1
|
Gao Z, Xu G, Wang S, Guo N, Yu Y, Wang X. Unusual presentation of PD-1 inhibitors in people living with HIV with advanced gastric cancer: Case report. Int J STD AIDS 2024; 35:733-738. [PMID: 38644514 DOI: 10.1177/09564624241248676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
This paper seeks to determine the effect of combination anti-PD-1 and antiretroviral therapy (ART) on people living with HIV (PLWH) with advanced gastric cancer. In our case, a PLWH with recurrent locally advanced gastric cancer was treated with anti-PD-1 inhibitor and ART. A significant reduction in tumor lesions (as demonstrated by contrast-enhanced CT imaging) and a better quality of life were achieved following treatment. There have been limited studies on the treatment of PLWH with advanced gastric cancer. Chemotherapy is most often used, however, with unsatisfactory outcomes. to date, there have been no published reports on the use of PD-1 inhibitors in PLWH with advanced gastric cancer. Our report provides a valuable reference for future management of such patients.
Collapse
Affiliation(s)
- Zhidi Gao
- Department of Oncology, Qingdao Branch of Shandong Public Health Clinical Center, Qingdao, People's Republic of China
| | - Guangyong Xu
- Department of Infectious Diseases, Qingdao Branch of Shandong Public Health Clinical Center, Qingdao, People's Republic of China
| | - Su Wang
- Department of Oncology, Hiser Hospital Affiliated to Qingdao University, Shandong, People's Republic of China
| | - Na Guo
- Department of Oncology, Qingdao Branch of Shandong Public Health Clinical Center, Qingdao, People's Republic of China
| | - Yang Yu
- Department of Oncology, Qingdao Branch of Shandong Public Health Clinical Center, Qingdao, People's Republic of China
| | - Xiaoni Wang
- Imaging Department, Qingdao Branch of Shandong Public Health Clinical Center, Qingdao, People's Republic of China
| |
Collapse
|
2
|
Coelho J, Roush SM, Xu AM, Puranam K, Mponda M, Kasonkanji E, Mulenga M, Tomoka T, Galeotti J, Brownlee A, Ghadially H, Damania B, Painschab M, Merchant A, Gopal S, Fedoriw Y. HIV and prior exposure to antiretroviral therapy alter tumour composition and tumour: T-cell associations in diffuse large B-cell lymphoma. Br J Haematol 2024; 205:194-206. [PMID: 38769021 PMCID: PMC11245366 DOI: 10.1111/bjh.19531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of lymphoma worldwide, accounting for up to 40% of new non-Hodgkin Lymphoma (NHL) globally. People living with HIV are up to 17 times more likely to develop NHL, and as such, DLBCL is the leading cause of cancer death in this high-risk population. While histologically indistinguishable, HIV-associated (HIV+) and HIV-negative (HIV-) DLBCL are molecularly distinct, and biological differences may have implications for the development of future therapeutic interventions. Further, the impact of immunologic differences in people with HIV, including preceding ART, remains largely unknown. Here, we investigate the impact of HIV infection and ART exposure on the clinical features of DLBCL and T-cell immune response by performing imaging mass cytometry on our unique patient cohort in Malawi. In this cohort, HIV infection is positively prognostic, and HIV+/ART-naïve patients have the best outcomes. No established biomarkers other than Ki67 are associated with HIV or ART status, and the only tumour-intrinsic biomarkers that remain prognostic are MYC and MYC/BCL2 protein co-expression. Finally, TCR clonality is associated with distinct tumour-T cell interactions by HIV/ART status, indicating differential anti-tumour immune responses. We demonstrate previously undescribed HIV and ART-related differences in the DLBCL tumour microenvironment.
Collapse
Affiliation(s)
- Jenny Coelho
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Sophia M. Roush
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Alexander M. Xu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Marriam Mponda
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
| | - Edwards Kasonkanji
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
| | - Maurice Mulenga
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
| | - Tamiwe Tomoka
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
| | - Jonathan Galeotti
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Amy Brownlee
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Hormas Ghadially
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Blossom Damania
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Department of Microbiology and Immunology, School of Medicine, UNC, Chapel Hill, NC, USA
| | - Matthew Painschab
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Division of Hematology, Department of Medicine, UNC, Chapel Hill, NC
| | - Akil Merchant
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Satish Gopal
- National Cancer Institute Center for Global Health, Rockville, MD, USA
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| |
Collapse
|
3
|
Li B, Lin X, Chen S, Qian Z, Wu H, Liao G, Chen H, Kang Z, Peng J, Liang G. The association between fear of progression and medical coping strategies among people living with HIV: a cross-sectional study. BMC Public Health 2024; 24:440. [PMID: 38347483 PMCID: PMC10860317 DOI: 10.1186/s12889-024-17969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Due to the chronic nature of HIV, mental health has become a critical concern in people living with HIV (PLWHIV). However, little knowledge exists about the association between fear of progression (FoP) and medical coping modes (MCMs) in PLWHIV in China. METHODS A cohort of 303 PLWHIV were consecutively enrolled and their demographic, clinical and psychological information was collected. The Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Support Rating Scale (SSRS), Internalized HIV Stigma Scale (IHSS) and MCMs Questionnaire were utilized. RESULTS Of the participants, 215 PLWHIV were classified into the low-level FoP group, and 88 were grouped into the high-level FoP group based on their FoP-Q-SF scores, according to the criteria for the classification of dysfunctional FoP in cancer patients. The high-level group had a higher proportion of acquired immunodeficiency syndrome (AIDS) stage (P = 0.005), lower education levels (P = 0.027) and lower income levels (P = 0.031). Additionally, the high-level group had lower scores in social support (P < 0.001) and its three dimensions, with total SSRS scores showing a negative correlation with two dimensions of FoP-Q-SF, namely physical health (r2 = 0.0409, P < 0.001) and social family (r2 = 0.0422, P < 0.001). Further, the high-level group had higher scores in four dimensions of internalized HIV stigma, and a positive relationship was found to exist between IHSS scores and FoP-Q-SF scores for physical health (r2 = 0.0960, P < 0.001) and social family (r2 = 0.0719, P < 0.001). Social support (OR = 0.929, P = 0.001), being at the AIDS stage (OR = 3.795, P = 0.001), and internalized HIV stigma (OR = 1.028, P < 0.001) were independent factors for FoP. Furthermore, intended MCMs were evaluated. FoP were positively correlated with avoidance scores (r2 = 0.0886, P < 0.001) and was validated as the only factor for the mode of confrontation (OR = 0.944, P = 0.001) and avoidance (OR = 1.059, P = 0.001) in multivariate analysis. CONCLUSION The incidence of dysfunctional FoP in our study population was relatively high. High-level FoP was associated with poor social support, high-level internalized HIV stigma and a negative MCM among PLWHIV.
Collapse
Affiliation(s)
- Bing Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaoli Lin
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Suling Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zhe Qian
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Houji Wu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Guichan Liao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hongjie Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zixin Kang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Guangyu Liang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| |
Collapse
|
4
|
Yang FY, He F, Chen DF, Tang CL, Woraikat S, Li Y, Qian K. Oncological features and prognosis of colorectal cancer in human immunodeficiency virus-positive patients: A retrospective study. World J Gastrointest Surg 2024; 16:29-39. [PMID: 38328311 PMCID: PMC10845290 DOI: 10.4240/wjgs.v16.i1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Due to the prolonged life expectancy and increased risk of colorectal cancer (CRC) among patients with human immunodeficiency virus (HIV) infection, the prognosis and pathological features of CRC in HIV-positive patients require examination. AIM To compare the differences in oncological features, surgical safety, and prognosis between patients with and without HIV infection who have CRC at the same tumor stage and site. METHODS In this retrospective study, we collected data from HIV-positive and -negative patients who underwent radical resection for CRC. Using random stratified sampling, 24 HIV-positive and 363 HIV-negative patients with colorectal adenocarcinoma after radical resection were selected. Using propensity score matching, we selected 72 patients, matched 1:2 (HIV-positive:negative = 24:48). Differences in basic characteristics, HIV acquisition, perioperative serological indicators, surgical safety, oncological features, and long-term prognosis were compared between the two groups. RESULTS Fewer patients with HIV infection underwent chemotherapy compared to patients without. HIV-positive patients had fewer preoperative and postoperative leukocytes, fewer preoperative lymphocytes, lower carcinoembryonic antigen levels, more intraoperative blood loss, more metastatic lymph nodes, higher node stage, higher tumor node metastasis stage, shorter overall survival, and shorter progression-free survival compared to patients who were HIV-negative. CONCLUSION Compared with CRC patients who are HIV-negative, patients with HIV infection have more metastatic lymph nodes and worse long-term survival after surgery. Standard treatment options for HIV-positive patients with CRC should be explored.
Collapse
Affiliation(s)
- Fu-Yu Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Fan He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - De-Fei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Cheng-Lin Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Saed Woraikat
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yao Li
- Department of General Surgery, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|
5
|
Konstantinidis I, Crothers K, Kunisaki KM, Drummond MB, Benfield T, Zar HJ, Huang L, Morris A. HIV-associated lung disease. Nat Rev Dis Primers 2023; 9:39. [PMID: 37500684 PMCID: PMC11146142 DOI: 10.1038/s41572-023-00450-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
Lung disease encompasses acute, infectious processes and chronic, non-infectious processes such as chronic obstructive pulmonary disease, asthma and lung cancer. People living with HIV are at increased risk of both acute and chronic lung diseases. Although the use of effective antiretroviral therapy has diminished the burden of infectious lung disease, people living with HIV experience growing morbidity and mortality from chronic lung diseases. A key risk factor for HIV-associated lung disease is cigarette smoking, which is more prevalent in people living with HIV than in uninfected people. Other risk factors include older age, history of bacterial pneumonia, Pneumocystis pneumonia, pulmonary tuberculosis and immunosuppression. Mechanistic investigations support roles for aberrant innate and adaptive immunity, local and systemic inflammation, oxidative stress, altered lung and gut microbiota, and environmental exposures such as biomass fuel burning in the development of HIV-associated lung disease. Assessment, prevention and treatment strategies are largely extrapolated from data from HIV-uninfected people. Smoking cessation is essential. Data on the long-term consequences of HIV-associated lung disease are limited. Efforts to continue quantifying the effects of HIV infection on the lung, especially in low-income and middle-income countries, are essential to advance our knowledge and optimize respiratory care in people living with HIV.
Collapse
Affiliation(s)
- Ioannis Konstantinidis
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristina Crothers
- Veterans Affairs Puget Sound Healthcare System and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ken M Kunisaki
- Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Heather J Zar
- Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Laurence Huang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
6
|
Gessese T, Asrie F, Mulatie Z. Human Immunodeficiency Virus Related Non-Hodgkin's Lymphoma. Blood Lymphat Cancer 2023; 13:13-24. [PMID: 37275434 PMCID: PMC10237187 DOI: 10.2147/blctt.s407086] [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: 02/18/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023]
Abstract
Human immunodeficiency virus infection is related with an increased risk of hematological malignancy principally, non-Hodgkin lymphoma. Most non-Hodgkin lymphomas are acquired immunodeficiency syndrome defining and constitute greater than 50% of all acquired immunodeficiency syndrome defining cancers. The main pathogenesis mechanisms are immunodeficiency, chronic antigenic stimulation, and the ability to infect cancer cells causing direct carcinogenesis. Human immunodeficiency virus related non-Hodgkin lymphomas are heterogeneous in immunophenotyping and molecular features; and choice of drug treatments is similar with sporadic types. The main objective is to assess the epidemiology, pathogenesis, and morphology of human immunodeficiency virus related non-Hodgkin lymphoma. The searching strategy was done by searching relevant original and review articles from www.biosemanticjane/org, Google scholar, Google, and PubMed sites using keywords like; Acquired immunodeficiency syndrome, Human immunodeficiency virus, and non-Hodgkin lymphoma. In conclusion, human immunodeficiency virus infected people continue to have elevated risk of non-Hodgkin lymphoma. Diffuse large B-cell lymphomas are the most common and severe subtype. The pathogenesis of this type of lymphoma is associated with chromosomal abnormalities that deregulate the expression of various oncogenes by different viral particles and cytokines. However, the role of these viral particles and cytokines on pathogenesis is not clearly stated, so further study could be required.
Collapse
Affiliation(s)
- Tesfaye Gessese
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fikir Asrie
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewudu Mulatie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
7
|
Antel K, Oosthuizen J, Brown K, Malherbe F, Loebenberg P, Seaton C, Baloyi S, Simba K, Chetty D, Louw VJ, Maartens G, Verburgh ER. Focused investigations to expedite cancer diagnosis among patients with lymphadenopathy in a tuberculosis and HIV-endemic region. AIDS 2023; 37:587-594. [PMID: 36472201 PMCID: PMC9974874 DOI: 10.1097/qad.0000000000003456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE In tuberculosis (TB)-endemic areas, lymphadenopathy is frequently due to TB adenitis, but lymphoma and cancers are important differential diagnoses and critical to diagnose at the earliest opportunity. Key obstacles to lymphoma diagnosis include empiric TB treatment and difficulty accessing a biopsy. We report on a specialized clinic utilizing high-yield investigations for patients with lymphadenopathy. METHODS This prospective interventional study investigated the utility of a core biopsy and the Xpert MTB/RIF Ultra (Ultra) on fine-needle aspirate (FNA) and tissue in a newly established lymph node biopsy clinic over 4 years. Electronic referral facilitated patient assessment within a week. Hematology fellows without specialist surgical or radiological expertise performed the biopsy on the first visit. RESULTS In 277 patients, including 43% people with HIV, TB was the most frequent diagnosis (34%), followed by lymphoma (27%) and other cancers (17%). Patients were seen a median of 5 days [interquartile range (IQR) 2-8.5 days] from referral. Core biopsy provided sufficient tissue for diagnosis in 96% of patients with lymphoma (72/75) and 94% of patients with cancer (44/47). FNA Ultra had a sensitivity of 73.9% [34/46; 95% confidence interval (CI) 58.9-85.7], and tissue Ultra 73% (46/63; 95% CI 60.3-83.4). There were six false-positive Ultra tests, highlighting the value of histology to either support TB or make an alternative diagnosis. CONCLUSION Core biopsies collected under the conditions described are safe and sensitive and can yield a rapid diagnosis. Combining Ultra and a core biopsy can accurately diagnose TB and cancer. This clinic provides an implementation model for resource-constrained and TB-endemic areas.
Collapse
Affiliation(s)
- Katherine Antel
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jenna Oosthuizen
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Karryn Brown
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Francois Malherbe
- Deparment of Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Perry Loebenberg
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Cylene Seaton
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Siphiwe Baloyi
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Department of Pathology, Faculty of Health Sciences, University of Cape Town
| | - Kudakwashe Simba
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Dharshnee Chetty
- Department of Pathology, Faculty of Health Sciences, University of Cape Town
| | - Vernon J. Louw
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Estelle R. Verburgh
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
8
|
Muchengeti M, Bartels L, Olago V, Dhokotera T, Chen WC, Spoerri A, Rohner E, Bütikofer L, Ruffieux Y, Singh E, Egger M, Bohlius J. Cohort profile: the South African HIV Cancer Match (SAM) Study, a national population-based cohort. BMJ Open 2022; 12:e053460. [PMID: 35410922 PMCID: PMC9003610 DOI: 10.1136/bmjopen-2021-053460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 03/16/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The South African HIV Cancer Match (SAM) Study is a national cohort of people living with HIV (PLWH). It was created using probabilistic record linkages of routine laboratory records of PLWH retrieved by National Health Laboratory Services (NHLS) and cancer data from the National Cancer Registry. The SAM Study aims to assess the spectrum and risk of cancer in PLWH in the context of the evolving South African HIV epidemic. The SAM Study's overarching goal is to inform cancer prevention and control programmes in PLWH in the era of antiretroviral treatment in South Africa. PARTICIPANTS PLWH (both adults and children) who accessed HIV care in public sector facilities and had HIV diagnostic or monitoring laboratory tests from NHLS. FINDINGS TO DATE The SAM cohort currently includes 5 248 648 PLWH for the period 2004 to 2014; 69% of these are women. The median age at cohort entry was 33.0 years (IQR: 26.2-40.9). The overall cancer incidence in males and females was 235.9 (95% CI: 231.5 to 240.5) and 183.7 (181.2-186.2) per 100 000 person-years, respectively.Using data from the SAM Study, we examined national cancer incidence in PLWH and the association of different cancers with immunodeficiency. Cancers with the highest incidence rates were Kaposi sarcoma, cervix, breast, non-Hodgkin's lymphoma and eye cancer. FUTURE PLANS The SAM Study is a unique, evolving resource for research and surveillance of malignancies in PLWH. The SAM Study will be regularly updated. We plan to enrich the SAM Study through record linkages with other laboratory data within the NHLS (eg, tuberculosis, diabetes and lipid profile data), mortality data and socioeconomic data to facilitate comprehensive epidemiological research of comorbidities among PLWH.
Collapse
Affiliation(s)
- Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Lina Bartels
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Victor Olago
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Tafadzwa Dhokotera
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Yann Ruffieux
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
9
|
Nissim O, Dees A, Cooper SL, Patel K, Lazenby GB. Cervical Cancer Among Women With HIV in South Carolina During the Era of Effective Antiretroviral Therapy. J Low Genit Tract Dis 2022; 26:109-114. [PMID: 35125483 DOI: 10.1097/lgt.0000000000000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to determine whether women with HIV (WWH) and cervical cancer were more likely to experience cancer-related death and to be diagnosed with cervical cancer at a younger age and in more advanced stages. MATERIALS AND METHODS This is a retrospective cohort study of all women diagnosed with cervical cancer in South Carolina from 1998 to 2018. Deidentified data were obtained from 2 statewide databases. A survival analysis was performed to evaluate differences in cancer survival between women with and without HIV. Wilcoxon rank sum test was used to determine differences in the median age at cancer diagnosis. χ2 test was used to assess differences in cancer stage according to HIV status. RESULTS Four thousand three hundred fourteen women were diagnosed with cervical cancer, and 53 (1.2%) had HIV infection. Survival time in months was similar between WWH and HIV-negative women (86 months [interquartile range {IQR} = 32-146] and 62 months [IQR = 18-153], p = .37; log-rank p = .26). Compared with HIV-negative women, WWH were less likely to experience cervical cancer-related death (36% vs. 19%, p = .005). Women with HIV were diagnosed with cervical cancer at a younger age (44 [IQR = 37-54] vs. 49 [IQR = 39-61], p = .02). Cervical cancer stage was similar at diagnosis between groups (tumor node metastasis stage, p = .97, and Surveillance, Epidemiology, and End Results summary stage, p = .41). CONCLUSIONS Women with HIV were younger at diagnosis than HIV-negative women, but they were no more likely to die from or have more advanced cervical cancer. Women with HIV were not more likely to develop cervical cancer before the age of 21 years and earlier screening is likely unnecessary.
Collapse
Affiliation(s)
- Oriel Nissim
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC; and Department of Radiologic Oncology, Hollings Cancer Center, Charleston, SC
| | | | | | | | | |
Collapse
|
10
|
Kieri O, Marrone G, Sönnerborg A, Nowak P. Incidence, Treatment, and Outcome of HIV-Associated Hematologic Malignancies in People Living with HIV in Sweden. AIDS Res Hum Retroviruses 2022; 38:135-142. [PMID: 34652958 DOI: 10.1089/aid.2021.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
People living with HIV (PLHIV) have an increased risk of hematologic malignancies (HMs). We aimed to characterize HMs among PLHIV at Karolinska University Hospital, Stockholm, Sweden. We studied all PLHIV receiving care at our center between 2004 and 2018. Data were retrieved retrospectively from InfCareHIV database and medical records. Around 3,484 patients received HIV care for a total of 22,903 person-years (py) with median follow-up of 7.6 years. HMs were identified in 43 patients with 30 cases of non-Hodgkin lymphoma (NHL), 9 cases of Hodgkin lymphoma (HL), 2 multicentric Castleman's disease, and 1 case each of myeloma and myelodysplastic syndrome. The incidence rate of NHL was 88/105 py and HL 39.6/105 py. The incidence of NHL declined 2004-2010 versus 2011-2018 (180.8 vs. 40.1/105 py; p = .001). Median time from HIV diagnosis to malignancy was shorter in NHL compared with HL (1.2 years vs. 8.9 years; p = .01) and effective HIV treatment was less common in NHL (33% vs. 100%; p < .001). The 5-year survival rate of NHL was 59% and HL 43%, significantly lower compared with lymphoma survival in the general population in Sweden. In the era of effective antiretroviral therapy (ART), the incidence rate of lymphoma was more than five times higher in PLHIV and 5-year survival significantly inferior. Efforts for earlier identification of HIV-infected individuals are likely to affect the incidence of NHL. Additionally, an effective screening for clinical and laboratory signs of HL in PLHIV on ART should be introduced to improve identification and survival of HL in this population.
Collapse
Affiliation(s)
- Oscar Kieri
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Gaetano Marrone
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Anders Sönnerborg
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine ANA Futura Laboratory, Karolinska Institute, Stockholm, Sweden
| | - Piotr Nowak
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine ANA Futura Laboratory, Karolinska Institute, Stockholm, Sweden
- The Laboratory for Molecular Infection Medicine Sweden MIMS, Umeå University, Umeå, Sweden
| |
Collapse
|
11
|
Elhadi M, Khaled A, Msherghi A. Infectious diseases as a cause of death among cancer patients: a trend analysis and population-based study of outcome in the United States based on the Surveillance, Epidemiology, and End Results database. Infect Agent Cancer 2021; 16:72. [PMID: 34972537 PMCID: PMC8719405 DOI: 10.1186/s13027-021-00413-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/28/2021] [Indexed: 12/14/2022] Open
Abstract
Background Infectious diseases are a major cause of morbidity and mortality among cancer patients. We aimed to determine the incidence of infectious diseases as a cause of death among cancer patients and analyze the trends and risk factors associated with mortality. Methods In total, 151,440 cancer patients who died from infectious diseases in the US diagnosed between 1973 and 2014 from the Surveillance, Epidemiology, and End Results program were enrolled. A trend analysis of annual cancer deaths caused by infectious diseases was conducted. Cox proportional hazards model and survival decision tree model were performed. Result The most common infectious diseases were pneumonia and influenza (n = 72,133), parasitic and other infectious (n = 47,310) diseases, and septicemia (n = 31,119). The patients’ mean age was 66.33 years; majority of them were male (62%). The overall incidence from 1973 to 2014 showed an insignificant decrease (annual percentage change = − 0.3, 95% confidence interval [CI] = − 2.2–1.7, P = 0.8). Parasitic and other infectious diseases, including HIV (standardized incidence ratio [SIR] = 1.77, 95% CI = 1.69–1.84), had the highest incidence, followed by septicemia (SIR = 0.84, 95% CI = 0.81–0.88), tuberculosis (SIR = 0.72, 95% CI = 0.51–0.99), and pneumonia (SIR = 0.63, 95% CI = 0.61–0.64). Based on the Cox regression analysis, old black male patients with intrahepatic tumor or acute leukemia of different grades, except the well-differentiated grade, had the highest risk of dying from infectious diseases. Conclusion Infectious diseases remain the major cause of morbidity and mortality among cancer patients. Early recognition of risk factors and timely intervention may help mitigate the negative consequences on patients’ quality of life and prognosis, improving the prognosis and preventing early death from infection, which is preventable in most cases. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-021-00413-z.
Collapse
Affiliation(s)
- Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, Tripoli, 13275, Libya.
| | - Ala Khaled
- Faculty of Medicine, University of Tripoli, Tripoli, 13275, Libya
| | - Ahmed Msherghi
- Faculty of Medicine, University of Tripoli, Tripoli, 13275, Libya
| |
Collapse
|
12
|
The Antiviral Drug Efavirenz in Breast Cancer Stem Cell Therapy. Cancers (Basel) 2021; 13:cancers13246232. [PMID: 34944852 PMCID: PMC8699628 DOI: 10.3390/cancers13246232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/12/2021] [Accepted: 12/08/2021] [Indexed: 11/20/2022] Open
Abstract
Simple Summary Cancer stem cells (CSCs) are responsible for tumour initiation, chemo- and radiotherapy resistance and cancer recurrence. CSCs display plasticity that enables them to alter their phenotype and function making them challenging to eliminate. In this study we explore the effects of an antiretroviral medication used to treat HIV/AIDS (Efavirenz) on cancer stem cells derived from multiple breast cancer cell lines. Efavirenz has been previously found to be effective in the treatment of triple-negative breast cancers, and here we show that it is also capable of altering CSC numbers, cell morphology, RNA/microRNA gene expression and levels of epithelial/mesenchymal CSC subtypes. This study shows that, with Efavirenz, it is possible to not only eliminate primary breast cancer cells, but also to promote changes in cell morphology. Abstract Although many breast cancer therapies show initial success in the treatment of the primary tumour, they often fail to eliminate a sub-population of cells known as cancer stem cells (CSCs). These cells are recognised for their self-renewal properties and for their capacity for differentiation often leading to chemo/radio-resistance. The antiviral drug Efavirenz has been shown to be effective in eliminating triple-negative breast cancer cells, and here we examine its effect on breast CSCs. The effects of Efavirenz on CSCs for several breast cancer cell lines were investigated by examining cellular changes upon drug treatment, including CSC numbers, morphology, RNA/microRNA expression and levels of epithelial/mesenchymal CSC subtypes. Efavirenz treatment resulted in a decrease in the size and number of tumorspheres and a reduction in epithelial-type CSC levels, but an increase in mesenchymal-type CSCs. Efavirenz caused upregulation of several CSC-related genes as well as miR-21, a CSC marker and miR-182, a CSC suppressor gene. We conclude that Efavirenz alters the phenotype and expression of key genes in breast CSCs, which has important potential therapeutic implications.
Collapse
|
13
|
Kibuuka H, Musingye E, Mwesigwa B, Semwogerere M, Iroezindu M, Bahemana E, Maswai J, Owuoth J, Esber A, Dear N, Crowell TA, Polyak CS, Ake JA. Predictors of All-Cause Mortality among People with HIV in a Prospective Cohort Study in East Africa and Nigeria. Clin Infect Dis 2021; 75:657-664. [PMID: 34864933 PMCID: PMC9464064 DOI: 10.1093/cid/ciab995] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS). Methods AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality. Results From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were aged ≥ 50 years, and 98.3% were ART-experienced. We observed 11.42 deaths per 1000 person-years (95% CI: 9.53–13.68) with causes ascertained in 54% of participants. Deaths were caused by malignancy (28.1%), infections (29.7%), and other non-HIV related conditions. Predictors of mortality included CD4 ≤ 350 cells/µL (aHR 2.01 [95% CI: 1.31–3.08]), a log10copies/mL increase of viral load (aHR 1.36 [95% CI: 1.22–1.51]), recent fever (aHR 1.85[95% CI: 1.22–2.81]), body mass index < 18.5 kg/m2 (aHR 2.20 [95% CI: 1.44–3.38]), clinical depression (aHR 2.42 [95% CI: 1.40–4.18]), World Health Organization (WHO) stage III (aHR 2.18 [95% CI: 1.31–3.61]), a g/dL increase in hemoglobin (aHR 0.79 [95% CI: .72–.85]), and every year on ART (aHR 0.67 [95% CI: .56–.81]). Conclusions The mortality rate was low in this cohort of mostly virally suppressed PLWH. Patterns of deaths and identified predictors suggest multiple targets for interventions to reduce mortality.
Collapse
Affiliation(s)
- Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Ezra Musingye
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Betty Mwesigwa
- Makerere University Walter Reed Project, Kampala, Uganda
| | | | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Abuja, Nigeria
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Mbeya, Tanzania
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,HJF Medical Research International, Kericho, Kenya
| | - John Owuoth
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | |
Collapse
|
14
|
Marhefka S, Lockhart E, Chen H, Meng H, Reina Ortiz M, Powell B, Shuter J. A tailored telehealth group tobacco cessation treatment program for people with HIV: Study protocol for a randomized controlled trial. Contemp Clin Trials 2021; 110:106475. [PMID: 34116206 DOI: 10.1016/j.cct.2021.106475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Smoking-related illnesses are the leading cause of death among people with HIV (PWH). Yet, there are few effective evidence-based interventions that help PWH quit smoking. The group-based program Positively Smoke Free is a biobehavioral cessation intervention for PWH with a growing evidence base. This study builds on prior work of Positively Smoke Free and addresses numerous weaknesses of prior trials for this population. We describe the Positively Quit Trial, a randomized controlled trial comparing a videoconferencing delivered Positively Smoke Free intervention to an attention-matched condition, assessing cessation over a 1-year period. METHODS This attention-matched, randomized (1:1) controlled trial compares Positively Smoke Free Video-Groups to an updated version of Healthy Relationship Video-Groups. Participants are PWH, aged 18 years and older, who smoke at least one cigarette per day. All are offered nicotine replacement therapy patches and given brief advice to quit. Participants are enrolled in 12 group sessions focusing on either smoking cessation for PWH or broader topics regarding living healthy with HIV; in both conditions, Social Cognitive Theory is the guiding theoretical framework. Participants complete assessments at baseline, days 42, 90, 180, and 360; self-reported abstinence is verified with a video-observed cheek swab sent to a lab and tested for cotinine. PRIMARY OUTCOMES Biochemically confirmed 7-day point prevalence smoking abstinence at day 360 is the primary outcome. Cost per quit, sustained abstinence at various timepoints, and biochemical confirmed abstinence at three and six months are secondary outcomes. Effects of smoking cessation on CD4 and virologic suppression are also explored.
Collapse
Affiliation(s)
- Stephanie Marhefka
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL 33612, United States of America.
| | - Elizabeth Lockhart
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL 33612, United States of America.
| | - Henian Chen
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL 33612, United States of America.
| | - Hongdao Meng
- College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL 33612, United States of America.
| | - Miguel Reina Ortiz
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL 33612, United States of America.
| | - Brittani Powell
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, Tampa, FL 33612, United States of America.
| | - Jonathan Shuter
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, United States of America.
| |
Collapse
|
15
|
Johnson SC. Primary Care Concerns for the Aging Population With HIV. TOPICS IN ANTIVIRAL MEDICINE 2021; 29:412-415. [PMID: 34856095 PMCID: PMC8670823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Because individuals with HIV are living longer, comorbidities are moving to the forefront of HIV patient care. People with HIV have a higher risk for HIV-related and non-HIV-related cancers than the general population, making cancer screening vital for this population. Immunizations are another important element of primary care for older adults with HIV, including a COVID-19 vaccine, about which data continue to evolve. This article summarizes a presentation by Steven C. Johnson, MD, at the International Antiviral Society-USA (IAS-USA) virtual HIV course Aging and HIV: Issues, Screening, and Management in Individuals with HIV as They Age in June 2021.
Collapse
|
16
|
The Role of Coinfections in the EBV-Host Broken Equilibrium. Viruses 2021; 13:v13071399. [PMID: 34372605 PMCID: PMC8310153 DOI: 10.3390/v13071399] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022] Open
Abstract
The Epstein–Barr virus (EBV) is a well-adapted human virus, and its infection is exclusive to our species, generally beginning in the childhood and then persisting throughout the life of most of the affected adults. Although this infection generally remains asymptomatic, EBV can trigger life-threatening conditions under unclear circumstances. The EBV lifecycle is characterized by interactions with other viruses or bacteria, which increases the probability of awakening its pathobiont capacity. For instance, EBV infects B cells with the potential to alter the germinal center reaction (GCR)—an adaptive immune structure wherein mutagenic-driven processes take place. HIV- and Plasmodium falciparum-induced B cell hyperactivation also feeds the GCR. These agents, along with the B cell tropic KSHV, converge in the ontogeny of germinal center (GC) or post-GC lymphomas. EBV oral transmission facilitates interactions with local bacteria and HPV, thereby increasing the risk of periodontal diseases and head and neck carcinomas. It is less clear as to how EBV is localized in the stomach, but together with Helicobacter pylori, they are known to be responsible for gastric cancer. Perhaps this mechanism is reminiscent of the local inflammation that attracts different herpesviruses and enhances graft damage and chances of rejection in transplanted patients. In this review, we discussed the existing evidence suggestive of EBV possessing the potential to synergize or cooperate with these agents to trigger or worsen the disease.
Collapse
|
17
|
Horner MJ, Shiels MS, Pfeiffer RM, Engels EA. Deaths Attributable to Cancer in the US Human Immunodeficiency Virus Population During 2001-2015. Clin Infect Dis 2021; 72:e224-e231. [PMID: 32710777 DOI: 10.1093/cid/ciaa1016] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) has reduced mortality among people living with human immunodeficiency virus (HIV), but cancer remains an important cause of death. We characterized cancer-attributable mortality in the HIV population during 2001-2015. METHODS We used data from population-based HIV and cancer registries in the United States (US). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) associating cancer diagnoses with overall mortality, we could perhaps cut these words to accommodate the word limit. However readers will probably want to know what statistical adjustments were made to the model. Population-attributable fractions (PAFs) were calculated using these HRs and the proportion of deaths preceded by cancer. Cancer-specific PAFs and cancer-attributable mortality rates were calculated for demographic subgroups, AIDS-defining cancers (Kaposi sarcoma [KS], non-Hodgkin lymphoma [NHL], cervical cancer), and non-AIDS-defining cancers. RESULTS Cancer-attributable mortality was 386.9 per 100 000 person-years, with 9.2% and 5.0% of deaths attributed to non-AIDS-defining and AIDS-defining cancers, respectively. Leading cancer-attributable deaths were from NHL (3.5%), lung cancer (2.4%), KS (1.3%), liver cancer (1.1%), and anal cancer (0.6%). Overall, cancer-attributable mortality declined from 484.0 per 100 000 person-years during 2001-2005 to 313.6 per 100 000 person-years during 2011-2015, while the PAF increased from 12.6% to 17.1%; the PAF for non-AIDS-defining cancers increased from 7.2% to 11.8% during 2011-2015. Cancer-attributable mortality was highest among those aged ≥60 years (952.2 per 100 000 person-years), with 19.0% of deaths attributed to non-AIDS-defining cancers. CONCLUSIONS Although cancer-attributable mortality has declined over time, it remains high and represents a growing fraction of deaths in the US HIV population. Mortality from non-AIDS-defining cancers may rise as the HIV population ages. ART access, early cancer detection, and improved cancer treatment are priorities for reducing cancer-attributable mortality.
Collapse
Affiliation(s)
- Marie-Josèphe Horner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| |
Collapse
|
18
|
Prospective evaluation of blood Epstein-Barr virus DNA load and antibody profile in HIV-related non-Hodgkin lymphomas. AIDS 2021; 35:861-868. [PMID: 33749224 DOI: 10.1097/qad.0000000000002839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The value of Epstein-Barr virus (EBV) biomarkers on the prognosis of HIV-related non-Hodgkin's lymphoma (NHL) has been poorly explored in the combined antiretroviral therapy (cART) era. DESIGN We evaluated EBV DNA load and EBV antibodies in HIV-NHL patients enrolled in the French ANRS-CO16 Lymphovir Cohort between 2008 and 2015. METHODS Whole blood and plasma EBV DNA load and serological profiles were analyzed in 76 HIV-infected patients at diagnosis of NHL and 6 months after the initiation of chemotherapy. RESULTS Prechemotherapy whole blood (WB) and plasma EBV DNA loads were positive for 80 and 45% of HIV-NHL patients, respectively. Pretreatment WB EBV DNA positivity was associated with a positive plasma HIV-1 RNA load (relative risk (RR), 4.42 [1.33; 14.72]) and plasma EBV DNA positivity with EBV in situ detection (RR 10.62 [2.38; 47.49]). Following chemotherapy, the proportions of patients with positive WB or plasma EBV DNA declined from 81 to 23% (P < 0.0001) and from 43 to 8% (P < 0.0001), respectively. Estimated 2-year progression-free survival did not differ according to prechemotherapy WB positivity (82% versus 67%, P = 0.15) or plasma EBV DNA positivity (76% versus 81%, P = 0.52). CONCLUSIONS The plasma EBV DNA load correlates with in situ EBV detection. The WB EBV DNA load correlates with HIV load. WB and plasma EBV DNA loads at NHL diagnosis do not constitute prognostic markers for HIV-NHL patients in the modern cART era.
Collapse
|
19
|
Re A, Cattaneo C, Montoto S. Treatment management of haematological malignancies in people living with HIV. LANCET HAEMATOLOGY 2020; 7:e679-e689. [PMID: 32791044 DOI: 10.1016/s2352-3026(20)30115-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/15/2020] [Accepted: 04/06/2020] [Indexed: 01/10/2023]
Abstract
Although the incidence of HIV-associated lymphomas decreased after the introduction of effective combination antiretroviral therapy, they became the most common AIDS-related cancer in high-income countries. Moreover, as people living with HIV live longer, a wide range of non-AIDS-related cancer has emerged, including other haematological malignancies. Nonetheless, combination antiretroviral therapy has offered people with HIV the opportunity to receive the same therapies as those provided to the general population, and intensive curative therapies have become the standard. However, several population-based studies highlight a major health-care disparity between people with HIV and those without, with people who are HIV positive often excluded from using innovative therapies and participating in prospective trials. In addition, patients from low-income countries frequently receive inappropriate treatment. The hope is that with increased awareness of effective curative options these disparities will decrease, and people with HIV will be given the same therapeutic opportunities and enrolled in clinical trials alongside patients who are HIV negative.
Collapse
Affiliation(s)
- Alessandro Re
- Department of Hematology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy.
| | - Chiara Cattaneo
- Department of Hematology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew's Hospital, London, UK
| |
Collapse
|
20
|
Clark E, Royse KE, Dong Y, Chang E, Raychaudhury S, Kramer J, White DL, Chiao E. Stable Incidence and Poor Survival for HIV-Related Burkitt Lymphoma Among the US Veteran Population During the Antiretroviral Era. J Acquir Immune Defic Syndr 2020; 84:18-25. [PMID: 32251095 PMCID: PMC7793609 DOI: 10.1097/qai.0000000000002303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite advances in diagnosis and treatment of both HIV and Burkitt lymphoma (BL), persons living with HIV remain at high risk for BL. We conducted this study to evaluate if there have been any changes in the risk of or survival after BL diagnosis among persons living with HIV during the antiretroviral era. SETTING Veterans living with HIV (VLWH) and age-matched HIV-negative controls receiving care between 1999 and 2016 were retrospectively identified using Veterans Health Administration electronic medical records. METHODS We identified BL diagnoses through Veterans Health Administration Cancer Registry review and International Classification of Diseases, Ninth/Tenth Revisions, codes, and we extracted demographic, lifestyle, and clinical variables from electronic medical record. We estimated hazard ratios (HR) and 95% confidence intervals (CIs) for BL risk and survival using Cox proportional models. RESULTS We identified 45,299 VLWH. Eighty-four developed BL (incidence rate = 21.2 per 100,000 person years; CI: 17.1 to 26.3). Median CD4 count at BL diagnosis was 238 cells per milliliter (SD: 324.74) and increased over time. Survival was truncated in VLWH with BL (P < 0.05). The risk of BL in VLWH was 38% less in blacks compared with whites (HR: 0.620; CI: 0.393 to 0.979; P = 0.0401). VLWH with an undetectable viral load for at least 40% of follow-up were 74% less likely to develop BL (HR: 0.261; CI: 0.143 to 0.478; P < 0.0001) and 86% less likely to die after diagnosis (HR: 0.141; CI: 0.058 to 0.348; P < 0.0001). CONCLUSIONS BL incidence among VLWH did not improve between 2000 and 2016. Survival after BL diagnosis in VLWH remains dismal as compared with their HIV-negative counterparts, although veterans with prolonged periods of undetectable viral load had improved prognosis.
Collapse
Affiliation(s)
- Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Kathryn E. Royse
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Yongquan Dong
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Elaine Chang
- Department of Medicine, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Suchismita Raychaudhury
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Jennifer Kramer
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Donna L. White
- Department of Medicine, Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA; Clinical Epidemiology and Comparative Effectiveness Program at Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA; Center for Translation in Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth Chiao
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
21
|
Escoin-Perez C, Blasco S, Juan-Vidal O. Immune checkpoint inhibitors in special populations. A focus on advanced lung cancer patients. Lung Cancer 2020; 144:1-9. [PMID: 32278215 DOI: 10.1016/j.lungcan.2020.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 12/13/2022]
Abstract
Immune checkpoint inhibitors (ICIs), including those targeting programmed cell death 1 (PD-1), its ligand 1 (PD-L1), or cytotoxic T-lymphocyte antigen 4 (CTLA-4) have become the standard treatment for several malignancies, including lung cancer. However, some patient populations have been routinely excluded from clinical trials or are underrepresented in these studies, as is the case of elderly patients or patients with poor performance status, brain metastases, solid organ transplant, autoimmune diseases, chronic viral infections (such as human immunodeficiency virus or chronic viral hepatitis B and C), or organ dysfunction. Thus, the safety and efficacy of ICIs in these special populations is still unclear, despite regulatory approval of these agents. This review analyzes and summarizes the available information on the efficacy and safety of ICIs in these special populations, focusing on patients with lung cancer.
Collapse
Affiliation(s)
- Corina Escoin-Perez
- Department of Medical Oncology, Hospital Universitario de La Ribera, Crta. Corbera, Km1. 46600 Alzira, Valencia, Spain.
| | - Sara Blasco
- Department of Medical Oncology, Hospital de Sagunto, Av. Ramón y Cajal, s/n. 46520 Sagunto, Valencia, Spain.
| | - Oscar Juan-Vidal
- Department of Medical Oncology, Hospital Universitario y Politécnico La Fe, Av. Fernando Abril Martorell, 106. 46026, Valencia, Spain.
| |
Collapse
|
22
|
Chang YY, Chang CH, Ku WW, Gau JP, Yu YB. Tumor lysis syndrome as a risk factor for very early mortality in HIV-associated non-Hodgkin's lymphoma: A 10-year single-center experience. J Chin Med Assoc 2020; 83:371-376. [PMID: 32101892 DOI: 10.1097/jcma.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite the effectiveness of combination antiretroviral therapy, persons living with human immunodeficiency virus (PLWHIV) remain at a high risk of developing non-Hodgkin lymphoma (NHL). We aimed to analyze the demographics and outcomes of the HIV-associated NHLs. METHODS Between 2005 and 2014, PLWHIV with NHLs were retrospectively enrolled at a tertiary referral center. Characteristics and survival were reviewed and analyzed. RESULTS Twenty-two HIV-associated NHLs were identified, with a median follow-up of 14 months (range, 0.1-139.7), including eight diffuse large B-cell lymphomas (DLBCLs), eight primary central nervous system lymphomas (PCNSLs), and six Burkitt's lymphomas (BLs). Nine patients (40.9%) were diagnosed with NHLs and HIV infection concurrently. The prognosis of DLBCL patients tended to be better prognosis than that of BL and PCNSL patients (median overall survival: not reached vs. 3.5 months, p = 0.056). Very early mortality (death within 14 days after NHL diagnosis) was noted in five patients (22.7%), and tumor lysis syndrome (TLS) is a predictive factor for very early mortality among PLWHIV (hazard ratio:11.3, 95% confidence interval: 1.1-114.4, p = 0.04). CONCLUSION Management of the early treatment phase of HIV-associated NHLs remains a major challenge. Careful intervention to patients with TLS might be the key to improve treatment outcomes.
Collapse
Affiliation(s)
- Yea-Yuan Chang
- Division of Infectious Diseases, Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC
- Division of Infectious Diseases, Department of Internal Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan, ROC
- Institute of Clinical Medicine and AIDS prevention and Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chih-Hao Chang
- Division of Gastroenterology, Department of Internal Medicine, Taipei City Hospital Zhongxiao Branch, Taipei, Taiwan, ROC
| | - Wen-Wei Ku
- Division of Infectious Diseases, Department of Internal Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan, ROC
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jyh-Pyng Gau
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yuan-Bin Yu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Oncology & Hematology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| |
Collapse
|
23
|
Risk and Predictors of Esophageal and Stomach Cancers in HIV-Infected Veterans: A Matched Cohort Study. J Acquir Immune Defic Syndr 2020; 81:e65-e72. [PMID: 30939533 DOI: 10.1097/qai.0000000000002038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND To evaluate the risks of esophageal and stomach carcinomas in people living with HIV (PLWH) compared with the general population and risk factors for these cancers in PLWH. SETTING Retrospective cohort study in the Veterans Health Administration. METHODS We compared incidence rates for esophageal and stomach cancers in 44,075 HIV-infected male veterans with those in a matched HIV-uninfected cohort (N = 157,705; 4:1 matched on age and HIV-index date). We used Cox regression models to estimate Hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with HIV infection and for cancer risk factors in PLWH. RESULTS In unadjusted models, HIV infection was associated with increased risks of esophageal squamous cell carcinoma (ESCC; HR, 2.21; 95% CI: 1.47 to 3.13) and gastric cardia cancer (HR, 1.69; 95% CI: 1.00 to 2.85) but associated with lower risk of esophageal adenocarcinoma (EAC; HR, 0.48; 95% CI: 0.31 to 0.74). After adjusting for age, race/ethnicity, smoking and alcohol use, HIV infection remained statistically significantly associated with elevated risk for ESCC [adjusted hazard ratio (aHR), 1.58; 95% CI: 1.02 to 2.47], especially among HIV-infected patients with CD4 count ≤200 (aHR, 2.20; 95% CI: 1.35 to 3.60). HIV infection was not associated with risks of EAC (aHR, 0.82; 95% CI: 0.53 to 1.26), gastric cardia (aHR, 0.80; 95% CI: 0.33 to 1.94), or noncardia (aHR, 1.06; 95% CI: 0.61 to 1.84) cancers. Risk factors for these cancers in HIV-infected patients were otherwise similar to those in general population (eg, Helicobacter pylori for gastric noncardia cancer). CONCLUSION HIV-infected individuals with low CD4 count are at highest risk for ESCC, but HIV infection was not independently associated with EAC or gastric cancer after adjusting for confounders.
Collapse
|
24
|
Abstract
Biomarkers that focus on lung cancer risk assessment, detection, prognosis, diagnosis, and personalized treatment are in various stages of development. This article provides an overview of lung cancer biomarker development, focusing on clinical utility and highlighting 2 unmet clinical needs: selection of high-risk patients for lung cancer screening and differentiation of early lung cancer from benign pulmonary nodules. The authors highlight biomarkers under development and those lung cancer screening and nodule management biomarkers post-clinical validation. Finally, trends in lung cancer biomarker development that may improve accuracy and accelerate implementation in practice are discussed.
Collapse
|
25
|
Sigel K, Park L, Justice A. HIV and cancer in the Veterans Health Administration System. Semin Oncol 2019; 46:334-340. [PMID: 31703932 DOI: 10.1053/j.seminoncol.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022]
Abstract
Cancer is a leading cause of death for people with HIV (PWH). The Veterans Healthcare System (VA) is the largest single institutional provider of HIV care in the United States. Cancer among Veterans with HIV is major issue and clinical research has expanded significantly during the antiretroviral therapy (ART) era providing numerous insights regarding cancer incidence, risk factors, prevention, treatment and outcomes for this unique group of patients. This work has been greatly facilitated by the availability of national VA data sources. Notably, patterns of cancer incidence have changed for Veterans with HIV during the ART era; non-AIDS defining malignancies now are the most common tumors. Despite better HIV control in the ART era, immunosuppression measured by low CD4 counts and HIV viremia have been associated with increased cancer risk. Cancer outcomes for Veterans with HIV may now be similar to uninfected Veterans, but information on outcomes and cancer treatment patterns remains limited, requiring further study to help inform prevention and treatment strategies.
Collapse
Affiliation(s)
- Keith Sigel
- Icahn School of Medicine at Mount Sinai, NY, NY.
| | - Lesley Park
- Stanford University School of Medicine, Palo Alto, CA
| | - Amy Justice
- VA Connecticut Healthcare System, West Haven, CT; Yale University School of Medicine
| |
Collapse
|
26
|
Philippe L, Lancar R, Laurent C, Algarte-Genin M, Chassagne-Clément C, Fabiani B, Pierre Chenard M, Lazure T, Parrens M, Charlotte F, Delattre C, Gibault L, Capron F, Goubin-Versini I, Petitjean B, Boué F, Mounier N, Costello R, Costagliola D, Prevot S, Besson C. In situ BCL2 expression is an independent prognostic factor in HIV-associated DLBCL, a LYMPHOVIR cohort study. Br J Haematol 2019; 188:413-423. [PMID: 31468517 DOI: 10.1111/bjh.16176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022]
Abstract
The prognostic value of cell of origin (COO) classification and BCL2 expression is not well established in diffuse large B-cell lymphoma (DLBCL) patients with human immunodeficiency virus (HIV) infection in the recent era. Phenotypic patterns were determined by immunohistochemistry (IHC) of pathological samples from patients with HIV-associated DLBCL prospectively enrolled in the French AIDS and Viral Hepatitis CO16 Lymphovir cohort between 2008 and 2015. Molecular subgroup classification into germinal centre B-cell (GCB) and non-GCB subtypes was determined using the Hans algorithm. Among 52 samples of systemic DLBCL subjected to centralized pathological analysis, 25 of the 42 tested for BCL2 expression were positive. Samples were further classified into GCB (n = 19) and non-GCB (n = 16) subtypes and 17 remained unclassified. In multivariable analysis, BCL2 expression was an independent pejorative prognostic biomarker [4-year progression-free survival (PFS): 52% for BCL2+ vs. 88% for BCL2- , P = 0·02] and tended to reduce 4-year overall survival (OS) (63% for BCL2+ vs. 88% for BCL2- , P = 0·06). The difference between CGB and non-GCB subtypes on PFS and OS did not reach significance (4-year PFS: 79% for GCB vs. 53% for non-GCB, P = 0·24 and 4-year OS: 78% for GCB vs. 69% for non-GCB, P = 0·34). BCL2 expression determined by IHC is an independent pejorative prognostic biomarker in HIV-associated DLBCL in the recent era. This supports the investigation of new therapeutic strategies in patients with BCL2 expression.
Collapse
Affiliation(s)
- Laure Philippe
- Unit of Haematology-Oncology, Centre Hospitalier Versailles, Le Chesnay, France.,Université Versailles Saint Quentin en Yvelines, Paris-Saclay University, Communauté Paris-Saclay, Saint-Quentin en Yvelines, France
| | - Remi Lancar
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | - Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, CHU Toulouse, Toulouse, France.,INSERM, U.1037, Centre de Recherche en Cancérologie de Toulouse-Purpan, Toulouse, France
| | - Michele Algarte-Genin
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | | | - Bettina Fabiani
- Department of Pathology, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Marie Pierre Chenard
- Department of Pathology, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France
| | - Thierry Lazure
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicêtre, France.,Department of Pathology, AP-HP, Hôpitaux Paris Sud, Paris Sud University, Le Kremlin-Bicetre, France
| | - Marie Parrens
- Department of Pathology, Haut-Lévêque Hospital, Southern Hospital Group, Bordeaux University Hospital, Pessac, France
| | - Frederic Charlotte
- Department of Pathology, Hopital Pitie-Salpetriere and Sorbonne University, Paris, France
| | | | - Laure Gibault
- Department of Pathology, Hôpital Européen Georges Pompidou, AP-HP, and Université Paris Descartes, Paris, France
| | - Frederique Capron
- Department of Pathology, Faculté de médecine Pierre-et-Marie-Curie, Hopital Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Bruno Petitjean
- Department of Pathology, René DUBOS Hospital, Cergy-Pontoise, France
| | - François Boué
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicêtre, France.,Clinical Immunology Unit, AP-HP, Hôpitaux Paris Sud Site Béclère, Clamart, France
| | - Nicolas Mounier
- Department of Onco-Haematology, Archet Hospital, Nice, France
| | - Regis Costello
- Department of Haematology, AP-HM, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Dominique Costagliola
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | - Sophie Prevot
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicêtre, France.,Department of Pathology, AP-HP, Hôpitaux Paris Sud, Paris Sud University, Le Kremlin-Bicetre, France
| | - Caroline Besson
- Unit of Haematology-Oncology, Centre Hospitalier Versailles, Le Chesnay, France.,Université Versailles Saint Quentin en Yvelines, Paris-Saclay University, Communauté Paris-Saclay, Saint-Quentin en Yvelines, France.,INSERM U1018, Centre pour la Recherche en Epidémiologie et Santé des Populations (CESP), Equipe "Générations et Santé" Gustave Roussy, Villejuif, France
| | | |
Collapse
|
27
|
Yin YX, Cai BB, Yin HC. Three new Cu(II)-organic coordination polymers: Crystal structures and inhibiting human gastric cancer cells activity evaluation. MAIN GROUP CHEMISTRY 2019. [DOI: 10.3233/mgc-180724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Yi-Xue Yin
- Department of Thoracic Surgery, Longnan First People’s Hospital, Longnan, Gansu, China
| | - Bin-Bin Cai
- Department of Medical Ultrasonics, Central Hospital of Bailongjiang Forestry Administration of Gansu Province, Longnan, Gansu, China
| | - Hui-Chun Yin
- Department of General Surgery, Wudu District First People’s Hospital, Longnan, Gansu, China
| |
Collapse
|
28
|
Damania B, Münz C. Immunodeficiencies that predispose to pathologies by human oncogenic γ-herpesviruses. FEMS Microbiol Rev 2019; 43:181-192. [PMID: 30649299 PMCID: PMC6435449 DOI: 10.1093/femsre/fuy044] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/30/2018] [Indexed: 12/13/2022] Open
Abstract
Human γ-herpesviruses include the closely related tumor viruses Epstein Barr virus (EBV) and Kaposi sarcoma-associated herpesvirus (KSHV). EBV is the most growth-transforming pathogen known and is linked to at least seven human malignancies. KSHV is also associated with three human cancers. Most EBV- and KSHV-infected individuals fortunately remain disease-free despite persistent infection and this is likely due to the robustness of the immune control that they mount against these tumor viruses. However, upon immune suppression EBV- and KSHV-associated malignancies emerge at increased frequencies. Moreover, primary immunodeficiencies with individual mutations that predispose to EBV or KSHV disease allow us to gain insights into a catalog of molecules that are required for the immune control of these tumor viruses. Curiously, there is little overlap between the mutation targets that predispose individuals to EBV versus KSHV disease, even so both viruses can infect the same host cell, human B cells. These differences will be discussed in this review. A better understanding of the crucial components in the near-perfect life-long immune control of EBV and KSHV should allow us to target malignancies that are associated with these viruses, but also induce similar immune responses against other tumors.
Collapse
Affiliation(s)
- Blossom Damania
- Lineberger Cancer Research Center and Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Christian Münz
- Viral Immunobiology, Institute of Experimental Immunology, University of Zürich, 8057 Zürich, Switzerland
| |
Collapse
|
29
|
Antel K, Levetan C, Mohamed Z, Louw VJ, Oosthuizen J, Maartens G, Verburgh E. The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting. BMC Cancer 2019; 19:384. [PMID: 31023278 PMCID: PMC6485177 DOI: 10.1186/s12885-019-5586-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 04/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Little is known about the pathway to diagnosis of lymphoma in Sub-Saharan Africa, despite the increased risk of lymphoma in people living with HIV (PLHIV). The challenges of diagnosis in this setting include diagnostic confusion with extrapulmonary tuberculosis (EPTB), which commonly causes lymphadenopathy in PLHIV. METHODS We analysed the time to diagnosis and treatment in patients using predetermined time intervals. Univariate and multivariable analyses were performed to determine the relationship between patient and disease-specific variables with delays to diagnosis. We were particularly interested in the impact of HIV, empiric tuberculosis therapy and fine-needle aspirate for cytology (FNAC) in contributing to delay. RESULTS Patients (n = 163), 29% HIV-infected, waited a median of 4 weeks before seeking medical attention. It took a median of 7 weeks for the diagnosis of lymphoma to be made from the time the patient sought medical attention, termed the healthcare practitioner interval. In multivariable logistic regression analysis, diagnostic delay > 6 weeks was associated with late-stage disease (OR 2.3, 95% CI 1.1-5.2) and Hodgkin lymphoma (HL) (OR 3.0, 95% CI 1.1-8.0). HIV status was not associated with diagnostic delay (OR 0.9, 95% CI 0.3-2.2). The median time to diagnosis was a median of 4 weeks longer for patients on tuberculous (TB) therapy (n = 16, p = 0.28) and patients who underwent an FNAC (n = 63, p = 0.04). Where FNAC was performed, it was diagnostic for lymphoma in only 11%. Diagnostic delay was not associated with overall survival. CONCLUSIONS Time-to-diagnosis of lymphoma in South Africa was similar to that reported from high-income countries and shows significant periods of delay between the onset of symptoms to diagnosis and treatment. The longest period of delay was in the health practitioner interval. Education regarding the significance of lymphadenopathy for both patients and health care practitioners and appropriate investigative steps preferably by best-practice algorithms specific to TB-endemic areas are needed to shorten the time-to-diagnosis of lymphoma.
Collapse
Affiliation(s)
- Katherine Antel
- Division of Haematology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa.
| | - Carly Levetan
- Medical advisor, Cell and Gene Therapy, Novartis Oncology, Sydney, Australia
| | - Zainab Mohamed
- Department of Oncology, University of Cape Town, Cape Town, South Africa
| | - Vernon J Louw
- Division of Haematology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Jenna Oosthuizen
- Division of Haematology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Pharmacology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Estelle Verburgh
- Division of Haematology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
30
|
Guidelines for Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection. J Low Genit Tract Dis 2019; 23:87-101. [DOI: 10.1097/lgt.0000000000000468] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
31
|
Hiv and Lymphoma: from Epidemiology to Clinical Management. Mediterr J Hematol Infect Dis 2019; 11:e2019004. [PMID: 30671210 PMCID: PMC6328036 DOI: 10.4084/mjhid.2019.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/23/2018] [Indexed: 01/19/2023] Open
Abstract
Patients infected with human immunodeficiency virus (HIV) are at increased risk for developing both non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). Even if this risk has decreased for NHL after the introduction of combination antiretroviral therapy (cART), they remain the most common acquired immune deficiency syndrome (AIDS)-related cancer in the developed world. They are almost always of B-cell origin, and some specific lymphoma types are more common than others. Some of these lymphoma types can occur in both HIV-uninfected and infected patients, while others preferentially develop in the context of AIDS. HIV-associated lymphoma differs from lymphoma in the HIV negative population in that they more often present with advanced disease, systemic symptoms, and extranodal involvement and are frequently associated with oncogenic viruses (Epstein-Barr virus and/or human herpesvirus-8). Before the introduction of cART, most of these patients could not tolerate the treatment strategies routinely employed in the HIV-negative population. The widespread use of cART has allowed for the delivery of full-dose and dose-intensive chemotherapy regimens with improved outcomes that nowadays can be compared to those seen in non-HIV infected patients. However, a great deal of attention should be paid to opportunistic infections and other infectious complications, cART-chemotherapy interactions, and potential cumulative toxicity. In the context of relatively sparse prospective and randomized trials, the optimal treatment of AIDS-related lymphomas remains a challenge, particularly in patients with severe immunosuppression. This paper will address epidemiology, pathogenesis, and therapeutic strategies in HIV-associated NHL and HL.
Collapse
|
32
|
Abstract
Malignancies were one of the earliest recognized manifestations that led to the description of the acquired immune deficiency syndrome (AIDS). The majority of cancers in AIDS patients are associated with coinfection with oncogenic viruses, such as Epstein-Barr virus, human herpesvirus 8, and human papillomavirus, with resulting malignancies occurring secondary to diminished immune surveillance against viruses and virus-infected tumor cells. Over 50% of AIDS lymphomas are associated with Epstein-Barr virus (EBV) and/or HHV8 infection. HHV8-associated diseases include Kaposi sarcoma (KS), primary effusion lymphoma (PEL), and multicentric Castleman disease (MCD). EBV is associated with several malignancies, including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Coinfection with HIV and HPV is associated with an increased risk of various squamous cell carcinomas of epithelial tissues. HAART has significantly impacted the incidence, management, and prognosis of AIDS-related malignancies. In addition to changing the natural history of HIV infection in regard to incidence and survival, HAART has dramatically decreased the incidence of certain virally mediated HIV-associated malignancies such as KS and primary CNS lymphoma. The beneficial effects of HAART on these tumors are attributed to drug-mediated HIV suppression and immune reconstitution. However, HAART has had a less favorable impact on EBV- and HPV-related malignancies. This chapter presents an overview of HIV-associated malignancies mediated by HHV-8, EBV, and HPV, and reviews the effect of HAART on the epidemiology, presentation, treatment, and outcomes of these cancers.
Collapse
|
33
|
Grover S, Desir F, Jing Y, Bhatia RK, Trifiletti DM, Swisher-McClure S, Kobie J, Moore RD, Rabkin CS, Silverberg MJ, Salters K, Mathews WC, Gill MJ, Thorne JE, Castilho J, Kitahata MM, Justice A, Horberg MA, Achenbach CJ, Mayor A, Althoff KN. Reduced Cancer Survival Among Adults With HIV and AIDS-Defining Illnesses Despite No Difference in Cancer Stage at Diagnosis. J Acquir Immune Defic Syndr 2018; 79:421-429. [PMID: 30211722 PMCID: PMC6203623 DOI: 10.1097/qai.0000000000001842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is not known whether immune dysfunction is associated with increased risk of death after cancer diagnosis in persons with HIV (PWH). AIDS-defining illness (ADI) can signal significant immunosuppression. Our objective was to determine differences in cancer stage and mortality rates in PWH with and without history of ADI. METHODS PWH with anal, oropharynx, cervical, lung cancers, or Hodgkin lymphoma diagnoses from January 2000 to December 2009 in the North American AIDS Cohort Collaboration on Research and Design were included. RESULTS Among 81,865 PWH, 814 had diagnoses included in the study; 341 (39%) had a history of ADI at time of cancer diagnosis. For each cancer type, stage at diagnosis did not differ by ADI (P > 0.05). Mortality and survival estimates for cervical cancer were limited by n = 5 diagnoses. Adjusted mortality rate ratios showed a 30%-70% increase in mortality among those with ADI for all cancer diagnoses, although only lung cancer was statistically significant. Survival after lung cancer diagnosis was poorer in PWH with ADI vs. without (P = 0.0001); the probability of survival was also poorer in those with ADI at, or before other cancers although not statistically significant. CONCLUSIONS PWH with a history of ADI at lung cancer diagnosis had higher mortality and poorer survival after diagnosis compared to those without. Although not statistically significant, the findings of increased mortality and decreased survival among those with ADI (vs. without) were consistent for all other cancers, suggesting the need for further investigations into the role of HIV-related immune suppression and cancer outcomes.
Collapse
Affiliation(s)
- Surbhi Grover
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Fidel Desir
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yuezhou Jing
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rohini K. Bhatia
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Daniel M. Trifiletti
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Julie Kobie
- Department of Biostatics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Charles S. Rabkin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Kate Salters
- BC Centre for Excellence in HIV/AIDS, Simon Fraser University, Vancouver, BC, CANADA
| | | | - M. John Gill
- Southern Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada
| | - Jennifer E. Thorne
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Chad J. Achenbach
- The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Angel Mayor
- Universidad Central del Caribe, Bayamón, Puerto Rico
| | - Keri N Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
34
|
|
35
|
Gheorghiță V, Conea IF, Radu AMC, Ștefan I, Mărdărescu M, Petrea S, Streinu-Cercel A. Epidemiological trends and therapeutic challenges of malignancies in adult HIV-1-infected patients receiving combination antiretroviral therapy in a tertiary hospital from Romania: An observational retrospective study. J Infect Public Health 2018; 12:182-189. [PMID: 30344102 DOI: 10.1016/j.jiph.2018.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/18/2018] [Accepted: 09/25/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Malignancies have become a leading cause of morbidity and mortality in people living with HIV (PLHIV). The primary endpoint of our study was to describe the epidemiology of acquired immunodeficiency syndrome (AIDS)-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs). Epidemiological disparities, mortality predictors and survival analysis within the two groups of patients were key secondary endpoints. METHODS We retrospectively evaluated all adult PLHIV with histopathologically proven cancers registered from 2010 to 2016 in the "Matei Balș" National Institute for Infectious Diseases, Bucharest, Romania. RESULTS 110 eligible patients have been included in the study. The incidence of ADCs decreased from 1.6% in 2010 to 0.3% in 2016, unlike NADCs which remained fairly stable over time (0.3%). The higher CD4 count and lower HIV-RNA level at the cancer diagnosis were associated with prolonged survival in ADCs group, but not in NADCs group. The mean CD4 count was 449/mm3 to survivors and 92/mm3 to non-survivors (p=0.017). The mean level of HIV-RNA was 64,671 copies/mL to survivors and 1,760,345 copies/mL to non-survivors (p=0.002). CONCLUSIONS A good therapeutic control of HIV infection at the diagnosis of ADCs was associated with better survival, emphasizing the key role of the effective cART in the management of HIV-associated cancers.
Collapse
Affiliation(s)
- Valeriu Gheorghiță
- ‟Carol Davila" University of Medicine and Pharmacy, Boulevard Eroii Sanitari, 8, Bucharest, Romania; Central Military University Emergency Hospital "Dr. Carol Davila",Calea Plevnei Street, 134, Bucharest, Romania
| | - Iuliana F Conea
- ‟Carol Davila" University of Medicine and Pharmacy, Boulevard Eroii Sanitari, 8, Bucharest, Romania.
| | - Adelina M C Radu
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Dr. Calistrat Grozovici Street, 1, Bucharest, Romania.
| | - Ion Ștefan
- Central Military University Emergency Hospital "Dr. Carol Davila",Calea Plevnei Street, 134, Bucharest, Romania; ‟Titu Maiorescu" University, Faculty of Medicine,Gheorghe Petrascu Street, 67A, Bucharest, Romania.
| | - Mariana Mărdărescu
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Dr. Calistrat Grozovici Street, 1, Bucharest, Romania.
| | - Sorin Petrea
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Dr. Calistrat Grozovici Street, 1, Bucharest, Romania.
| | - Adrian Streinu-Cercel
- ‟Carol Davila" University of Medicine and Pharmacy, Boulevard Eroii Sanitari, 8, Bucharest, Romania; National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Dr. Calistrat Grozovici Street, 1, Bucharest, Romania.
| |
Collapse
|
36
|
Babey H, Quéré G, Descourt R, Le Calloch R, Lanfranco L, Nousbaum JB, Cornec D, Tison A, Chouaid C. Immune-checkpoint inhibitors to treat cancers in specific immunocompromised populations: a critical review. Expert Rev Anticancer Ther 2018; 18:981-989. [PMID: 29995451 DOI: 10.1080/14737140.2018.1499468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Because of their efficacy against numerous cancers, immune-checkpoint inhibitors (ICIs), anti-cytotoxic T-lymphocyte antigen-4, and anti-programmed cell death monoclonal antibodies are being used ever more often in oncology. However, some patients were excluded from clinical trials because of their comorbidities despite their potentially higher cancer frequencies, as is the case for immunocompromised patients. Areas covered: We analyzed reported preclinical and clinical information and evaluated the risk/benefit ratio for four immunocompromised populations: people living with human immunodeficiency virus (PLHs), solid-organ transplant recipients, recipients of hematopoietic stem-cell allografts, and patients with autoimmune diseases. Expert commentary: Information available in the literature is fragmentary and scarce, making it difficult to evaluate the risk/benefit ratio. It can, nonetheless, be noted that ICI use in PLHs seems possible. For solid-organ transplant recipients, the risk for the graft seems elevated. For the other two populations, it is difficult to conclude at this time.
Collapse
Affiliation(s)
- Hélène Babey
- a Institut de Cancerologie de Bretagne occidentale , Centre Hospitalier Universitaire de Brest , Brest , France
| | - Gilles Quéré
- a Institut de Cancerologie de Bretagne occidentale , Centre Hospitalier Universitaire de Brest , Brest , France
| | - Renaud Descourt
- a Institut de Cancerologie de Bretagne occidentale , Centre Hospitalier Universitaire de Brest , Brest , France
| | - Ronan Le Calloch
- b Service des maladies du sang, médecine interne, maladies infectieuses (MIIS) , Centre Hospitalier de Quimper Cornouaille , Quimper , France.,c Université de Brest , Fédération Inter Hospitalier d'Immuno-Hématologie de Bretagne Occidentale (FIHBO) , Brest , France
| | - Luca Lanfranco
- d Service de néphrologie , Centre Hospitalier Universitaire de Brest , Brest , France.,e UMR1227, Lymphocytes B et Autoimmunité, Inserm, LabEx IGO , Université de Brest , Brest , France
| | - Jean-Baptiste Nousbaum
- f Service d'Hépato-gastroentérologie , Centre Hospitalier Universitaire de Brest , Brest , France.,g Registre Finistérien des Tumeurs Digestives, EA 7479 SPURBO , Université de Bretagne Occidentale , Brest , France
| | - Divi Cornec
- e UMR1227, Lymphocytes B et Autoimmunité, Inserm, LabEx IGO , Université de Brest , Brest , France.,h Rhumatologie et Centre National de Référence des Maladies Auto-Immunes Rares CERAINO , CHRU de Brest , Brest , France
| | - Alice Tison
- e UMR1227, Lymphocytes B et Autoimmunité, Inserm, LabEx IGO , Université de Brest , Brest , France.,h Rhumatologie et Centre National de Référence des Maladies Auto-Immunes Rares CERAINO , CHRU de Brest , Brest , France
| | - Christos Chouaid
- i Service de pneumologie , Centre Hospitalier Intercommunal de Créteil , Créteil , France
| |
Collapse
|
37
|
Benefits and harms of lung cancer screening in HIV-infected individuals with CD4+ cell count at least 500 cells/μl. AIDS 2018; 32:1333-1342. [PMID: 29683843 PMCID: PMC5991188 DOI: 10.1097/qad.0000000000001818] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Lung cancer is the leading cause of non-AIDS-defining cancer deaths among HIV-infected individuals. Although lung cancer screening with low-dose computed tomography (LDCT) is endorsed by multiple national organizations, whether HIV-infected individuals would have similar benefit as uninfected individuals from lung cancer screening is unknown. Our objective was to determine the benefits and harms of lung cancer screening among HIV-infected individuals. DESIGN We modified an existing simulation model, the Lung Cancer Policy Model, for HIV-infected patients. DATA SOURCES Veterans Aging Cohort Study, Kaiser Permanente Northern California HIV Cohort, and medical literature. TARGET POPULATION HIV-infected current and former smokers. TIME HORIZON Lifetime. PERSPECTIVE Population. INTERVENTION Annual LDCT screening from ages 45, 50, or 55 until ages 72 or 77 years. MAIN OUTCOME MEASURES Benefits assessed included lung cancer mortality reduction and life-years gained; harms assessed included numbers of LDCT examinations, false-positive results, and overdiagnosed cases. RESULTS OF BASE-CASE ANALYSIS For HIV-infected patients with CD4 cell count at least 500 cells/μl and 100% antiretroviral therapy adherence, screening using the Centers for Medicare & Medicaid Services criteria (age 55-77, 30 pack-years of smoking, current smoker or quit within 15 years of screening) would reduce lung cancer mortality by 18.9%, similar to the mortality reduction of uninfected individuals. Alternative screening strategies utilizing lower screening age and/or pack-years criteria increase mortality reduction, but require more LDCT examinations. LIMITATIONS Strategies assumed 100% screening adherence. CONCLUSION Lung cancer screening reduces mortality in HIV-infected patients with CD4 cell count at least 500 cells/μl, with a number of efficient strategies for eligibility, including the current Centers for Medicare & Medicaid Services criteria.
Collapse
|
38
|
|
39
|
Fink VI, Jenkins CA, Castilho JL, Person AK, Shepherd BE, Grinsztejn B, Netto J, Crabtree-Ramirez B, Cortés CP, Padgett D, Jayathilake K, McGowan C, Cahn P. Survival after cancer diagnosis in a cohort of HIV-positive individuals in Latin America. Infect Agent Cancer 2018; 13:16. [PMID: 29760767 PMCID: PMC5941620 DOI: 10.1186/s13027-018-0188-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/25/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study aimed to evaluate trends and predictors of survival after cancer diagnosis in persons living with HIV in the Caribbean, Central, and South America network for HIV epidemiology cohort. METHODS Demographic, cancer, and HIV-related data from HIV-positive adults diagnosed with cancer ≤ 1 year before or any time after HIV diagnosis from January 1, 2000-June 30, 2015 were retrospectively collected. Cancer cases were classified as AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC). The association of mortality with cancer- and HIV-related factors was assessed using Kaplan-Meier curves and Cox proportional hazards models stratified by clinic site and cancer type. RESULTS Among 15,869 patients, 783 had an eligible cancer diagnosis; 82% were male and median age at cancer diagnosis was 39 years (interquartile range [IQR]: 32-47). Patients were from Brazil (36.5%), Argentina (19.9%), Chile (19.7%), Mexico (19.3%), and Honduras (4.6%). A total of 564 ADC and 219 NADC were diagnosed. Patients with NADC had similar survival probabilities as those with ADC at one year (81% vs. 79%) but lower survival at five years (60% vs. 69%). In the adjusted analysis, risk of mortality increased with detectable viral load (adjusted hazard ratio [aHR] = 1.63, p = 0.02), age (aHR = 1.02 per year, p = 0.002) and time between HIV and cancer diagnoses (aHR = 1.03 per year, p = 0.01). CONCLUSION ADC remain the most frequent cancers in the region. Overall mortality was related to detectable viral load and age. Longer-term survival was lower after diagnosis of NADC than for ADC, which may be due to factors unrelated to HIV.
Collapse
Affiliation(s)
- Valeria I. Fink
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
| | - Cathy A. Jenkins
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Jessica L. Castilho
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Anna K. Person
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Bryan E. Shepherd
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
| | - Juliana Netto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
| | - Brenda Crabtree-Ramirez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: Unidad del Paciente Ambulatorio (UPA), 5to piso Vasco de Quiroga # 15 Col. Sección XVI Delegación Tlalpan; C.P, 14000 Mexico City, Mexico
| | | | - Denis Padgett
- Instituto Hondureño de Seguridad Social, Barrio la Granja, Tegucigalpa Honduras, Hospital Escuela Universitario: Av La Salud, Tegucigalpa, Honduras
| | - Karu Jayathilake
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Catherine McGowan
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Pedro Cahn
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
| | - on behalf of CCASAnet
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: Unidad del Paciente Ambulatorio (UPA), 5to piso Vasco de Quiroga # 15 Col. Sección XVI Delegación Tlalpan; C.P, 14000 Mexico City, Mexico
- Fundación Arriarán, Santa Elvira 629, Santiago, Chile
- Instituto Hondureño de Seguridad Social, Barrio la Granja, Tegucigalpa Honduras, Hospital Escuela Universitario: Av La Salud, Tegucigalpa, Honduras
| |
Collapse
|
40
|
Criss SD, Sheehan DF, Palazzo L, Kong CY. Population impact of lung cancer screening in the United States: Projections from a microsimulation model. PLoS Med 2018; 15:e1002506. [PMID: 29415013 PMCID: PMC5802442 DOI: 10.1371/journal.pmed.1002506] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/12/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous simulation studies estimating the impacts of lung cancer screening have ignored the changes in smoking prevalence over time in the United States. Our primary rationale was to perform, to our knowledge, the first simulation study that estimates the health outcomes of lung cancer screening with explicit modeling of smoking trends for the whole US population. METHODS/FINDINGS Utilizing a well-validated microsimulation model, we estimated the benefits and harms of an annual low-dose computed tomography screening scenario with a realistic screening adherence rate versus a no-screening scenario for the US population from 2016-2030. The Centers for Medicare and Medicaid Services (CMS) eligibility criteria were applied: age 55-77 years at time of screening, history of at least 30 pack-years of smoking, and current smoker or former smoker with fewer than 15 years since quitting. In the screened population, cumulative mortality reduction was projected to reach 16.98% (95% CI 16.90%-17.07%). Cumulative mortality reduction was estimated to be 3.52% (95% CI 3.50%-3.53%) for the overall study population, with annual mortality reduction peaking at 4.38% (95% CI 4.36%-4.41%) in 2021 and falling to 3.53% (95% CI 3.50%-3.56%) by 2030. Lung cancer screening would save a projected 148,484 life-years (95% CI 147,429-149,540) across the total population through 2030. There were estimated to be 9,054 (95% CI 9,011-9,098) overdiagnosed cases among the 252,429 (95% CI 251,208-253,649) screen-detected lung cancer diagnoses, yielding an overdiagnosis rate of 3.59%. The limitations of our study are that we do not explicitly model race or socioeconomic status and our model was calibrated to data from studies performed in academic centers, both of which may impact the generalizability of our results. We also exclusively model the effects of the CMS guidelines for lung cancer screening and not any other screening strategies. CONCLUSIONS The mortality reduction and life-years gained estimated by this study are lower than those of single birth cohort studies. Single cohort studies neglect the changing dynamics of smoking behavior across generations, whereas this study reflects the trend of decreasing smoking prevalence since the 1960s. Maximum benefit could be derived from lung cancer screening through 2021; in later years, mortality reduction due to screening will decline. If a comprehensive screening program is not implemented in the near future, the opportunity to achieve these benefits will have passed.
Collapse
Affiliation(s)
- Steven D. Criss
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Deirdre F. Sheehan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lauren Palazzo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
41
|
Abstract
Pulmonary complications remain among the most frequent causes of morbidity and mortality for individuals with HIV despite the advent of antiretroviral therapy (ART) and improvement in its efficacy and availability. The prevalence of non-infectious pulmonary diseases is rising in this population, reflecting both an increase in smoking and the independent risk associated with HIV. The unique mechanisms of pulmonary disease in these patients remain poorly understood, and direct effects of HIV, genetic predisposition, inflammatory pathways, and co-infections have all been implicated. Lung cancer, chronic obstructive pulmonary disease (COPD), and pulmonary hypertension are the most prevalent non-infectious pulmonary diseases in persons with HIV, and the risk of each of these diseases is higher among HIV-infected (HIV+) persons than in the general population. This review discusses the latest advances in the literature on these important complications of HIV infection.
Collapse
Affiliation(s)
- M Triplette
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - K Crothers
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA
| | - E F Attia
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
42
|
Hybrid 2D/3D-quantitative structure-activity relationship and modeling studies perspectives of pepstatin A analogs as cathepsin D inhibitors. Future Med Chem 2017; 10:5-26. [PMID: 29235371 DOI: 10.4155/fmc-2017-0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Cathepsin D, one of the attractive targets in the treatment of breast cancer, has been implicated in HIV neuropathogenesis with potential proteolytic effects on chemokines. Methodology/result: Diverse modeling tools were used to reveal the key structural features affecting the inhibitory activities of 78 pepstatin A analogs. Analyses were performed to investigate the stability, rationality and fluctuation of the analogs. Results showed a clear correlation between the experimental and predicted activities of the analogs as well as the variation in their activities relative to structural modifications. CONCLUSION The insight gained from this study offers theoretical references for understanding the mechanism of action of cathepsin D and will aid in the design of more potent and clinically-relevant drugs. Graphical abstract [Formula: see text].
Collapse
|
43
|
Hessol NA, Ma D, Scheer S, Hsu LC, Schwarcz SK. Changing temporal trends in non-AIDS cancer mortality among people diagnosed with AIDS: San Francisco, California, 1996-2013. Cancer Epidemiol 2017; 52:20-27. [PMID: 29175052 DOI: 10.1016/j.canep.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Antiretroviral therapy (ART) has reduced AIDS-defining cancer (ADC) mortality, but its effect on non-AIDS-defining cancer (NADC) mortality is unclear. To help inform cancer prevention and screening, we evaluated trends in NADC mortality among people with AIDS (PWA) in the ART era. METHODS This retrospective cohort study analyzed AIDS surveillance data, including causes of death from death certificates, for PWA in San Francisco who died in 1996-2013. Proportional mortality ratios (PMRs), and year, age, race, sex-adjusted standardized mortality ratios (SMRs) were calculated for 1996-1999, 2000-2005, and 2006-2013, corresponding to advances in ART. RESULTS The study included 5822 deceased PWA of whom 90% were male and 68% were aged 35-54 at time of death. Over time, the PMRs significantly decreased for ADCs (2.6%, 1.4%, 1.2%) and increased for NADCs (4.3%, 7.0%, 12.3%). For all years combined (1996-2013) and compared to the California population, significantly elevated SMRs were observed for these cancers: all NADCs combined (2.1), anal (58.4), Hodgkin lymphoma (10.5), liver (5.2), lung/larynx (3.0), rectal (5.2), and tongue (4.7). Over time, the SMRs for liver cancer (SMR 19.8, 11.2, 5.0) significantly decreased while the SMRs remained significantly elevated over population levels for anal (SMR 123, 48.2, 45.5), liver (SMR 19.8, 11.2, 5.0), and lung/larynx cancer (SMR 5.3, 4.7, 3.6). CONCLUSION A decline in ADC PMRs and increase in NADC PMRs represent a shift in the cancer burden, likely due to ART use. Moreover, given their elevated SMRs, anal, liver, and lung/larynx cancer remain targets for improved cancer prevention, screening, and treatment.
Collapse
Affiliation(s)
- Nancy A Hessol
- Departments of Clinical Pharmacy and of Medicine, University of California, 3333 California Street, Suite 420, San Francisco, CA, 94143-0613, USA.
| | - Danning Ma
- Department of Clinical Pharmacy, University of California, 3333 California Street, San Francisco, CA, 94143-0613, USA
| | - Susan Scheer
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6012, USA
| | - Ling C Hsu
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6012, USA
| | - Sandra K Schwarcz
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6012, USA
| |
Collapse
|
44
|
Tanaka LF, Latorre MDRDO, Gutierrez EB, Curado MP, Dal Maso L, Herbinger KH, Froeschl G, Heumann C. Cancer survival in people with AIDS: A population-based study from São Paulo, Brazil. Int J Cancer 2017; 142:524-533. [PMID: 28971480 DOI: 10.1002/ijc.31081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/11/2017] [Accepted: 09/20/2017] [Indexed: 01/21/2023]
Abstract
Cancer survival among people with AIDS (PWA) has been described in developed countries, but there is lack of data from developing countries. The aim of this study was to evaluate survival after cancer diagnosis in PWA and compare it with people without AIDS (non-PWA) in São Paulo, Brazil. A probabilistic record linkage was carried out between the databases of the Population-based Cancer Registry of São Paulo (PBCR-SP) and the AIDS registry of SP (SINAN) to identify PWA who developed cancer. For comparison, non-PWA were frequency matched from the PBCR-SP by cancer site/type, sex, age, and period. Hazard ratio (HR) stratified by matching variables was estimated using a Cox proportional hazards model. A total of 1,294 PWA (20 patients with two primary site tumors) were included in the site/type-specific analyses. AIDS-defining cancers (ADC) comprised 51.9% of cases assessed. The all-cancer 5-year overall survival in PWA was 49.4% versus 72.7% in non-PWA (HR = 2.64; 95%CI = 2.39-2.91). Survival was impaired in PWA for both ADC (HR = 2.93; 95%CI = 2.49-3.45) and non-ADC (HR = 2.51; 95%CI = 2.21-2.84), including bladder (HR = 8.11; 95% CI = 2.09-31.52), lung (HR = 2.93; 95%CI = 1.97-4.36) and anal cancer (HR = 2.53; 95%CI = 1.63-3.94). These disparities were seen mainly in the first year after cancer diagnosis. The overall survival was significantly lower in PWA in comparison with non-PWA in São Paulo, as seen in high-income countries. Efforts to enhance early diagnosis and ensure proper cancer treatment in PWA should be emphasized.
Collapse
Affiliation(s)
- Luana F Tanaka
- Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.,Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.,Population-Based Cancer Registry of São Paulo, Department of Epidemiology, University of São Paulo, São Paulo, Brazil
| | - Maria do Rosário D O Latorre
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.,Population-Based Cancer Registry of São Paulo, Department of Epidemiology, University of São Paulo, São Paulo, Brazil
| | - Eliana B Gutierrez
- Municipal STD-AIDS Program, Secretaria Municipal de Saúde, São Paulo, Brazil
| | - Maria P Curado
- A. C. Camargo Cancer Center, São Paulo, Brazil.,International Prevention Research Institute, Lyon, France
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Guenter Froeschl
- Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Christian Heumann
- Department of Statistics, University of Munich (LMU), Munich, Germany
| |
Collapse
|
45
|
Nkanga MSN, Longo-Mbenza B, Adeniyi OV, Ngwidiwo JB, Katawandja AL, Kazadi PRB, Nzonzila AN. Ageing, exposure to pollution, and interactions between climate change and local seasons as oxidant conditions predicting incident hematologic malignancy at KINSHASA University clinics, Democratic Republic of CONGO (DRC). BMC Cancer 2017; 17:559. [PMID: 28835214 PMCID: PMC5569529 DOI: 10.1186/s12885-017-3547-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/14/2017] [Indexed: 01/06/2023] Open
Abstract
Background The global burden of hematologic malignancy (HM) is rapidly rising with aging, exposure to polluted environments, and global and local climate variability all being well-established conditions of oxidative stress. However, there is currently no information on the extent and predictors of HM at Kinshasa University Clinics (KUC), DR Congo (DRC). This study evaluated the impact of bio-clinical factors, exposure to polluted environments, and interactions between global climate changes (EL Nino and La Nina) and local climate (dry and rainy seasons) on the incidence of HM. Methods This hospital-based prospective cohort study was conducted at Kinshasa University Clinics in DR Congo. A total of 105 black African adult patients with anaemia between 2009 and 2016 were included. HM was confirmed by morphological typing according to the French-American-British (FAB) Classification System. Gender, age, exposure to traffic pollution and garages/stations, global climate variability (El Nino and La Nina), and local climate (dry and rainy seasons) were potential independent variables to predict incident HM using Cox regression analysis and Kaplan Meier curves. Results Out of the total 105 patients, 63 experienced incident HM, with an incidence rate of 60%. After adjusting for gender, HIV/AIDS, and other bio-clinical factors, the most significant independent predictors of HM were age ≥ 55 years (HR = 2.4; 95% CI 1.4–4.3; P = 0.003), exposure to pollution and garages or stations (HR = 4.9; 95% CI 2–12.1; P < 0.001), combined local dry season + La Nina (HR = 4.6; 95%CI 1.8–11.8; P < 0.001), and combined local dry season + El Nino (HR = 4; 95% CI 1.6–9.7; P = 0.004). HM types included acute myeloid leukaemia (28.6% n = 18), multiple myeloma (22.2% n = 14), myelodysplastic syndromes (15.9% n = 10), chronic myeloid leukaemia (15.9% n = 10), chronic lymphoid leukaemia (9.5% n = 6), and acute lymphoid leukaemia (7.9% n = 5). After adjusting for confounders using Cox regression analysis, age ≥ 55 years, exposure to pollution, combined local dry season + La Nina and combined local dry season + El Nino were the most significant predictors of incident hematologic malignancy. Conclusion These findings highlight the importance of aging, pollution, the dry season, El Nino and La Nina as related to global warming as determinants of hematologic malignancies among African patients from Kinshasa, DR Congo. Cancer registries in DRC and other African countries will provide more robust database for future researches on haematological malignancies in the region.
Collapse
Affiliation(s)
- Mireille Solange Nganga Nkanga
- Département de Biologie Médicale, Service de Biologie Clinique, CUK, Faculté de Médecine, Kinshasa, Democratic Republic of Congo
| | - Benjamin Longo-Mbenza
- Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, 5117, Mthatha, South Africa.
| | - Oladele Vincent Adeniyi
- Cecilia Makiwane Hospital/Walter Sisulu University, Faculty of Health Sciences, East London, South Africa.
| | - Jacques Bikaula Ngwidiwo
- Département de Biologie Médicale, Service de Biologie Clinique, CUK, Faculté de Médecine, Kinshasa, Democratic Republic of Congo
| | - Antoine Lufimbo Katawandja
- Département de Biologie Médicale, Service de Biologie Clinique, CUK, Faculté de Médecine, Kinshasa, Democratic Republic of Congo
| | | | | |
Collapse
|
46
|
Increased incidence of cancer observed in HIV/hepatitis C virus-coinfected patients versus HIV-monoinfected. AIDS 2017; 31:1099-1107. [PMID: 28441174 DOI: 10.1097/qad.0000000000001448] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer is a growing problem in persons living with HIV infection (PLWH) and hepatitis C virus (HCV) coinfection could play an additional role in carcinogenesis. Herein, all cancers in an HIV-mono and HIV/HCV-coinfected cohort were evaluated and compared to identify any differences between these two populations. METHODS A retrospective cohort study was conducted including all cancers in PLWH between 1993 and 2014. Cancers were classified in two groups: AIDS-defining cancer (ADC) and non-AIDS-defining cancer (NADC). Cancer incidence rates were calculated and compared with that observed in the Spanish general population (GLOBOCAN, 2012), computing the standardized incidence ratios (SIRs). A competing risk approach was used to estimate the probability of cancer after HIV diagnosis. Cumulative incidence in HIV-monoinfected and HIV/HCV-coinfected patients was also compared using multivariable analysis. RESULTS A total of 185 patients (117 HIV-monoinfected and 68 HIV/HCV) developed cancer in the 26 580 patient-years cohort, with an incidence rate of 696 cancers per 100 000 person-years, higher than in the general population (SIR = 3.8). The incidence rate of NADC in HIV/HCV-coinfected patients was 415.0 (SIR = 3.4), significantly higher than in monoinfected (377.3; SIR = 1.8). After adjustments, HIV/HCV-coinfected patients had a higher cumulative incidence of NADC than HIV-monoinfected (adjusted hazard ratio = 1.80), even when excluding hepatocellular carcinomas (adjusted hazard ratio = 1.26). CONCLUSION PLWH have a higher incidence of NADC than the general population and HCV-coinfection is associated with a higher incidence of NADC. These data justify the need for prevention strategies in these two populations and the importance of eradicating HCV.
Collapse
|
47
|
Riedel DJ, Stafford KA, Vadlamani A, Redfield RR. Virologic and Immunologic Outcomes in HIV-Infected Patients with Cancer. AIDS Res Hum Retroviruses 2017; 33:482-489. [PMID: 27824263 DOI: 10.1089/aid.2016.0181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Achievement and maintenance of virologic suppression after cancer diagnosis have been associated with improved outcomes in HIV-infected patients, but few studies have analyzed the virologic and immunologic outcomes after a cancer diagnosis. All HIV-infected patients with a diagnosis of cancer between 2000 and 2011 in an urban clinic population in Baltimore, MD, were included for review. HIV-related outcomes (HIV-1 RNA viral load and CD4 cell count) were abstracted and compared for patients with non-AIDS-defining cancers (NADCs) and AIDS-defining cancers (ADCs). Four hundred twelve patients with baseline CD4 or HIV-1 RNA viral load data were analyzed. There were 122 (30%) diagnoses of ADCs and 290 (70%) NADCs. Patients with NADCs had a higher median age (54 years vs. 43 years, p < .0001) and a higher frequency of hepatitis C coinfection (52% vs. 36%, p = .002). The median baseline CD4 was lower for patients with ADCs (137 cells/mm3 vs. 314 cells/mm3) and patients with NADCs were more likely to be suppressed at cancer diagnosis (59% vs. 25%) (both p < .0001). The median CD4 for patients with NADCs was significantly higher than patients with ADCs at 6 and 12 months after diagnosis and higher at 18 and 24 months, but not significantly. Patients with an NADC had 2.19 times (95% CI 1.04-4.62) the adjusted odds of being suppressed at 12 months and 2.17 times the odds (95% CI 0.92-5.16) at 24 months compared to patients with an ADC diagnosis. For patients diagnosed with ADCs and NADCs in this urban clinic setting, both virologic suppression and immunologic recovery improved over time. Patients with NADCs had the highest odds of virologic suppression in the 2 years following cancer diagnosis.
Collapse
Affiliation(s)
- David J. Riedel
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kristen A. Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aparna Vadlamani
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert R. Redfield
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
48
|
Linke-Serinsöz E, Fend F, Quintanilla-Martinez L. Human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) related lymphomas, pathology view point. Semin Diagn Pathol 2017; 34:352-363. [PMID: 28506687 DOI: 10.1053/j.semdp.2017.04.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The contribution of Epstein Barr virus (EBV) and Kaposi sarcoma herpes virus (KSHV) to the development of specific types of malignant lymphomas occurring in the human immunodeficiency virus (HIV) setting has been extensively studied since the beginning of the HIV epidemic 35 years ago. The introduction of highly active antiretroviral therapies (HAART) in 1996 has changed dramatically the incidence of HIV-related malignancies. Nevertheless, malignant lymphomas continue to be the major group of malignances observed in HIV infected individuals, and the most common cause of cancer related-deaths. Common features of the predominant B-cell lymphomas in the HIV+ setting are the frequent plasmacytoid morphology of the neoplastic cells, advanced stage, aggressive disease and frequent extranodal involvement. In this article, we review the evolving concepts and definitions of the various EBV-associated lymphomas in HIV+ patients, including diffuse large B-cell lymphoma, Burkitt lymphoma, classical Hodgkin lymphoma, plasmablastic lymphoma and primary effusion lymphoma. The current knowledge regarding the pathogenesis of these malignancies, the interplay between HIV and EBV co-infection in the development of certain HIV related lymphomas, and the emerging paradigm that suggests that HIV may play a direct role in lymphomagenesis are explored as well.
Collapse
Affiliation(s)
- Ebru Linke-Serinsöz
- Institute of Pathology, University Hospital Tübingen, Eberhard-Karls-University of Tübingen and Comprehensive Cancer Center, Tübingen, Germany
| | - Falko Fend
- Institute of Pathology, University Hospital Tübingen, Eberhard-Karls-University of Tübingen and Comprehensive Cancer Center, Tübingen, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology, University Hospital Tübingen, Eberhard-Karls-University of Tübingen and Comprehensive Cancer Center, Tübingen, Germany.
| |
Collapse
|
49
|
Mortality and virological failure among HIV-infected people who inject drugs on antiretroviral treatment in China: An observational cohort study. Drug Alcohol Depend 2017; 170:189-197. [PMID: 27987476 PMCID: PMC6301141 DOI: 10.1016/j.drugalcdep.2016.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE HIV-infected people who inject drugs (PWID) have a disproportionally low rate of access to antiretroviral therapy (ART). We aimed to assess the impact of ART on 12-month mortality and virological failure of HIV-infected PWID in China, stratified by methadone maintenance treatment (MMT) and active drug use status. METHODS HIV-infected PWID who initiated ART at 29 clinics in 2011 were enrolled and followed in this prospective cohort study. Kaplan-Meier curves and log-rank tests were used to compare the survival probability. Risk factors for mortality and virological failure were evaluated by Cox proportional hazards models and logistic regression analyses. RESULTS A total of 1,633 participants initiated ART. At the time of initiation, 324 were on MMT, 625 were engaged in active drug use, and 684 had discontinued drug use but were not on MMT. At the 12-month follow-up, 80.3% remained on ART, 13.5% had discontinued ART, and 6.2% had died. Among the MMT group, active drug use group, and drug abstinent group, we observed all-cause mortality of 4.9%, 12.0%, and 1.5% and virological suppression of 51.9%, 41.1%, and 68.7%, respectively. Factors associated with both mortality and virological failure were drug use status, unemployment, and treatment facility type. CONCLUSION For HIV-infected PWID receiving ART, engagement in MMT and discontinuation of drug use were more likely to be associated with lower mortality and virological failure compared with active drug use. In order to maximize the clinical impact of ART, HIV treatment programs in China should be further integrated with MMT and social services.
Collapse
|
50
|
Sigel K, Wisnivesky J, Crothers K, Gordon K, Brown ST, Rimland D, Rodriguez-Barradas MC, Gibert C, Goetz MB, Bedimo R, Park LS, Dubrow R. Immunological and infectious risk factors for lung cancer in US veterans with HIV: a longitudinal cohort study. Lancet HIV 2016; 4:e67-e73. [PMID: 27916584 DOI: 10.1016/s2352-3018(16)30215-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/08/2016] [Accepted: 09/16/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND HIV infection is independently associated with risk of lung cancer, but few data exist for the relation between longitudinal measurements of immune function and lung-cancer risk in people living with HIV. METHODS We followed up participants with HIV from the Veterans Aging Cohort Study for a minimum of 3 years between Jan 1, 1998, and Dec 31, 2012, and used cancer registry data to identify incident cases of lung cancer. The index date for each patient was the later of the date HIV care began or Jan 1, 1998. We excluded patients with less than 3 years' follow-up, prevalent diagnoses of lung cancer, or incomplete laboratory data. We used Cox regression models to investigate the relation between different time-updated lagged and cumulative exposures (CD4 cell count, CD8 cell count, CD4/CD8 ratio, HIV RNA, and bacterial pneumonia) and risk of lung cancer. Models were adjusted for age, race or ethnicity, smoking, hepatitis C virus infection, alcohol use disorders, drug use disorders, and history of chronic obstructive pulmonary disease and occupational lung disease. FINDINGS We identified 277 cases of incident lung cancer in 21 666 participants with HIV. In separate models for each time-updated 12 month lagged, 24 month simple moving average cumulative exposure, increased risk of lung cancer was associated with low CD4 cell count (p trend=0·001), low CD4/CD8 ratio (p trend=0·0001), high HIV RNA concentration (p=0·004), and more cumulative bacterial pneumonia episodes (12 month lag only; p trend=0·0004). In a mutually adjusted model including these factors, CD4/CD8 ratio and cumulative bacterial pneumonia episodes remained significant (p trends 0·003 and 0·004, respectively). INTERPRETATION In our large HIV cohort in the antiretroviral therapy era, we found evidence that dysfunctional immune activation and chronic inflammation contribute to the development of lung cancer in the setting of HIV infection. These findings could be used to target lung-cancer prevention measures to high-risk groups. FUNDING US National Institutes of Health.
Collapse
Affiliation(s)
- Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Juan Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristina Crothers
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kirsha Gordon
- Department of Medicine, VA Connecticut Healthcare System and Yale Schools of Medicine and Public Health, New Haven, CT, USA
| | - Sheldon T Brown
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Infectious Diseases Section, James J Peters VA Medical Center, Bronx, NY, USA
| | - David Rimland
- Infectious Diseases Section, Atlanta VA Medical Center and Emory University School of Medicine, Decatur, GA, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Cynthia Gibert
- Department of Medicine, George Washington University School of Medicine and Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Matthew Bidwell Goetz
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Roger Bedimo
- Division of Infectious Diseases, VA North Texas Health Care System, Dallas, TX, USA
| | - Lesley S Park
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Robert Dubrow
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|