer compared with general population, both AIDS-defining cancers (Kaposi's sarcoma, non Hodgkin's lymphoma, invasive cervical cancer) and non-AIDS-defining cancers. Although the advent of the highly active antiretroviral therapy era has decreased the Kaposi's sarcoma and non-Hodgkin's lymphoma incidences, non-AIDS-defining malignancies, such as lung cancer, hepatocarcinoma, anal cancer and skin cancers, remain a major cause of morbidity and death in the HIV-infected population. The clinical presentation is often different between the infected and non-infected populations, often with a more advanced stage at diagnosis, a more aggressive pathology, and associated morbidities like immunosuppression, leading to poorer outcomes. Numerous studies have focused on HIV-related malignancies' treatment, however specific guidelines are still missing. Practitioners have to be careful with interactions between antiretroviral and antineoplastic drugs, particularly through the cytochrome P 450. Because of this, a national multidisciplinary approach, "Cancer and HIV, " was started in 2013 thanks to the National Institute of Cancer (INCa). The aim of this review is to present a scientific update about AIDS-and non-AIDS-defining malignancies, both in their clinical aspects and regarding their specific therapeutic management.
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28
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Chen CH, Chung CY, Wang LH, Lin C, Lin HL, Lin HC. Risk of cancer among HIV-infected patients from a population-based nested case-control study: implications for cancer prevention. BMC Cancer 2015; 15:133. [PMID: 25885746 PMCID: PMC4369071 DOI: 10.1186/s12885-015-1099-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/20/2015] [Indexed: 12/31/2022] Open
Abstract
Background The burden of cancer is likely to increase among the human immunodeficiency virus (HIV)-positive population as it ages due to successful antiretroviral therapy (ART). The purpose of this study was to determine the risk of cancer in HIV-infected patients. Methods This study was a matched nested case–control study. It was performed using the National Health Insurance Research Database of Taiwan. The control group included non–HIV-infected patients matched by sex, age, and year of enrollment. Logistic regression analyses were performed and simultaneously adjusted for potential confounders (income, urbanization, and Charslon index of comorbidity to evaluate HIV infection as an independent risk of cancer. We calculated the overall and sex-specific standardized incidence ratios (SIR) to investigate the pattern of cancer risk and overall cancer risk in the patients with HIV infection. Results Of the 1,115 HIV-infected patients, 104 (9.33%) developed cancer during the 11-year follow-up period. The risk of cancer for patients with HIV infection was significant (adjusted odds ratio = 3.89, 95% confidence interval [CI] = 2.92–5.19) after adjustment for potential confounders. There was a significantly increased risk of developing non-Hodgkin lymphoma (SIR = 25.73, 95% CI = 6.83-90.85), cervical cancer (SIR = 4.01, 95% CI = 1.0-16.06), lymphoma (SIR = 20.26, 95% CI = 5.86-70.10), and respiratory and intrathoracic cancer (SIR = 20.09, 95% CI = 2.34-172.09) compared with the control group. In addition, HIV-infected patients were at significant risk for renal, oral, breast, liver, skin, and colorectal cancer. Conclusions Patients with HIV infection are at increased risk for several specific cancers. Our results support the implementation of an active and accelerated cancer screening schedule for patients with HIV infection to increase their life span.
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Affiliation(s)
- Chang-Hua Chen
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan. .,College of Medicine & Nursing, Hung Kuang University, Taichung City, Taiwan.
| | - Chih-Yuan Chung
- Division of Hematology and Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
| | - Li-Hsuan Wang
- Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan. .,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
| | - Che Lin
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. .,Department of Environmental Engineering, National Chung-Hsing University, Taichung, Taiwan.
| | - Hsiu-Li Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. .,Department of Neurology, General Cathay Hospital, Sijhih Branch, New Taipei City, Taiwan.
| | - Hsiu-Chen Lin
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing Street, 11031, Taipei, Taiwan. .,Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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Abstract
OBJECTIVE Evaluate the risk of female breast cancer associated with HIV-CXCR4 (X4) tropism as determined by various genotypic measures. METHODS A breast cancer case-control study, with pairwise comparisons of tropism determination methods, was conducted. From the Women's Interagency HIV Study repository, one stored plasma specimen was selected from 25 HIV-infected cases near the breast cancer diagnosis date and 75 HIV-infected control women matched for age and calendar date. HIV-gp120 V3 sequences were derived by Sanger population sequencing (PS) and 454-pyro deep sequencing (DS). Sequencing-based HIV-X4 tropism was defined using the geno2pheno algorithm, with both high-stringency DS [false-positive rate (3.5) and 2% X4 cutoff], and lower stringency DS (false-positive rate, 5.75 and 15% X4 cutoff). Concordance of tropism results by PS, DS, and previously performed phenotyping was assessed with kappa (κ) statistics. Case-control comparisons used exact P values and conditional logistic regression. RESULTS In 74 women (19 cases, 55 controls) with complete results, prevalence of HIV-X4 by PS was 5% in cases vs 29% in controls (P = 0.06; odds ratio, 0.14; confidence interval: 0.003 to 1.03). Smaller case-control prevalence differences were found with high-stringency DS (21% vs 36%, P = 0.32), lower stringency DS (16% vs 35%, P = 0.18), and phenotyping (11% vs 31%, P = 0.10). HIV-X4 tropism concordance was best between PS and lower stringency DS (93%, κ = 0.83). Other pairwise concordances were 82%-92% (κ = 0.56-0.81). Concordance was similar among cases and controls. CONCLUSIONS HIV-X4 defined by population sequencing (PS) had good agreement with lower stringency DS and was significantly associated with lower odds of breast cancer.
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Gomez A, Montero AJ, Hurley J. Clinical outcomes in breast cancer patients with HIV/AIDS: a retrospective study. Breast Cancer Res Treat 2015; 149:781-8. [PMID: 25663516 PMCID: PMC7102268 DOI: 10.1007/s10549-015-3275-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/29/2022]
Abstract
The purpose of the study is to describe what is the presentation of breast cancer in women with HIV, their tolerance to therapy, the most common complications of treatment and their outcomes. Retrospective chart review of patients with HIV diagnosed with breast cancer between January 1, 1989 and December 31, 2013 at the University of Miami/Jackson Memorial Hospital (UM/JMH) 47 females and 1 male were included in the analysis. The median age of diagnosis was 46 years (IQR 41–52) and 64 % of the women were premenopausal. Median CD4+ count was 330 cells/µL (IQR 131–589 cells/µL). 41 % had AIDS at time of diagnosis. 94 % of patients presented with locoregional disease and 6 % with late stage breast cancer. 52 % had ER+ tumors. 6 % had HER-2/neu tumor expression and 21 % had triple negative disease. The 5 year PFS was 50 % (95 % CI 34–64 %), the 5 year OS was 44 % (95 % CI 29–58 %), and the Breast cancer-specific survival was 57 % (95 % CI 40–70 %). Death was attributed to breast cancer in 22 patients, AIDS progression in 6 patients, other medical condition in 1, and for 4, the cause was unknown. Serious adverse events were documented in 46 % of patients treated with chemotherapy. Targeted therapy was well tolerated. Patients with HIV/AIDS and breast cancer pose a major challenge for oncologists. Surgery, radiation, and endocrine therapy are well tolerated. Standard dose chemotherapy can have life-threatening side effects which can be managed with growth factor support and antimicrobial prophylaxis. All cancer therapy can be given while continuing with antiviral therapy at full dose.
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Affiliation(s)
- Alexandra Gomez
- Internal Medicine Resident, University of Miami/Jackson Memorial Hospital, 1475 NW 12th Ave, Miami, FL, 33136, USA,
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Robbins HA, Pfeiffer RM, Shiels MS, Li J, Hall HI, Engels EA. Excess cancers among HIV-infected people in the United States. J Natl Cancer Inst 2015; 107:dju503. [PMID: 25663691 DOI: 10.1093/jnci/dju503] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nearly 900 000 people in the United States are living with diagnosed human immunodeficiency virus (HIV) infection and therefore increased cancer risk. The total number of cancers occurring among HIV-infected people and the excess number above expected background cases are unknown. METHODS We derived cancer incidence rates for the United States HIV-infected and general populations from Poisson models applied to linked HIV and cancer registry data and from Surveillance, Epidemiology, and End Results program data, respectively. We applied these rates to estimates of people living with diagnosed HIV at mid-year 2010 to estimate total and expected cancer counts, respectively. We subtracted expected from total cancers to estimate excess cancers. RESULTS An estimated 7760 (95% confidence interval [CI] = 7330 to 8320) cancers occurred in 2010 among HIV-infected people, of which 3920 cancers (95% CI = 3480 to 4470) or 50% (95% CI = 48 to 54%) were in excess of expected. The most common excess cancers were non-Hodgkin's lymphoma (NHL; n = 1440 excess cancers, occurring in 88% excess), Kaposi's sarcoma (KS, n = 910, 100% excess), anal cancer (n = 740, 97% excess), and lung cancer (n = 440, 52% excess). The proportion of excess cancers that were AIDS defining (ie, KS, NHL, cervical cancer) declined with age and time since AIDS diagnosis (both P < .001). For anal cancer, 83% of excess cases occurred among men who have sex with men, and 71% among those living five or more years since AIDS onset. Among injection drug users, 22% of excess cancers were lung cancer, and 16% were liver cancer. CONCLUSIONS The excess cancer burden in the US HIV population is substantial, and patterns across groups highlight opportunities for cancer control initiatives targeted to HIV-infected people.
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Affiliation(s)
- Hilary A Robbins
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HAR, RMP, MSS, EAE); National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA (JL, HIH).Current affiliation: HAR is currently affiliated with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HAR, RMP, MSS, EAE); National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA (JL, HIH).Current affiliation: HAR is currently affiliated with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HAR, RMP, MSS, EAE); National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA (JL, HIH).Current affiliation: HAR is currently affiliated with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jianmin Li
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HAR, RMP, MSS, EAE); National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA (JL, HIH).Current affiliation: HAR is currently affiliated with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - H Irene Hall
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HAR, RMP, MSS, EAE); National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA (JL, HIH).Current affiliation: HAR is currently affiliated with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HAR, RMP, MSS, EAE); National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA (JL, HIH).Current affiliation: HAR is currently affiliated with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Grulich AE, Vajdic CM. The epidemiology of cancers in human immunodeficiency virus infection and after organ transplantation. Semin Oncol 2014; 42:247-57. [PMID: 25843729 DOI: 10.1053/j.seminoncol.2014.12.029] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The authors provide an update on the association between immune deficiency and cancer risk in people with human immunodeficiency virus (HIV) and in solid organ transplant recipients. Over the past decade, it has become clear that a wider range of about 20 mostly infection-related cancers occur at increased rates in people with immune deficiency. The human herpes virus 8 (HHV8) and Epstein Barr Virus (EBV)-related cancers of Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) are most closely related to level of immune deficiency. Transplant recipients also have a greatly increased risk of squamous cell carcinoma (SCC) of the skin, related to direct carcinogenic effects of the pharmaceuticals used for immune suppression. For those three cancer types, the increased cancer risk is largely reversed when immune deficiency is decreased by treatment of HIV or by reduction of iatrogenic immune suppression. Other infection-related cancers also occur at increased rates, but it is not clear whether reduction of immune deficiency reduces cancer risk. Prostate and breast cancer do not occur at increased rates, providing strong evidence that these cancers are unlikely to be related to infection. Epidemiological and clinical trends in these two populations have led to substantial recent changes in cancer occurrence.
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Affiliation(s)
- Andrew E Grulich
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Claire M Vajdic
- Adult Cancer Program, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Hessamfar M, Colin C, Bruyand M, Decoin M, Bonnet F, Mercié P, Neau D, Cazanave C, Pellegrin JL, Dabis F, Morlat P, Chêne G. Severe morbidity according to sex in the era of combined antiretroviral therapy: the ANRS CO3 Aquitaine Cohort. PLoS One 2014; 9:e102671. [PMID: 25076050 PMCID: PMC4116171 DOI: 10.1371/journal.pone.0102671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/22/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To describe trends and determinants of severe morbidity in HIV-infected women and men. DESIGN A French prospective cohort of HIV-infected patients of both sexes and all transmission categories. METHODS We used hospital admission data from January 2000 to December 2008. A severe morbid event (SME) was defined as a clinical event requiring hospitalization for ≥48 h, several events could be reported during hospitalization. Yearly incidence rates of SME were estimated and compared using Generalized Estimating Equations. RESULTS Among 4,987 patients (27% women), followed for a median of 8.7 years, 1,473 (30%) were hospitalized (3,049 hospitalizations for 5,963 SME). The yearly incidence rate of hospitalization decreased in men, from 155 in 2000 to 80/1,000 person-years (PY) in 2008 and in women, from 125 to 71/1,000 PY, (p<0.001). This trend was observed for all SME except for hepatic events, stable in men (15 to 13/1,000 PY) and increasing in women (2.5 to 11.5), cardiovascular events increasing in men (6 to 10/1,000 PY) and in women (6 to 14) and non-AIDS non-hepatic malignancies increasing in men (4 to 7/1,000 PY) and stable in women (2.5). Intraveneous drug users, age >50 years, HIV RNA >10,000 copies, CD4 <500/mm3, AIDS stage, hepatitis C co-infection and cardiovascular risk factors (diabetes, high blood pressure, and tobacco use) were associated with SME. CONCLUSIONS HIV-infected individuals in care in France require less and less frequently hospitalization. Women are now presenting with severe hepatic and cardio-vascular events. Disparities in SME between men and women are primarily explained by different exposure patterns to risk factors. Women should be targeted to benefit cardiovascular prevention policies as well as men.
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Affiliation(s)
- Mojgan Hessamfar
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
| | - Céline Colin
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
| | - Mathias Bruyand
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
| | - Madeleine Decoin
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
| | - Fabrice Bonnet
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
| | - Patrick Mercié
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Immunologie Clinique, Bordeaux, France
| | - Didier Neau
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU de Bordeaux, Fédération des Maladies Infectieuses et Tropicales, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Charles Cazanave
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU de Bordeaux, Fédération des Maladies Infectieuses et Tropicales, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Jean-Luc Pellegrin
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - François Dabis
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
| | - Philippe Morlat
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
| | - Geneviève Chêne
- INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France
- Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France
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Singh SN, Zhu Y, Chumsri S, Kesmodel S, Gilliam BL, Riedel DJ. Outcomes and chemotherapy-related toxicity in HIV-infected patients with breast cancer. Clin Breast Cancer 2013; 14:e53-9. [PMID: 24418743 DOI: 10.1016/j.clbc.2013.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 11/14/2013] [Accepted: 11/17/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Sukhwant N Singh
- Department of Medicine, University of Maryland Greenebaum Cancer Center, Baltimore, MD
| | - Yue Zhu
- Department of Surgery, Division of General and Oncologic Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Saranya Chumsri
- Department of Medicine, University of Maryland Greenebaum Cancer Center, Baltimore, MD
| | - Susan Kesmodel
- Department of Surgery, Division of General and Oncologic Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Bruce L Gilliam
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD
| | - David J Riedel
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD.
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Abstract
In the highly active antiretroviral therapy (HAART) era, the incidence of non-AIDS-defining cancers (NADC) has increased and contributes to a growing proportion of mortality in the aging HIV-infected population. The underlying pathogenic mechanisms of increased cancer risk are incompletely understood. Potential contributors include oncogenic effects of the HIV virus, immunosuppression, chronic inflammation and immune activation, exposure to HAART, higher rates of oncogenic viral coinfections and traditional cancer risk factors. HIV-infected patients often present with NADC at younger ages with more aggressive or advanced stage disease. However, when standard cancer therapy is given, treatment outcomes appear similar to the non-HIV population. These facts highlight the importance of clinicians' maintaining a high index of suspicion, performing age-appropriate screening, and optimizing cancer therapy. Development of novel strategies for screening, prevention, and treatment of NADC will be required to reverse these epidemiologic trends and improve the survival of HIV-infected patients.
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Affiliation(s)
- James Cutrell
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9113, USA.
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Caring for women living with HIV: gaps in the evidence. J Int AIDS Soc 2013; 16:18509. [PMID: 24088395 PMCID: PMC3789211 DOI: 10.7448/ias.16.1.18509] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 08/12/2013] [Accepted: 08/15/2013] [Indexed: 02/07/2023] Open
Abstract
Introduction In the management of HIV, women and men generally undergo the same treatment pathway, with gender differences being given limited consideration. This is in spite of accumulating evidence that there are a number of potential differences between women and men which may affect response to treatment, pharmacokinetics, toxicities and coping. There are also notable psychological, behavioural, social and structural factors that may have a unique impact on women living with HIV (WLWH). Despite our increasing knowledge of HIV and advances in treatment, there are significant gaps in the data relating specifically to women. One of the factors contributing to this situation is the under-representation of women in all aspects of HIV clinical research. Furthermore, there are clinical issues unique to women, including gynaecologic and breast diseases, menopause-related factors, contraception and other topics related to women's and sexual health. Methods Using scoping review methodology, articles from the literature from 1980 to 2012 were identified using appropriate MeSH headings reflecting the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. Titles and abstracts were scanned to determine whether they were relevant to non-reproductive health in WLWH, and papers meeting inclusion criteria were reviewed. Results This review summarizes our current knowledge of the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. It suggests that there are a number of gender differences in disease and treatment outcomes, and distinct women-specific issues, such as menopause and co-morbidities, that pose significant challenges to the care of WLWH. Conclusions Based on a review of this evidence, outstanding questions and areas where further studies are required to determine gender differences in the efficacy and safety of treatment and other clinical and psychological issues specifically affecting WLWH have been identified. Well-controlled and adequately powered clinical studies are essential to help provide answers to these questions and to contribute to activities aimed at improving the health and wellbeing of WLWH.
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Abstract
PURPOSE OF REVIEW The growing burden of non-AIDS defining malignancies (non-ADMs) among people living with HIV/AIDS (PLWHA) highlights the need for cancer prevention and early detection. In this article, we propose screening guidelines for non-ADMs in PLWHA. RECENT FINDINGS A number of recent findings may help direct cancer screening guidelines in PLWHA. Screening for lung cancer with low-dose helical chest computerized tomography (LDCT) in the National Lung Screening Trial data demonstrated a decrease in lung cancer and all-cause mortality. Recent studies have demonstrated a favorable experience among PLWHA with liver transplantation. Overdiagnosis is common with breast and prostate cancer screening. Anal cancer rates were substantially higher for HIV-infected MSM, other men and women than for HIV-uninfected individuals. SUMMARY Screening recommendations for the general population can be applied to PLWHA patients for breast, colon and prostate cancer. Screening for lung cancer with LDCT could be considered in PLWHA at risk. American Association for the Study of Liver Diseases screening recommendations with biennial ultrasonography may be applied to at-risk PLWHA for hepatocellular carcinoma. All HIV-infected adults should be offered anal cancer screening as part of clinical care at specialized centres.
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Affiliation(s)
- Deepthi Mani
- Division of Internal Medicine, Multicare Good Samaritan Hospital, Puyallup, WA, USA
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Cubasch H, Joffe M, Hanisch R, Schuz J, Neugut AI, Karstaedt A, Broeze N, van den Berg E, McCormack V, Jacobson JS. Breast cancer characteristics and HIV among 1,092 women in Soweto, South Africa. Breast Cancer Res Treat 2013; 140:177-86. [PMID: 23801159 PMCID: PMC3706733 DOI: 10.1007/s10549-013-2606-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 06/08/2013] [Indexed: 02/16/2023]
Abstract
In the low-income HIV-endemic regions of sub-Saharan Africa, malignancies related to HIV have long been recognized as a major public health problem. However, epithelial malignancies associated with older age, such as breast cancer, are also rising dramatically in those regions. We compared consecutive HIV-positive and -negative black women diagnosed with breast cancer at a large public hospital in Soweto, South Africa, on age, year of diagnosis, stage, grade, and receptor status, and grouped HIV-positive patients by CD4 cell counts. We computed prevalence ratios of the associations of HIV status and CD4 category with stage, grade, receptor status, and among the HIV-positive patients, receipt of ART, controlling for age and year of diagnosis. Of 1,092 patients, 765 were tested for HIV; 151 (19.7 %) tested positive, a prevalence similar to that in the source population. Although, HIV-positive patients were younger than HIV-negative patients (p < 0.001), HIV status was not associated with the tumor characteristics. Thirty-seven women (25.9 %) had CD4 cell counts <200 cells/μl. Patients in that severely immunocompromised group were older than those in the other groups (p = 0.01). This study is the first to analyze the association of HIV with breast cancer in a large sample. Based on similar HIV prevalence in our sample and the population of the hospital's catchment area, clinicians serving HIV-endemic communities should promote routine HIV testing of younger breast cancer patients and immediate treatment of those who test positive, prior to the initiation of chemotherapy. Research is needed on treatment and outcomes given HIV and low CD4 cell count.
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Affiliation(s)
- Herbert Cubasch
- University of the Witwatersrand, Johannesburg, South Africa
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Maureen Joffe
- University of the Witwatersrand, Johannesburg, South Africa
- Wits Health Consortium, Johannesburg, South Africa
| | - Rachel Hanisch
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, 69008 France
| | - Joachim Schuz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, 69008 France
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, Room 732, New York, NY 10032 USA
| | - Alan Karstaedt
- University of the Witwatersrand, Johannesburg, South Africa
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Nadine Broeze
- University of the Witwatersrand, Johannesburg, South Africa
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Eunice van den Berg
- University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, 69008 France
| | - Judith S. Jacobson
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, Room 732, New York, NY 10032 USA
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Shalekoff S, Schramm DB, Lassaunière R, Picton AC, Tiemessen CT. Differences are evident within the CXCR4–CXCL12 axis between ethnically divergent South African populations. Cytokine 2013; 61:792-800. [DOI: 10.1016/j.cyto.2013.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 11/09/2012] [Accepted: 01/01/2013] [Indexed: 01/05/2023]
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Masood S. Characteristics of systemic diseases in the breast: clinical, imaging and pathologic features. ACTA ACUST UNITED AC 2012; 8:593-9. [PMID: 22934732 DOI: 10.2217/whe.12.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite tremendous efforts placed on advances in diagnosis and treatment of the spectrum of breast disease, the impact of systemic diseases on the breast has remained under recognized. Distinction between a variety of benign breast diseases versus those that are manifestations of a systemic disease is critically important for appropriate treatment planning and follow-up of patients. This article is designed to provide an overview of different systemic diseases that can present as a breast lesion. Attempts are made to highlight the significance of the distinction between benign breast disease versus benign conditions that present as the result of a systemic disease. Naturally, distinction between any benign condition versus breast carcinoma is a part of the evaluation process.
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Affiliation(s)
- Shahla Masood
- Department of Pathology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
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Cancer and the 'other' noncommunicable chronic diseases in older people living with HIV/AIDS in resource-limited settings: a challenge to success. AIDS 2012; 26 Suppl 1:S65-75. [PMID: 22781178 DOI: 10.1097/qad.0b013e328355ab72] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE There is considerable research around the morbidity and mortality related to noncommunicable diseases (NCDs), particularly cardiovascular disease and diabetes, among people living with HIV/AIDS (PLWHA) in resource-richer settings. Less is known about the burden and appropriate management of NCDs, particularly 'other' NCDs including cancer, renal, pulmonary, neurocognitive and mental health conditions, among older PLWHA in resource-limited settings (RLSs). We undertook a literature review of these other NCDs to explore what is currently known about them and identify areas of further research. METHODS Systematic literature review of published manuscripts and selected conference abstracts and reports. RESULTS Although there is growing recognition of the importance of these NCDs among the aging population of PLWHA in RLSs, significant gaps remain in understanding the epidemiology and risk factors among older PLWHA in these settings. Even more concerning is the limited available evidence for effective and feasible approaches to prevention, screening and treatment of these conditions. The burden of these NCDs is related to both the aging of the population of PLWHA and an increased risk due to HIV infection, other comorbidities associated with HIV infection or transmission risk and underlying risk factors in the general community. Results from resource-richer settings and RLSs highlight malignancies, neurocognitive and mental health as well as renal disease as the most significant challenges currently and likely to increase in the future. CONCLUSION Although some lessons can be taken from the growing experience with NCDs in older PLWHA in resource-richer settings, additional research is needed to better understand their risk and impact and identify optimal models of care to effectively address this challenge in the areas where the majority of older PLWHA will be receiving care.
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Deeken JF, Tjen-A-Looi A, Rudek MA, Okuliar C, Young M, Little RF, Dezube BJ. The rising challenge of non-AIDS-defining cancers in HIV-infected patients. Clin Infect Dis 2012; 55:1228-35. [PMID: 22776851 DOI: 10.1093/cid/cis613] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Since the advent of HAART, patients with HIV infection have seen a significant improvement in their morbidity, mortality, and life expectancy. The incidence of AIDS-defining illnesses, including AIDS-defining malignancies, has been on the decline. However, deaths due to non-AIDS-defining illnesses have been on the rise. These so-called non-AIDS-defining cancers (NADCs) include cancers of the lung, liver, kidney, anus, head and neck, and skin, as well as Hodgkin's lymphoma. It is poorly understood why this higher rate of NADCs is occurring. The key challenge facing oncologists is how to administer chemotherapy effectively and safely to patients on antiretroviral therapy. The challenge to clinicians caring for HIV-infected patients is to develop and implement effective means to screen, treat, and prevent NADCs in the future. This review presents data on the epidemiology and etiology of NADCs, as well as ongoing research into this evolving aspect of the HIV epidemic.
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Affiliation(s)
- John F Deeken
- Division of Hematology/Oncology, Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007, USA.
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Spano JP, Lanoy E, Mounier N, Katlama C, Costagliola D, Heard I. Breast cancer among HIV infected individuals from the ONCOVIH study, in France: therapeutic implications. Eur J Cancer 2012; 48:3335-41. [PMID: 22766516 DOI: 10.1016/j.ejca.2012.05.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/15/2012] [Accepted: 05/15/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND The cross-sectional ONCOVIH study prospectively enrolled HIV-infected adults and children with newly diagnosed malignancies in France in 2006. METHOD We report the characteristics HIV-infected patients with breast cancer from the ONCOVIH study. Standardised questionnaires included characteristics of HIV infection and malignancy. Survival was estimated using Kaplan-Meier estimates. RESULTS Overall, 21 patients with breast cancer (two men and 19 women) were included with a median age of 43.8 years, (range: 30.1-65.5). At time of tumour diagnosis, the median CD4 count was 384/mm(3) (range: 180-1039) the median duration of known seropositivity 7.7 years (range: 0-20.3); 14 patients were under combined antiretroviral therapy for a median duration of 5.7 years (range: 1.1-10.6), of whom 11 had a controlled viral load (<500 copies/mL). The median tumour size was 1.8 cm (range: 1.0-7.0). In women, 17 (89.5%) had invasive ductal carcinoma, 17 (89.5%) with HER2 negative receptors, 8 (42.1%) with ER+ expression, and 7 (36.8%) with PR+ expression. A majority of women received chemotherapy (73.7%), surgery (68.4%) and radiotherapy (57.9%). Their one-year survival rate was estimated as 77.8% (95%confidence interval (CI): 58.6-97.0%). CONCLUSIONS We discuss the risk of breast cancer in infected patients, and the importance of taking into account the different contributing factors for breast cancer in HIV-infected individuals.
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Affiliation(s)
- Jean-Philippe Spano
- AP-HP, Groupe Hospitalier Pitié-Salpétrière, Département d'Oncologie Médicale du Prof. David Khayat, 47 Boulevard de l'Hôpital, Paris, France.
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[Non-AIDS defining malignancies, or the sleeping giant: an update]. Enferm Infecc Microbiol Clin 2012; 31:319-27. [PMID: 22658412 DOI: 10.1016/j.eimc.2012.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/14/2012] [Accepted: 03/16/2012] [Indexed: 12/25/2022]
Abstract
Non-AIDS defining malignancies (NADM) are a very heterogeneous group of cancers with increasing importance in subjects with HIV infection. They develop in patients that are younger than general population and their clinical manifestations are usually atypical, with higher tumour grades, more aggressive clinical behaviour and metastatic disease. The outcome is poor, with rapid progression, a high rate of relapse, and a poor response to treatment. There are several factors that influence their development: HIV infection, chronic immunosuppression, and co-infection with some oncogenic viruses. The most frequent NADM are those associated with human papillomavirus infection, lung cancer, hepatic cancer, and Hodgkin lymphoma. Their management is based on three essential points: the treatment of the specific malignancy, the use of antiretroviral therapy, and the prophylaxis and treatment of opportunistic infections. The two factors significantly associated with prevention of NADM are a CD4+ lymphocyte count more than 500/mm(3), and an undetectable viral load.
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Goedert JJ, Pfeiffer R, Zhu M, Yang XR, Garcia-Closas M, Lissowska J, Kopp WC. Peripheral blood immunologic phenotype of population-based breast cancer cases and matched controls. Eur J Clin Invest 2012; 42:572-4. [PMID: 22073930 PMCID: PMC3288213 DOI: 10.1111/j.1365-2362.2011.02610.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- James J. Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD
- Corresponding author: James J. Goedert, M.D., 6120 Executive Boulevard, Room 7068, Rockville MD 20852. FAX: 301-402-0817
| | - Ruth Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD
| | - Mingzhu Zhu
- Clinical Support Lab, SAIC-Frederick, Inc., Frederick, MD
| | - Xiaohong R. Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD
| | | | - Jolanta Lissowska
- Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland
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Oliveira Cobucci RN, Saconato H, Lima PH, Rodrigues HM, Prudêncio TL, Junior JE, Giraldo PC, Gonçalves AKDS. Comparative incidence of cancer in HIV-AIDS patients and transplant recipients. Cancer Epidemiol 2012; 36:e69-73. [PMID: 22236649 DOI: 10.1016/j.canep.2011.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/30/2011] [Accepted: 12/04/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Studies have found a relationship between decreased immunity and increased incidence of cancer. METHODS A systematic review of observational studies evaluating the incidence of cancer in both organ recipients and people with HIV/AIDS compared with the general population. Eligible studies were searched up to March 2011 in the following databases: Pubmed, Embase, Scielo, Cancerlit and Google scholar. In this study, the standardized incidence ratios (SIR) of cancer in people with HIV/AIDS and of organ transplant recipients were compared with those found among the general population. RESULTS Twenty-five studies of transplant and HIV-associated cancer risk, involving 866776 people with HIV/AIDS or organ recipients and 21260 new cases of cancer, were included. The risk for the development of new cancer cases was higher among people with HIV/AIDS (SIR=4, IC95% 3.78-4.24) and who received organs (SIR=3.28, IC95% 3.06-3.52) when compared with the general population. CONCLUSION Similar SIR in both immunocompromised populations suggests that the weakened immune system is responsible for the increased risk of new cases of cancer among these groups. Research investments are needed to develop effective cancer prevention strategies in these populations.
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Abstract
Non-AIDS-defining cancers are a rising health concern among HIV-infected patients. Cancer screening is now an important component of health maintenance in HIV clinical practice. The decision to screen an HIV-infected patient for cancer should include an assessment of individualized risk for the particular cancer, life expectancy, and the harms and benefits associated with the screening test and its potential outcome. HIV-infected patients are at enhanced risk of several cancers compared to the general population; anal cancer, hepatocellular carcinoma, Hodgkin's lymphoma, and lung cancer all have good evidence demonstrating an enhanced risk in HIV-infected persons. A number of cancer screening interventions have shown benefit for specific cancers in the general population, but data on the application of these tests to HIV-infected persons are limited. Here we review the epidemiology and background literature relating to cancer screening interventions in HIV-infected persons. We then use these data to inform a conceptual model for evaluating HIV-infected patients for cancer screening.
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Mbulaiteye SM, Bhatia K, Adebamowo C, Sasco AJ. HIV and cancer in Africa: mutual collaboration between HIV and cancer programs may provide timely research and public health data. Infect Agent Cancer 2011; 6:16. [PMID: 22004990 PMCID: PMC3223125 DOI: 10.1186/1750-9378-6-16] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 10/17/2011] [Indexed: 01/02/2023] Open
Abstract
The eruption of Kaposi sarcoma (KS) and aggressive non-Hodgkin lymphoma (NHL) in young homosexual men in 1981 in the West heralded the onset of the human immunodeficiency virus (HIV) infection epidemic, which remains one of the biggest challenges to global public health and science ever. Because KS and NHL were increased >10,000 and 50-600 times, respectively, with HIV, they were designated AIDS defining cancers (ADC). Cervical cancer (CC), increased 5-10 times was also designated as an ADC. A few other cancers are elevated with HIV, including Hodgkin lymphoma (10 times), anal cancer (15-30 times), and lung cancer (4 times) are designated as non-AIDS defining cancers (NADCs). Since 1996 when combination antiretroviral therapy (cART) became widely available in the West, dramatic decreases in HIV mortality have been observed and substantial decrease in the incidence of ADCs. Coincidentally, the burden of NADCs has increased as people with HIV age with chronic HIV infection. The impact of HIV infection on cancer in sub-Saharan Africa, where two thirds of the epidemic is concentrated, remains poorly understood. The few studies conducted indicate that risks for ADCs are also increased, but quantitatively less so than in the West. The risks for many cancers with established viral associations, including liver and nasopharynx, which are found in Africa, do not appear to be increased. These data are limited because of competing mortality, and cancer is under diagnosed, pathological confirmation is rare, and cancer registration not widely practiced. The expansion of access to life-extending cART in sub-Saharan Africa, through programs such as the Global Fund for AIDS, Malaria, and Tuberculosis and the US President's Emergency Program for AIDS Relief (PEPFAR), is leading to dramatic lengthening of life of HIV patients, which will likely influence the spectrum and burden of cancer in patients with HIV. In this paper, we review current literature and explore merits for integrating cancer research in established HIV programs to obtain timely data about the incidence and burden of cancer in HIV-infected persons in Africa.
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Affiliation(s)
- Sam M Mbulaiteye
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD 20852, USA.
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Breast cancer in a cohort of human immunodeficiency virus (HIV)-infected women from Rio de Janeiro, Brazil: a cases series report and an incidence rate estimate. Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70211-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Veljkovic M, Branch DR, Dopsaj V, Veljkovic V, Veljkovic N, Glisic S, Colombatti A. Can natural antibodies to VIP or VIP-like HIV-1 glycoprotein facilitate prevention and supportive treatment of breast cancer? Med Hypotheses 2011; 77:404-8. [PMID: 21684085 DOI: 10.1016/j.mehy.2011.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 05/23/2011] [Accepted: 05/26/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The incidence of non-AIDS-defining cancer is remarkably higher in HIV-infected than in the general population. In contrast, breast cancer risk is significantly reduced in the HIV-infected population. The molecular mechanisms underlying the phenomenon of suppression of breast cancer in the HIV-infected population may serve as a basis for development of a new platform for prevention and treatment of breast cancer. HYPOTHESIS Various evidences indicate that vasoactive intestinal peptide (VIP) plays an important role in growth, and differentiation of breast cancer. We previously showed (i) that natural antibodies recognizing VIP and the gp120-derived peptide NTM significantly contribute to the control of HIV disease progression by suppression of VIP-like activity of HIV-1 gp120 and (ii) that physical exercise stimulates production of these natural antibodies. These findings suggest that natural anti-VIP/NTM antibodies could contribute to a decrease of breast cancer in the HIV-infected population by suppression of VIP, which may play a pro/oncogenic function. Aerobic exercise which stimulates production of anti-VIP/NTM antibodies could be used as prevention and supportive treatment of breast cancer. IMPACT Immunotherapy based on natural anti-VIP/NTM antibodies could serve as an effective adjunct therapy for the treatment of breast cancer. Similarly, aerobic exercise, which stimulates production of these antibodies, should be considered as an inexpensive and safe preventive and supportive breast cancer therapy. Natural anti-VIP/NTM antibodies also represent promising prognostic marker for breast cancer.
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