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Suk-Ouichai C, Coghill AE, Schabath MB, Sanchez JA, Chahoud J, Necchi A, Giuliano AR, Spiess PE. A clinical overview of people living with HIV and genitourinary cancer care. Nat Rev Urol 2024; 21:373-383. [PMID: 38238527 DOI: 10.1038/s41585-023-00846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 06/10/2024]
Abstract
The number of people living with HIV infection has been increasing globally. Administration of antiretroviral therapy is effective in controlling the infection for most patients and, as a consequence, people living with HIV (PLWH) now often have a long life expectancy. However, their risk of developing cancer - most notably virus-related cancers - has been increasing. To date, few studies have assessed the risk of genitourinary cancers in PLWH, and robust scientific data on their treatment-related outcomes are lacking. Previous studies have noted that PLWH are at a reduced risk of prostate cancer; however, low adoption and/or availability of prostate cancer screening among these patients might be confounding the validity of this finding. In genitourinary cancers, advanced stage at diagnosis and reduced cancer-specific mortality have been reported in PLWH. These data likely reflect, at least in part, the inequity of health care access for PLWH. Notably, systemic chemotherapy and/or radiotherapy could decrease total CD4+ cell counts, which could, therefore, increase the risk of morbidity and mortality from cancer treatments in PLWH. Immune checkpoint inhibitors have become the therapeutic backbone for many advanced malignancies in the general population; however, most studies validating their efficacy have excluded PLWH owing to concerns of severe adverse effects from immune checkpoint inhibitors themselves and/or related to their immunosuppressed status. To our knowledge, no genitourinary cancer survivorship programme exists that specifically caters to the needs of PLWH. By including PLWH in ongoing cancer trials, we can gain invaluable insights that will help to improve cancer care specifically for PLWH.
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Affiliation(s)
- Chalairat Suk-Ouichai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anna E Coghill
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Julian A Sanchez
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Andrea Necchi
- Department of Medical Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
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Chawki S, Ploussard G, Montlahuc C, Verine J, Mongiat-Artus P, Desgrandchamps F, Molina JM. Bladder Cancer in HIV-infected Adults: An Emerging Issue? Case-Reports and Systematic Review. PLoS One 2015; 10:e0144237. [PMID: 26642314 PMCID: PMC4671620 DOI: 10.1371/journal.pone.0144237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 11/16/2015] [Indexed: 01/08/2023] Open
Abstract
Objectives Non-AIDS-related malignancies now represent a frequent cause of death among HIV-infected patients. Albeit bladder cancer is one of the most common malignancies worldwide, it has been rarely reported among HIV-infected patients. We wished to assess the prevalence and characteristics of bladder cancer in HIV-infected patients. Methods We conducted a single center retrospective study from 1998 to 2013 in a university hospital in Paris. Cases of bladder cancer among HIV-infected patients were identified using the electronic records of the hospital database and of the HIV-infected cohort. Patient characteristics and outcomes were retrieved from patients charts. A systematic review of published cases of bladder cancers in patients with HIV-infection was also performed. Results During the study period we identified 15 HIV-infected patients (0.2% of the cohort) with a bladder cancer. Patients were mostly men (73%) and smokers (67%), with a median age of 56 years at cancer diagnosis. Bladder cancer was diagnosed a median of 14 years after HIV-infection. Most patients were on ART (86%) with median current and nadir CD4 cell counts of 506 and 195 cells/mm3, respectively. Haematuria (73%) was the most frequent presenting symptom and HPV-associated lesions were seen in 6/10 (60%) patients. Histopathology showed transitional cell carcinoma in 80% and a high proportion of tumors with muscle invasion (47%) and high histologic grade (73%). One-year survival rate was 74.6%. The systematic review identified 13 additional cases of urothelial bladder cancers which shared similar features. Conclusions Bladder cancers in HIV-infected patients remain rare but may occur in relatively young patients with a low nadir CD4 cell count, have aggressive pathological features and can be fatal.
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Affiliation(s)
- Sylvain Chawki
- Department of Infectious Diseases, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
| | - Guillaume Ploussard
- Department of Urology, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
| | - Claire Montlahuc
- Department of Biostatistic and Medical Information, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
| | - Jérome Verine
- Department of Pathology, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
| | - Pierre Mongiat-Artus
- Department of Urology, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
| | - François Desgrandchamps
- Department of Urology, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris Diderot, Paris 7, Sorbonne Paris Cité, Paris, France
- * E-mail:
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Benabdallah JO, Collins CW, Carucci LR, Moore KE, Gater DR, Klausner AP. Aggressive bladder carcinoma in an HIV-positive man with tetraplegia and neurogenic bladder. J Spinal Cord Med 2011; 34:248-50. [PMID: 21675364 PMCID: PMC3066499 DOI: 10.1179/107902610x12883422813705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND/OBJECTIVE Patients with neurogenic bladder secondary to spinal cord injury who are managed long term with an indwelling catheter are known to be at increased risk for transitional cell carcinoma of the bladder. Immunosuppression is a known risk factor for malignancies that often are more aggresSive than those seen in normal populations. METHOD Case report and discussion of management recommendations. RESULTS We summarize the case of a 44-year-old HIV-positive C5-C6 incomplete tetraplegic male (date of injury 1980), who was diagnosed with transitional cell carcinoma of the bladder and succumbed to disease within 6 months of diagnosis. The patient was a non-smoker who was never managed with an indwelling catheter. There has been no such case reported in the literature. CONCLUSIONS HIV infection in the presence of a neurogenic bladder may carry an increased risk of aggressive bladder malignancy. More studies are warranted to determine whether routine annual screening with cystoscopy in all patients with HIV and neurogenic bladder is indicated.
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Affiliation(s)
- Justin O. Benabdallah
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Clinton W. Collins
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Laura R. Carucci
- Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Kenneth E. Moore
- Center for Spinal Cord Injury & Disorders, H.H. McGuire Veterans Affairs Hospital, Richmond, VA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA,Center for Spinal Cord Injury & Disorders, H.H. McGuire Veterans Affairs Hospital, Richmond, VA
| | - Adam P. Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA,Department of Surgery/Division of Urology, H.H. McGuire Veterans Affairs Hospital, Richmond, VA,Correspondence to: Adam P. Klausner, M.D., Associate Professor & Warren W. Koontz Professor of Urologic Research, Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine. P.O. Box 980118, Richmond, VA 23298-0118.
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Dietrich K, Schned A, Fortuny J, Heaney J, Marsit C, Kelsey KT, Karagas MR. Glucocorticoid therapy and risk of bladder cancer. Br J Cancer 2009; 101:1316-20. [PMID: 19773763 PMCID: PMC2768444 DOI: 10.1038/sj.bjc.6605314] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Use of immunosuppressive drugs post organ transplantation, and prolonged use of glucorticoids for other conditions have been associated with subsequent risk of certain malignancies, that is, skin cancers and lymphoma. There is evidence that the incidence of bladder cancer is also elevated among organ transplant recipients, however, it is unknown whether other groups of patients, that is, those taking oral glucocorticoids, likewise are at an increased risk. Methods: In a population-based case–control study in New Hampshire, USA, we compared the use of glucocorticoids in 786 bladder cancer cases and in 1083 controls. We used unconditional logistic regression analysis to compute adjusted odds ratios (ORs) associated with oral glucocorticoid use. Results: In our analysis, the risk of bladder cancer was related to a history of prolonged oral glucocorticoid use (OR=1.85, 95% CI=1.24–2.76, adjusted for age, gender and smoking). Associations with oral glucocorticoid use were stronger for invasive tumours (OR=2.12, 95% CI=1.17–3.85) and tumours with high (3+) p53 staining intensity (OR=2.35, 95% CI=1.26–4.36). Conclusion: Our results raise the possibility of an increased risk of bladder cancer from systemic use of glucocorticoids, and a potential role of immune surveillance in bladder cancer aetiology.
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Affiliation(s)
- K Dietrich
- Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH 03756, USA
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Gaughan EM, Dezube BJ, Bower M, Aboulafia DM, Bohac G, Cooley TP, Pantanowitz L. HIV-associated bladder cancer: a case series evaluating difficulties in diagnosis and management. BMC Urol 2009; 9:10. [PMID: 19719844 PMCID: PMC2746230 DOI: 10.1186/1471-2490-9-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 08/31/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic human immunodeficiency virus (HIV) infection is associated with an increased incidence of Non-Acquired Immunodeficiency Syndrome (non-AIDS) defining cancers. To date, only a limited number of cases of bladder cancer have been linked with HIV infection. We sought to describe the clinical characteristics of HIV-associated bladder cancer. METHODS A retrospective study was performed involving HIV-positive patients with bladder cancer, combining cases from multiple institutions with published case reports. Data regarding patient demographics, HIV status, clinical presentation, pathology, cancer treatment, and outcome were analyzed using descriptive statistics. RESULTS Eleven patients were identified with a median age of 55 years (range, 33-67). The median CD4+ count at cancer diagnosis was 280 cells/mm3 (range, 106-572 cells/mm3). Six patients (55%) had a known risk factor for bladder cancer, and nine (82%) presented with hematuria. Ten patients had transitional cell carcinoma, and most had superficial disease at presentation. Treatment included mainly transurethral resection of bladder tumor followed by a combination of local and systemic therapies. One patient received intravesical bacillus Calmette-Guèrin (BCG) without complication. Several patients (55%) were alive following therapy, although many (64%) suffered from local relapse and metastatic disease. CONCLUSION Bladder cancer is part of the growing list of cancers that may be encountered in patients living longer with chronic HIV-infection. Our patients presented at a younger age and with only mild immunosuppression, however, they experienced an expected course for their bladder cancer. Hematuria in an HIV-infected patient warrants a complete evaluation.
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Affiliation(s)
- Elizabeth M Gaughan
- Department of Medicine (Hematology-Oncology), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Abstract
PURPOSE OF REVIEW Non-AIDS defining cancer (NADC) has emerged as an important cause of morbidity and mortality in the HIV-infected population. Insight into the incidence, spectrum, risk factors, management, and outcome of these cancers has continued to emerge. The recent literature on this topic is reviewed. RECENT FINDINGS Several recent studies have explored the shifting spectrum of NADC in both developed and underdeveloped regions of the world. Investigators have shown only a minor difference in the geographic spectrum of NADC. Although several NADC have continued to occur at rates significantly higher than expected, a noticeable decline was observed in other cancers despite antiretroviral therapy. Factors other than HIV and immunosuppression proved to be important in the risk, treatment response, and outcome of these neoplasms. Studies dealing with the management of several NADC were published, including the role of highly active antiretroviral therapy (HAART). SUMMARY An increased overall relative risk of developing NADC continues to be reported in the HIV-infected population worldwide. The development of NADC appears to be multifactorial. Although control of HIV viremia has proven to be beneficial, the impact of HAART on NADC incidence rates and survival is not uniform. Further effort is needed to resolve the direct and indirect effects of HIV on NADC in order to guide effective prevention and treatment strategies of these malignancies.
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