1
|
Kurosawa S, Yoshimura Y, Takada Y, Yokota T, Hibi M, Hirahara A, Yoshida T, Okubo S, Masuda M, So Y, Miyata N, Nakayama H, Sakurai A, Sato K, Ito C, Aisa Y, Nakazato T. A predictive model for HIV-related lymphoma. AIDS 2024; 38:1627-1637. [PMID: 38831732 PMCID: PMC11296280 DOI: 10.1097/qad.0000000000003949] [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] [Received: 02/09/2024] [Revised: 04/24/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES To address the paucity of HIV-related lymphoma (HRL)-specific prognostic scores for the Japanese population by analyzing domestic cases of HRL and constructing a predictive model. DESIGN A single-center retrospective study coupled with a review of case reports of HRL. METHODS We reviewed all patients with HRL treated at our hospital between 2007 and 2023 and conducted a comprehensive search for case reports of HRL from Japan using public databases. A multivariate analysis for overall survival (OS) was performed using clinical parameters, leading to the formulation of the HIV-Japanese Prognostic Index (HIV-JPI). RESULTS A total of 19 patients with HRL were identified in our institution, whereas the literature review yielded 44 cases. In the HIV-JPI, a weighted score of 1 was assigned to the following factors: age at least 45 years, HIV-RNA at least 8.0×10 4 copies/ml, Epstein-Barr virus-encoded small RNA positivity, and Ann Arbor classification stage IV. The overall score ranged from 0 to 4. We defined the low-risk group as scores ranging from 0 to 2 and the high-risk group as scores ranging from 3 to 4. The 3-year OS probability of the high-risk group [30.8%; 95% confidence interval (CI): 9.5-55.4%) was significantly poorer than that of the low-risk group (76.8%; 95% CI: 52.8-89.7%; P < 0.01). CONCLUSION This retrospective analysis established pivotal prognostic factors for HRL in Japanese patients. The HIV-JPI, derived exclusively from Japanese patients, highlights the potential for stratified treatments and emphasizes the need for broader studies to further refine this clinical prediction model.
Collapse
Affiliation(s)
| | - Yukihiro Yoshimura
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | | | | | | | | | | | | | | | - Yuna So
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Nobuyuki Miyata
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | | | | | - Kosuke Sato
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | | | | | | |
Collapse
|
2
|
Ma Y, Zhang J, Yang X, Chen S, Weissman S, Olatosi B, Alberg A, Li X. Association of CD4 + cell count and HIV viral load with risk of non-AIDS-defining cancers. AIDS 2023; 37:1949-1957. [PMID: 37382882 PMCID: PMC10538428 DOI: 10.1097/qad.0000000000003637] [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: 06/30/2023]
Abstract
OBJECTIVES HIV-induced immunodeficiency contributes to an increased risk of non-AIDS-defining cancers (NADC). This study aims to identify the most predictive viral load (VL) or CD4 + measures of NADC risk among people with HIV (PWH). DESIGN Extracted from South Carolina electronic HIV reporting system, we studied adult PWH who were cancer-free at baseline and had at least 6 months of follow-up since HIV diagnosis between January 2005 and December 2020. METHODS Using multiple proportional hazards models, risk of NADC was investigated in relation to 12 measures of VL and CD4 + cell count at three different time intervals before NADC diagnosis. The best VL/CD4 + predictor(s) and final model were determined using Akaike's information criterion. RESULTS Among 10 413 eligible PWH, 449 (4.31%) developed at least one type of NADC. After adjusting for potential confounders, the best predictors of NADC were the proportion of days with viral suppression (hazard ratio [HR]: 0.47 (>25% and ≤50% vs. 0), 95% confidence interval [CI]: [0.28, 0.79]) and proportion of days with low CD4 + cell count (AIC = 7201.35) (HR: 12.28 (>75% vs. = 0), 95% CI: [9.29, 16.23]). CONCLUSIONS VL and CD4 + measures are strongly associated with risk of NADC. In analyses examining three time windows, proportion of days with low CD4 + cell count was the best CD4 + predictor for each time window. However, the best VL predictor varied across time windows. Thus, using the best combination of VL and CD4 + measures for a specific time window should be considered when predicting NADC risk.
Collapse
Affiliation(s)
- Yunqing Ma
- Department of Epidemiology and Biostatistics
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics
- South Carolina SmatState Center for Healthcare Quality
| | - Xueying Yang
- South Carolina SmatState Center for Healthcare Quality
- Department of Health Promotion, Education and Behavior
| | - Shujie Chen
- Department of Epidemiology and Biostatistics
| | - Sharon Weissman
- South Carolina SmatState Center for Healthcare Quality
- Department of Internal Medicine, School of Medicine
| | - Bankole Olatosi
- South Carolina SmatState Center for Healthcare Quality
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | - Xiaoming Li
- South Carolina SmatState Center for Healthcare Quality
- Department of Health Promotion, Education and Behavior
| |
Collapse
|
3
|
A Rare Case of Plasmablastic Lymphoma in a Patient with HIV and SARS-CoV-2 Infections. Curr Oncol 2022; 29:1537-1543. [PMID: 35323329 PMCID: PMC8947703 DOI: 10.3390/curroncol29030129] [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: 01/24/2022] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Lesions commonly associated with HIV infection include oral candidiasis, herpes simplex infection, oral Kaposi’s sarcoma, hairy leukoplakia, periodontal diseases (linear gingival erythema and necrotizing ulcerative periodontitis), xerostomia, human papillomavirus-associated warts, aphthous ulcers, non-Hodgkin’s lymphoma, histoplasmosis, carcinoma, exfoliative cheilitis, and HIV salivary gland disease. Non-Hodgkin’s lymphoma (NHL) is the most common cancer in people living with HIV (PLWH), and the incidence is increased for aggressive B-cell NHL. Plasmablastic lymphoma (PbL) is a rare and aggressive B-cell malignancy that is often unresponsive to chemotherapy and usually has a poor prognosis. We hereby present the case of a patient with a recent history of COVID-19 infection who was diagnosed with HIV and NHL, with manifestations in the oral cavity and a favorable evolution after the introduction of antiviral therapy, specific chemotherapy, and radiotherapy. Dental expertise is necessary for the appropriate management of oral manifestations of HIV infection or AIDS, and lymphoma should be included in the differential diagnosis of any oral lesions.
Collapse
|
4
|
Malmström S, Wagner P, Yilmaz A, Svedhem V, Carlander C. Failure to restore CD4+ cell count associated with infection-related and noninfection-related cancer. AIDS 2022; 36:447-457. [PMID: 34711738 DOI: 10.1097/qad.0000000000003117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess incidence and relative risk of cancer in Sweden, by HIV status, from 1988 to 2017. DESIGN Population-based register study. METHODS From the Swedish Total Population Register, all people born between 1940 and 2000 (n = 8 587 629), and resident in Sweden sometime 1983-2017 were identified and linked to National HIV Register InfCareHIV, National Cancer Register, and LISA database. We present incidence and adjusted hazard ratios (adjHR) of infection and noninfection-related cancer for three periods between 1988 and 2017. RESULTS Incidence and relative risk of infection-related cancer decreased but remained higher in people with HIV (PWH) than in HIV-negative. The proportion attributable to infection remained higher in PWH than in HIV-negative (44 vs. 9%). Women with HIV had lower risk of infection-related cancer than men with HIV [adjusted hazard ratio (adjHR) 0.6, 95% CI 0.4-0.9], mainly driven by lower incidence of Kaposi's sarcoma (adjHR 0.1, 95% CI 0.0-0.4). Current viral suppression (adjHR 0.3, 95% CI 0.2-0.5) was associated with lower risk of infection-related cancer. Current CD4+ cell count less than 200 cells/μl was associated with both infection-related (adjHR 15.3, 95% CI 10.7-21.8) and noninfection-related cancer (adjHR 2.5, 95% CI 1.5-4.1), as was CD4+ cell count increases less than 100 cells/μl post antiretroviral therapy (ART) (infection-related cancer adjHR 6.6, 95% CI 4.2-10.6, noninfection-related cancer adjHR 2.0, 95% CI 1.2-3.3). CONCLUSION Current CD4+ cell count and failure to restore CD4+ cell count both associated with infection and noninfection-related cancer. Viral suppression associated with lower risk of infection-related cancer. Early HIV detection and early adherent ART remain essential for cancer prevention.
Collapse
Affiliation(s)
- Stina Malmström
- Department of Infectious Diseases, Västmanland County Hospital Västerås
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
| | - Philippe Wagner
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | | | - Christina Carlander
- Centre for Clinical Research Västmanland, Västmanland County Hospital, Uppsala University, Västerås
- Department of Medicine Huddinge
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
Dhokotera T, Bohlius J, Egger M, Spoerri A, Ncayiyana JR, Naidu G, Olago V, Zwahlen M, Singh E, Muchengeti M. Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study. BMJ Open 2021; 11:e043941. [PMID: 34663647 PMCID: PMC8524277 DOI: 10.1136/bmjopen-2020-043941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the spectrum of cancers in adolescents and young adults (AYAs) living with and without HIV in South Africa. DESIGN Cross-sectional study with cancer records provided by the National Cancer Registry (NCR) and HIV records from the National Health Laboratory Service (NHLS). SETTING AND PARTICIPANTS The NHLS is the largest provider of pathology services in the South African public sector. The NCR is a division of the NHLS. We included AYAs (aged 10-24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8479). HIV status was obtained through record linkages and text mining. PRIMARY AND SECONDARY OUTCOMES We determined the spectrum of cancers by HIV status in AYAs. We used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex, ethnicity and calendar period. We imputed (post hoc) the HIV status for AYA with unknown HIV status. RESULTS 8479 AYAs were diagnosed with cancer, HIV status was known for 45% (n=3812). Of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi's sarcoma (adjusted OR (aOR) 218, 95% CI 89.9 to 530), cervical cancer (aOR 2.18, 95% CI 1.23 to 3.89), non-Hodgkin's lymphoma (aOR 2.12, 95% CI 1.69 to 2.66) and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27 to 5.86) than AYAs without HIV. About 44% (n=1062) of AYAs with HIV-related cancers had not been tested for HIV. CONCLUSIONS Targeted HIV testing for AYAs diagnosed with cancer, followed by immediate start of antiretroviral therapy, screening for cervical precancer and vaccination against human papilloma virus is needed to decrease cancer burden in AYAs living with HIV in South Africa.
Collapse
Affiliation(s)
- Tafadzwa Dhokotera
- National Cancer Registry, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town School of Public Health and Family Medicine, Observatory, Western Cape, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jabulani Ronnie Ncayiyana
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town School of Public Health and Family Medicine, Observatory, Western Cape, South Africa
| | - Gita Naidu
- Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Victor Olago
- National Cancer Registry, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- South African DSI-NRF Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
6
|
Elvstam O, Marrone G, Medstrand P, Treutiger CJ, Svedhem V, Gisslén M, Björkman P. Associations Between Plasma Human Immunodeficiency Virus (HIV) Ribonucleic Acid Levels and Incidence of Invasive Cancer in People With HIV After Initiation of Combination Antiretroviral Therapy. Open Forum Infect Dis 2021; 8:ofab131. [PMID: 34189159 PMCID: PMC8231372 DOI: 10.1093/ofid/ofab131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) viremia could be involved in the increased risk of cancer in people with HIV (PWH) receiving combination antiretroviral therapy (cART). We analyzed the association between plasma HIV ribonucleic acid levels in PWH starting cART and incident invasive cancer using the Swedish cohort InfCare HIV linked with national registers. Methods Adults starting cART in 1996–2017 were included if they had ≥1 viral load (VL) measurement before receiving any antiretroviral agent (pre-ART VL) and ≥2 VLs ≥6 months after start of cART. Viremia during cART was analyzed both as viremia-copy-years and categorized as suppression (<50 copies/mL), low-level viremia ([LLV] 50–999 copies/mL), and nonsuppression (≥1000 copies/mL). The main outcome was a composite of invasive malignancies with increased incidence among PWH. We fitted proportional subhazard models (including sex, age, pre-ART CD4 count, and injection drug use) for both pre-ART VL and viremia during cART. Results After 32 105 person-years, 3254 of 4931 participants (66%) were classified as suppressed, 438 (9%) were classified as LLV, and 1221 (25%) were classified as nonsuppressed. Neither viremia category nor cumulative viremia during cART had a statistically significant association with cancer. Higher pre-ART VL was associated with cancer (adjusted subhazard ratio, 1.4; 95% confidence interval, 1.0–1.8); this remained statistically significant with viremia during cART in the model. In subanalysis, the association with pre-ART VL was statistically significant for acquired immune deficiency syndrome (AIDS)-defining and infection-related non-AIDS-defining cancer, but not for other malignancies. Conclusions In this nationwide cohort, pre-ART VL was an independent predictor of invasive cancer, whereas viremia profile during cART was not associated with cancer incidence.
Collapse
Affiliation(s)
- Olof Elvstam
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Gaetano Marrone
- Department of Infectious Diseases and Clinical Virology, Karolinska University Hospital, Stockholm, Sweden
| | - Patrik Medstrand
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Carl Johan Treutiger
- Department of Infectious Diseases/Venhälsan, South General Hospital, Stockholm, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Björkman
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
7
|
Kimani SM, Painschab MS, Horner MJ, Muchengeti M, Fedoriw Y, Shiels MS, Gopal S. Epidemiology of haematological malignancies in people living with HIV. Lancet HIV 2020; 7:e641-e651. [PMID: 32791045 PMCID: PMC10199168 DOI: 10.1016/s2352-3018(20)30118-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022]
Abstract
People living with HIV or AIDS are at increased risk of Hodgkin and non-Hodgkin lymphoma compared with HIV-negative individuals. Data on the risk of multiple myeloma or leukaemia are inconsistent and of low quality but the risk does not seem to be increased. Specific haematological malignancies occur in different contexts of age, CD4 cell count, HIV control, viral co-infections, or chronic inflammation, and the expansion of combination antiretroviral therapy has led to varied demographic and epidemiological shifts among people with HIV. Increased use of combination antiretroviral therapy has substantially reduced the risks of diffuse large B-cell lymphoma, Burkitt lymphoma, and primary CNS lymphoma, and to a lesser extent, Hodgkin lymphoma. There is no effect of combination antiretroviral therapy use on multiple myeloma or leukaemia. Although many cases of HIV are in low-income and middle-income countries, high-quality epidemiological data for haematological malignancies from these regions are scarce. Closing this gap is an essential first step in decreasing mortality from HIV-associated haematological malignancies worldwide. Finally, although multicentric Castleman disease is not a neoplastic condition, it is an emerging precursor to neoplastic high-grade B-cell lymphoproliferation among people with HIV, especially for individuals on long-term combination antiretroviral therapy with well controlled HIV.
Collapse
Affiliation(s)
- Stephen M Kimani
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Matthew S Painschab
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Marie-Josèphe Horner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Yuri Fedoriw
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Satish Gopal
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi.
| |
Collapse
|
8
|
Caby F, Guiguet M, Weiss L, Winston A, Miro JM, Konopnicki D, Le Moing V, Bonnet F, Reiss P, Mussini C, Poizot-Martin I, Taylor N, Skoutelis A, Meyer L, Goujard C, Bartmeyer B, Boesecke C, Antinori A, Quiros-Roldan E, Wittkop L, Frederiksen C, Castagna A, Thurnheer MC, Svedhem V, Jose S, Costagliola D, Mary-Krause M, Grabar S. CD4/CD8 Ratio and the Risk of Kaposi Sarcoma or Non-Hodgkin Lymphoma in the Context of Efficiently Treated Human Immunodeficiency Virus (HIV) Infection: A Collaborative Analysis of 20 European Cohort Studies. Clin Infect Dis 2020; 73:50-59. [PMID: 34370842 DOI: 10.1093/cid/ciaa1137] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A persistently low CD4/CD8 ratio has been reported to inversely correlate with the risk of non-AIDS defining cancer in people living with human immunodeficiency virus (HIV; PLWH) efficiently treated by combination antiretroviral therapy (cART). We evaluated the impact of the CD4/CD8 ratio on the risk of Kaposi sarcoma (KS) or non-Hodgkin lymphoma (NHL), still among the most frequent cancers in treated PLWH. METHODS PLWH from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) were included if they achieved virological control (viral load ≤ 500 copies/mL) within 9 months following cART and without previous KS/LNH diagnosis. Cox models were used to identify factors associated with KS or NHL risk, in all participants and those with CD4 ≥ 500/mm3 at virological control. We analyzed the CD4/CD8 ratio, CD4 count and CD8 count as time-dependent variables, using spline transformations. RESULTS We included 56 708 PLWH, enrolled between 2000 and 2014. At virological control, the median (interquartile range [IQR]) CD4 count, CD8 count, and CD4/CD8 ratio were 414 (296-552)/mm3, 936 (670-1304)/mm3, and 0.43 (0.28-0.65), respectively. Overall, 221 KS and 187 NHL were diagnosed 9 (2-37) and 18 (7-42) months after virological control. Low CD4/CD8 ratios were associated with KS risk (hazard ratio [HR] = 2.02 [95% confidence interval {CI } = 1.23-3.31]) when comparing CD4/CD8 = 0.3 to CD4/CD8 = 1) but not with NHL risk. High CD8 counts were associated with higher NHL risk (HR = 3.14 [95% CI = 1.58-6.22]) when comparing CD8 = 3000/mm3 to CD8 = 1000/mm3). Similar results with increased associations were found in PLWH with CD4 ≥ 500/mm3 at virological control (HR = 3.27 [95% CI = 1.60-6.56] for KS; HR = 5.28 [95% CI = 2.17-12.83] for NHL). CONCLUSIONS Low CD4/CD8 ratios and high CD8 counts despite effective cART were associated with increased KS/NHL risks respectively, especially when CD4 ≥ 500/mm3.
Collapse
Affiliation(s)
- Fabienne Caby
- Unité VIH-IST, Service d'Immuno-Hématologie, Hôpital Victor Dupouy, Argenteuil, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Marguerite Guiguet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Laurence Weiss
- Université de Paris, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Centre Hôtel Dieu, Paris, France
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Deborah Konopnicki
- St Pierre University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Vincent Le Moing
- Department of Infectious Disease, University Hospital of Montpellier, Montpellier, France
| | - Fabrice Bonnet
- CHU de Bordeaux and INSERM U1219, ISPED, Université de Bordeaux, Bordeaux, France
| | - Peter Reiss
- HIV Monitoring Foundation, Amsterdam, The Netherlands, and Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Isabelle Poizot-Martin
- Aix Marseille Université, APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Hôpital Sainte- Marguerite, Service d'Immuno-hématologie clinique, Marseille, France
| | - Ninon Taylor
- Department of Dermatology, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Athanasios Skoutelis
- 5th Department of Medicine and Infectious Diseases "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Laurence Meyer
- INSERM CESP U1018, Université Paris-Saclay, APHP Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Cécile Goujard
- Service de Médecine interne et d'Immunologie clinique, AP-HP Université Paris-Saclay, Hôpital Bicêtre, Faculté de Médecine-Université Paris-Saclay, Centre de recherche en épidémiologie et santé des populations CESP-Inserm U1018, Le Kremlin Bicêtre, France
| | - Barbara Bartmeyer
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Christoph Boesecke
- German Centre for Infection Research, Cologne-Bonn; Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - Andrea Antinori
- HIV/AIDS Department, National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Eugenia Quiros-Roldan
- Department of Infectious and Tropical Diseases, Universitá degli Studi di Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Linda Wittkop
- Université Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'information médicale, Bordeaux, France
| | - Casper Frederiksen
- University of Copenhagen, Section of Forensic Genetics, Copenhagen, Denmark
| | | | | | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital and Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sophie Jose
- Transforming Cancer Services Team-Public Health England Partnership, National Cancer Registration and Analysis Service, Wellington House, London United Kingdom
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Murielle Mary-Krause
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.,Université de Paris, Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Biostatistique et Epidémiologie, Hôpital cochin, Paris, France
| | | |
Collapse
|
9
|
Abstract
BACKGROUND Hematological malignancies have continued to be highly prevalent among people living with HIV (PLHIV). This study assessed the occurrence of, risk factors for, and outcomes of hematological and nonhematological malignancies in PLHIV in Asia. METHODS Incidence of malignancy after cohort enrollment was evaluated. Factors associated with development of hematological and nonhematological malignancy were analyzed using competing risk regression and survival time using Kaplan-Meier. RESULTS Of 7455 patients, 107 patients (1%) developed a malignancy: 34 (0.5%) hematological [0.08 per 100 person-years (/100PY)] and 73 (1%) nonhematological (0.17/100PY). Of the hematological malignancies, non-Hodgkin lymphoma was predominant (n = 26, 76%): immunoblastic (n = 6, 18%), Burkitt (n = 5, 15%), diffuse large B-cell (n = 5, 15%), and unspecified (n = 10, 30%). Others include central nervous system lymphoma (n = 7, 21%) and myelodysplastic syndrome (n = 1, 3%). Nonhematological malignancies were mostly Kaposi sarcoma (n = 12, 16%) and cervical cancer (n = 10, 14%). Risk factors for hematological malignancy included age >50 vs. ≤30 years [subhazard ratio (SHR) = 6.48, 95% confidence interval (CI): 1.79 to 23.43] and being from a high-income vs. a lower-middle-income country (SHR = 3.97, 95% CI: 1.45 to 10.84). Risk was reduced with CD4 351-500 cells/µL (SHR = 0.20, 95% CI: 0.05 to 0.74) and CD4 >500 cells/µL (SHR = 0.14, 95% CI: 0.04 to 0.78), compared to CD4 ≤200 cells/µL. Similar risk factors were seen for nonhematological malignancy, with prior AIDS diagnosis showing a weak association. Patients diagnosed with a hematological malignancy had shorter survival time compared to patients diagnosed with a nonhematological malignancy. CONCLUSIONS Nonhematological malignancies were common but non-Hodgkin lymphoma was more predominant in our cohort. PLHIV from high-income countries were more likely to be diagnosed, indicating a potential underdiagnosis of cancer in low-income settings.
Collapse
|
10
|
Puronen CE, Ford ES, Uldrick TS. Immunotherapy in People With HIV and Cancer. Front Immunol 2019; 10:2060. [PMID: 31555284 PMCID: PMC6722204 DOI: 10.3389/fimmu.2019.02060] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 12/16/2022] Open
Abstract
HIV infection alters the natural history of several cancers, in large part due to its effect on the immune system. Immune function in people living with HIV may vary from normal to highly dysfunctional and is largely dependent on the timing of initiation (and continuation) of effective antiretroviral therapy (ART). An individual's level of immune function in turn affects their cancer risk, management, and outcomes. HIV-associated lymphocytopenia and immune dysregulation permit immune evasion of oncogenic viruses and premalignant lesions and are associated with inferior outcomes in people with established cancers. Various types of immunotherapy, including monoclonal antibodies, interferon, cytokines, immunomodulatory drugs, allogeneic hematopoietic stem cell transplant, and most importantly ART have shown efficacy in HIV-related cancer. Emerging data suggest that checkpoint inhibitors targeting the PD-1/PD-L1 pathway can be safe and effective in people with HIV and cancer. Furthermore, some cancer immunotherapies may also affect HIV persistence by influencing HIV latency and HIV-specific immunity. Studying immunotherapy in people with HIV and cancer will advance clinical care of all people living with HIV and presents a unique opportunity to gain insight into mechanisms for HIV eradication.
Collapse
Affiliation(s)
- Camille E Puronen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Emily S Ford
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Thomas S Uldrick
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Division of Global Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| |
Collapse
|
11
|
Shepherd L, Ryom L, Law M, Hatleberg CI, de Wit S, Monforte AD, Battegay M, Phillips A, Bonnet F, Reiss P, Pradier C, Grulich A, Sabin C, Lundgren J, Mocroft A. Differences in Virological and Immunological Risk Factors for Non-Hodgkin and Hodgkin Lymphoma. J Natl Cancer Inst 2019; 110:598-607. [PMID: 29267895 DOI: 10.1093/jnci/djx249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/27/2017] [Indexed: 12/18/2022] Open
Abstract
Background Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) are increased in populations with immune dysfunction, including people living with HIV; however, there is little evidence for to what degree immunological and virological factors differently affect NHL and HL risk. Methods Data from the Data Collection on Adverse events of Anti-HIV Drugs Study cohort were analyzed to identify independent risk factors for NHL and HL using hazard ratios (HRs), focusing on current and cumulative area under the curve (AUC) measures of immunological and virological status. Variables with different associations with NHL and HL were identified using marginal Cox models. All statistical tests were two-sided. Results Among 41 420 people followed for 337 020 person-years, 392 developed NHL (incidence rate = 1.17/1000 person-years of follow-up [PYFU], 95% confidence interval [CI] = 1.06 to 1.30) and 149 developed HL (incidence rate = 0.44/1000 PYFU, 95% CI = 0.38 to 0.52). Higher risk of both NHL and HL was associated with lower current CD4 cell count (adjusted HR [aHR] of NHL for CD4 <100 vs > 599 cells/mm3 = 8.08, 95% CI = 5.63 to 11.61; HL = 4.58, 95% CI = 2.22 to 9.45), whereas higher current HIV viral load (aHR of NHL for HIV-VL >1000 vs < 50 copies/mL = 1.97, 95% CI = 1.50 to 2.59) and higher AUC of HIV-VL (aHR of NHL for highest vs lowest quintile = 2.91, 95% CI = 1.92 to 4.41) were associated with NHL only. Both current and AUC of HIV-VL were factors that had different associations with NHL and HL, where the hazard ratio for NHL was progressively higher than for HL with increasing HIV-VL category. Lower current CD4 cell count had a strong but similar association with both NHL and HL. Conclusions CD4 depletion increased risk of both types of lymphomas while current and accumulated HIV-VL was associated with NHL only. This suggests that NHL development is related to both CD4 cell depletion and added immune dysfunction derived from ongoing HIV replication. This latter factor was not associated with HL risk.
Collapse
Affiliation(s)
- Leah Shepherd
- Research Department of Infection and Population Health, UCL, London, UK
| | - Lene Ryom
- CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthew Law
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Camilla Ingrid Hatleberg
- CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stephane de Wit
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antonella d'Arminio Monforte
- Dipartimento di Scienze della Salute, Clinica di Malattie Infectitive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrew Phillips
- Research Department of Infection and Population Health, UCL, London, UK
| | - Fabrice Bonnet
- CHU de Bordeaux and INSERM U1219, Université de Bordeaux, Bordeaux, France
| | - Peter Reiss
- Academic Medical Center, Division of Infectious Diseases, Department of Global Health, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, the Netherlands
| | | | | | - Caroline Sabin
- Research Department of Infection and Population Health, UCL, London, UK
| | - Jens Lundgren
- CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Research Department of Infection and Population Health, UCL, London, UK
| |
Collapse
|
12
|
Hernández-Ramírez RU, Qin L, Lin H, Leyden W, Neugebauer RS, Althoff KN, Achenbach CJ, Hessol NA, D’Souza G, Gebo KA, Gill MJ, Grover S, Horberg MA, Li J, Mathews WC, Mayor AM, Park LS, Rabkin CS, Salters K, Justice AC, Moore RD, Engels EA, Silverberg MJ, Dubrow R. Association of immunosuppression and HIV viraemia with non-Hodgkin lymphoma risk overall and by subtype in people living with HIV in Canada and the USA: a multicentre cohort study. Lancet HIV 2019; 6:e240-e249. [PMID: 30826282 PMCID: PMC6531288 DOI: 10.1016/s2352-3018(18)30360-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Research is needed to better understand relations between immunosuppression and HIV viraemia and risk for non-Hodgkin lymphoma, a common cancer in people living with HIV. We aimed to identify key CD4 count and HIV RNA (viral load) predictors of risk for non-Hodgkin lymphoma, overall and by subtype. METHODS We studied people living with HIV during 1996-2014 from 21 Canadian and US cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. To determine key independent predictors of risk for non-Hodgkin lymphoma, we assessed associations with time-updated recent, past, cumulative, and nadir or peak measures of CD4 count and viral load, using demographics-adjusted, cohort-stratified Cox models, and we compared models using Akaike's information criterion. FINDINGS Of 102 131 people living with HIV during the study period, 712 people developed non-Hodgkin lymphoma. The key independent predictors of risk for overall non-Hodgkin lymphoma were recent CD4 count (ie, lagged by 6 months; <50 cells per μL vs ≥500 cells per μL, hazard ratio [HR] 3·2, 95% CI 2·2-4·7) and average viral load during a 3-year window lagged by 6 months (a cumulative measure; ≥100 000 copies per mL vs ≤500 copies per mL, HR 9·6, 95% CI 6·5-14·0). These measures were also the key predictors of risk for diffuse large B-cell lymphoma (recent CD4 count <50 cells per μL vs ≥500 cells per μL, HR 2·4, 95% CI 1·4-4·2; average viral load ≥100 000 copies per mL vs ≤500 copies per mL, HR 7·5, 95% CI 4·5-12·7). However, recent CD4 count was the sole key predictor of risk for CNS non-Hodgkin lymphoma (<50 cells per μL vs ≥500 cells per μL, HR 426·3, 95% CI 58·1-3126·4), and proportion of time viral load was greater than 500 copies per mL during the 3-year window (a cumulative measure) was the sole key predictor for Burkitt lymphoma (100% vs 0%, HR 41·1, 95% CI 9·1-186·6). INTERPRETATION Both recent immunosuppression and prolonged HIV viraemia have important independent roles in the development of non-Hodgkin lymphoma, with likely subtype heterogeneity. Early and sustained antiretroviral therapy to decrease HIV replication, dampen B-cell activation, and restore overall immune function is crucial for preventing non-Hodgkin lymphoma. FUNDING National Institutes of Health, Centers for Disease Control and Prevention, US Agency for Healthcare Research and Quality, US Health Resources and Services Administration, Canadian Institutes of Health Research, Ontario Ministry of Health and Long Term Care, and the Government of Alberta.
Collapse
Affiliation(s)
- Raúl U. Hernández-Ramírez
- Corresponding author: Raúl U.
Hernández-Ramírez, Department of Biostatistics, Yale School of
Public Health, New Haven, CT 06520-8034, USA
| | - Li Qin
- Department of Internal Medicine, Yale School of Medicine, New
Haven, CT, USA
| | - Haiqun Lin
- Department of Biostatistics, Yale School of Public Health, Yale
School of Medicine, New Haven, CT, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California,
Oakland, CA, USA
| | | | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg
School of Public Health, Baltimore, MD, USA
| | - Chad J. Achenbach
- Division of Infectious Diseases, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA
| | - Nancy A. Hessol
- Department of Clinical Pharmacy, University of California, San
Francisco, San Francisco, CA, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins University Bloomberg
School of Public Health, Baltimore, MD, USA
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta,
Canada
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente
Mid-Atlantic States, Rockville, MD, USA
| | - Jun Li
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | | | - Angel M. Mayor
- Retrovirus Research Center, Universidad Central del Caribe School
of Medicine, Bayamon, Puerto Rico
| | - Lesley S. Park
- Stanford Center for Population Health Sciences, Stanford
University School of Medicine, Palo Alto, CA, USA
| | - Charles S. Rabkin
- Infections and Immunoepidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, Rockville, MD,
USA
| | - Kate Salters
- Epidemiology and Population Health, British Columbia Centre for
Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Amy C. Justice
- Department of Internal Medicine, Yale School of Medicine, New
Haven, CT, USA,Department of Health Policy and Management, Yale School of Public
Health, Yale School of Medicine, New Haven, CT, USA,Research Service, Veterans Affairs Connecticut Healthcare System,
West Haven, CT, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, Rockville, MD,
USA
| | | | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public
Health, Yale School of Medicine, New Haven, CT, USA
| | | |
Collapse
|
13
|
Non-Hodgkin lymphoma in people with HIV. Lancet HIV 2019; 6:e209-e210. [PMID: 30826280 DOI: 10.1016/s2352-3018(19)30039-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 11/24/2022]
|
14
|
Abstract
OBJECTIVE To compare non-Hodgkin lymphoma (NHL) incidence rates in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of adults living with HIV who started ART after 1995 within the framework of the International epidemiology Databases to Evaluate AIDS (IeDEA) and the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). We used flexible parametric survival models to compare regional NHL rates at 2 years after ART start and to identify risk factors for NHL. RESULTS We included 210 898 adults with 1.1 million person-years (pys) of follow-up and 1552 incident NHL cases (raw overall incidence rate 142/100 000 pys). After adjusting for age at ART start, first-line ART regimen, calendar period of ART start, and especially current CD4 cell count, NHL rates were similar across regions for most population groups. However, South African women remained at increased risk of developing NHL compared with their European counterparts [adjusted hazard ratio [aHR] 1.79, 95% CI 1.19-2.70]. In Europe, Latin, and North America, NHL risk was highest in MSM (aHR 1.30, 95% CI 1.14-1.48), followed by heterosexual men (referent), and women (aHR 0.66, 95% CI 0.57-0.78). CONCLUSIONS The risk of developing NHL is higher in women in South Africa than in Europe and higher in MSM compared with heterosexual men and women. Reasons for these differences remain unclear. Early ART access and regular patient monitoring to avert low CD4 cell counts remain key for NHL prevention.
Collapse
|
15
|
Abstract
Survival with human immunodeficiency virus (HIV) infection has greatly improved due to effective antiretroviral therapy (ART). As infectious complications have declined, malignancy now accounts for over one-third of deaths among people living with HIV (PLWH). Based on practices in the general population, cancer screening of PLWH can decrease both morbidity and mortality. In this article, we review and consider directed approaches for colorectal, breast, cervical and lung cancer screening. Furthermore, routine physical examinations may detect lymphomas and skin, anal and oral cancers. Comprehensive cancer prevention in PLWH should also include ART adherence, vaccination against oncogenic viruses, treatment of hepatitis viruses and smoking cessation. Cancer screening for PLWH warrants further research on safety and efficacy as well as targeted efforts to increase adherence.
Collapse
|
16
|
El-Amine R, Germini D, Zakharova VV, Tsfasman T, Sheval EV, Louzada RAN, Dupuy C, Bilhou-Nabera C, Hamade A, Najjar F, Oksenhendler E, Lipinski M, Chernyak BV, Vassetzky YS. HIV-1 Tat protein induces DNA damage in human peripheral blood B-lymphocytes via mitochondrial ROS production. Redox Biol 2017; 15:97-108. [PMID: 29220699 PMCID: PMC5725280 DOI: 10.1016/j.redox.2017.11.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/25/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection is associated with B-cell malignancies in patients though HIV-1 is not able to infect B-cells. The rate of B-cell lymphomas in HIV-infected individuals remains high even under the combined antiretroviral therapy (cART) that reconstitutes the immune function. Thus, the contribution of HIV-1 to B-cell oncogenesis remains enigmatic. HIV-1 induces oxidative stress and DNA damage in infected cells via multiple mechanisms, including viral Tat protein. We have detected elevated levels of reactive oxygen species (ROS) and DNA damage in B-cells of HIV-infected individuals. As Tat is present in blood of infected individuals and is able to transduce cells, we hypothesized that it could induce oxidative DNA damage in B-cells promoting genetic instability and malignant transformation. Indeed, incubation of B-cells isolated from healthy donors with purified Tat protein led to oxidative stress, a decrease in the glutathione (GSH) levels, DNA damage and appearance of chromosomal aberrations. The effects of Tat relied on its transcriptional activity and were mediated by NF-κB activation. Tat stimulated oxidative stress in B-cells mostly via mitochondrial ROS production which depended on the reverse electron flow in Complex I of respiratory chain. We propose that Tat-induced oxidative stress, DNA damage and chromosomal aberrations are novel oncogenic factors favoring B-cell lymphomas in HIV-1 infected individuals. B-cells of HIV-infected individuals exhibit elevated levels of oxidative stress, DNA damage and chromosomal aberrations. Purified HIV-1 Tat protein reproduces this effect and induces oxidative stress and DNA damage in B-cells. HIV-1 Tat induces mitochondrial oxidative stress and activates NF-kB in B-cells. This condition increases the risk of developing chromosomal abnormalities and translocations.
Collapse
Affiliation(s)
- Rawan El-Amine
- UMR 8126, Paris Saclay University, Paris-Sud University, Institut Gustave Roussy, CNRS, Villejuif 94805, France; LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, 94805 Villejuif, France, 119334 Moscow, Russia; Doctoral school of Sciences and Technology (EDST), Lebanese University, Hadath, Lebanon; Department of Life and Earth Sciences, Faculty of Sciences II/Doctoral School of Sciences and Technology (EDST), Lebanese University, Jdeidet El Metn-Fanar, Lebanon; Department of Chemistry and Biochemistry, Faculty of Sciences II/EDST, Lebanese University, Jdeidet El Metn-Fanar, Lebanon
| | - Diego Germini
- UMR 8126, Paris Saclay University, Paris-Sud University, Institut Gustave Roussy, CNRS, Villejuif 94805, France; LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, 94805 Villejuif, France, 119334 Moscow, Russia
| | - Vlada V Zakharova
- UMR 8126, Paris Saclay University, Paris-Sud University, Institut Gustave Roussy, CNRS, Villejuif 94805, France; LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, 94805 Villejuif, France, 119334 Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, M.V. Lomonosov Moscow State University, 119992 Moscow, Russia
| | - Tatyana Tsfasman
- UMR 8126, Paris Saclay University, Paris-Sud University, Institut Gustave Roussy, CNRS, Villejuif 94805, France; LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, 94805 Villejuif, France, 119334 Moscow, Russia
| | - Eugene V Sheval
- LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, 94805 Villejuif, France, 119334 Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, M.V. Lomonosov Moscow State University, 119992 Moscow, Russia
| | - Ruy A N Louzada
- UMR 8200, Institut Gustave Roussy, CNRS, Villejuif 94805, France
| | - Corinne Dupuy
- UMR 8200, Institut Gustave Roussy, CNRS, Villejuif 94805, France
| | - Chrystèle Bilhou-Nabera
- Biological Hematology Service-U.F. of Onco-Hematology Cytogenetics-Hôpital Saint-Antoine, 75012 Paris, France
| | - Aline Hamade
- Department of Life and Earth Sciences, Faculty of Sciences II/Doctoral School of Sciences and Technology (EDST), Lebanese University, Jdeidet El Metn-Fanar, Lebanon
| | - Fadia Najjar
- Department of Chemistry and Biochemistry, Faculty of Sciences II/EDST, Lebanese University, Jdeidet El Metn-Fanar, Lebanon
| | - Eric Oksenhendler
- Department of Clinical Immunology, Hôpital Saint-Louis, 75010 Paris, France
| | - Marс Lipinski
- UMR 8126, Paris Saclay University, Paris-Sud University, Institut Gustave Roussy, CNRS, Villejuif 94805, France; LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, 94805 Villejuif, France, 119334 Moscow, Russia
| | - Boris V Chernyak
- LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, 94805 Villejuif, France, 119334 Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, M.V. Lomonosov Moscow State University, 119992 Moscow, Russia
| | - Yegor S Vassetzky
- UMR 8126, Paris Saclay University, Paris-Sud University, Institut Gustave Roussy, CNRS, Villejuif 94805, France; LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, 94805 Villejuif, France, 119334 Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, M.V. Lomonosov Moscow State University, 119992 Moscow, Russia.
| |
Collapse
|
17
|
Abstract
OBJECTIVE To determine whether there is a threshold of detectable HIV RNA under 1000 copies/ml after antiretroviral therapy initiation associated with 10-year all-cause mortality. DESIGN This study included nearly 8000 patients from a US-based multicenter clinical cohort who started antiretroviral therapy between 1 January 1998 and 31 December 2013. Viral load was assessed 6 months after initiation of therapy. Patients were followed from 6 months after therapy initiation (between 1 July 1998 and 30 June 2014) until death, and data were administratively censored after 10 years or on 31 December 2014. METHODS We used nonparametric multiple imputation to account for left-censored viral load measurements, Cox proportional hazards models to estimate all-cause mortality hazard ratios, Nelson-Aalen cumulative hazard estimates to construct risk curves, and inverse probability of exposure weights to standardize estimated hazard ratios and risk curves to the total study population. RESULTS Plots of standardized hazard ratio estimates and 95% confidence intervals indicated there was no demonstrable viral load threshold between 30 and 500 copies/ml associated with a marked increase in 10-year mortality. The standardized 10-year risk of mortality among patients with viral loads between 400 and 999 copies/ml 6 months after starting treatment was comparable with the risk of mortality among patients with viral loads between 1000 and 4 million copies/ml (20 vs. 23%). CONCLUSION Incomplete suppression of plasma HIV RNA 6 months after starting therapy is associated with substantial 10-year all-cause mortality risk, highlighting the importance of rapid viral load suppression after therapy initiation.
Collapse
|
18
|
Silas OA, Achenbach CJ, Hou L, Murphy RL, Egesie JO, Sagay SA, Agbaji OO, Agaba PE, Musa J, Manasseh AN, Jatau ED, Dauda AM, Akanbi MO, Mandong BM. Outcome of HIV-associated lymphoma in a resource-limited setting of Jos, Nigeria. Infect Agent Cancer 2017; 12:34. [PMID: 28592989 PMCID: PMC5460353 DOI: 10.1186/s13027-017-0144-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphoma is a leading cause of cancer-related death among human immunodeficiency virus (HIV)-infected individuals in the current era of potent anti-retroviral therapy (ART). Globally, mortality after HIV-associated lymphoma has profound regional variation. Little is known about HIV-associated lymphoma mortality in Nigeria and other resource-limited setting in sub-Saharan Africa. Therefore, we evaluated the all-cause mortality after lymphoma and associated risk factors including HIV at the Jos University Teaching Hospital (JUTH) Nigeria. METHODS We conducted a ten-year retrospective cohort study of lymphoma patients managed in JUTH. The main outcome measured was all-cause mortality and HIV infection was the main exposure variable. Overall death rate was estimated using the total number of death events and cumulative follow up time from lymphoma diagnosis to death. Cox proportional hazard regression was used to assess factors associated with mortality after lymphoma diagnosis. RESULTS Out of 40 lymphoma patients evaluated, 8(20.0%) were HIV positive and 32(80.0%) were HIV negative. After 127.63 person- years of follow-up, there were 16 deaths leading to a crude mortality rate of 40.0 per 100 person-years. The 2-year probability of survival was 30% for HIV-infected patients and 74% for HIV-uninfected. Median survival probability for HIV-infected patients was 2.1 years and 7.6 years for those without HIV. Unadjusted hazard of death was associated with late stage, HR 11.33(95% CI 2.55, 50.26,p = 0.001); low cumulative cycles of chemotherapy, HR 6.43(95% CI 1.80, 22.89,p = 0.004); greater age, HR 5.12(95% CI 1.45,18.08,p = 0.01); presence of comorbidity, HR 3.43(95% CI 1.10,10.78,p = 0.03); and HIV-infection, HR 3.32(95% CI 1.05, 10.51,p = 0.04). In an adjusted model only stage was significantly associated with death, AHR 5.45(1.14-26.06, p = 0.03). CONCLUSION Our findings suggest that HIV- infection accounted for three times probability of death in lymphoma patients compared to their HIV-uninfected counterparts due to late stage of lymphoma presentation in this population. Also initiation of chemotherapy was associated with lower probability of death among lymphoma patients managed at JUTH, Nigeria. Earlier stage at lymphoma diagnosis and prompt therapeutic intervention is likely to improve survival in these patients. Future research should undertake collaborative studies to obtain comprehensive regional data and identify unique risk factors of poor outcomes among HIV-infected patients with lymphoma in Nigeria.
Collapse
Affiliation(s)
- Olugbenga Akindele Silas
- Pathology Department, Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Chad J Achenbach
- Feinberg School of Medicine, Department of Medicine, Northwestern University and Center for Global Health, Chicago, Illinois USA
| | - Lifang Hou
- Feinberg School of Medicine, Department of Medicine, Northwestern University and Center for Global Health, Chicago, Illinois USA
| | - Robert L Murphy
- Feinberg School of Medicine, Department of Medicine, Northwestern University and Center for Global Health, Chicago, Illinois USA
| | - Julie O Egesie
- Hematology Department Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Solomon A Sagay
- Department of Obstetrics and Gynecology Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Oche O Agbaji
- Department of Internal Medicine Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Patricia E Agaba
- Department of Family Medicine Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynecology Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Agabus N Manasseh
- Pathology Department, Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Ezra D Jatau
- Hematology Department Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Ayuba M Dauda
- Pathology Department, Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Maxwell O Akanbi
- Department of Internal Medicine Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Barnabas M Mandong
- Pathology Department, Faculty of Medical Sciences, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| |
Collapse
|
19
|
Vrbic M, Petkovic I, Vrbic S, Jovanovic M, Rankovic A, Popovic-Dragonjic L, Djordjevic-Spasic M. Two-Year Complete Remission of Diffuse Large B-Cell Lymphoma in an Immunological Nonresponder HIV-Infected Patient: Case Report. Case Rep Oncol 2017; 10:356-360. [PMID: 28559819 PMCID: PMC5436016 DOI: 10.1159/000471847] [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: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION HIV-infected patients are affected significantly more frequently by all types of lymphoma, with diffuse large B-cell lymphoma (DLBCL) as the most prevalent histological type. Since the introduction of combination antiretroviral therapy (cART) morbidity and mortality of DLBCL has been markedly reduced, which is primarily interpreted as a result of the drug-mediated immune reconstitution. CASE REPORT We present a previously healthy, 44-year-old HIV-infected man with DLBCL of the oral cavity, treated with immunochemotherapy and cART. During HIV-directed treatment, despite the successful virologic response, a satisfactory immunological response was not achieved. However, the patient had a 2-year complete remission after first-line treatment of DLBCL. CONCLUSION Response to cART strongly predicts outcome in patients with DLBCL. Close monitoring of HIV-directed therapy efficacy, especially as to achievement of successful virologic response, independently associated with prolonged survival, is essential for estimating future DLBCL treatment strategies.
Collapse
Affiliation(s)
- Miodrag Vrbic
- aClinic of Infectious Diseases, Clinical Centre Nis, Nis, Serbia
| | - Ivan Petkovic
- bClinic of Oncology, Clinical Centre Nis, Nis, Serbia
| | | | - Maja Jovanovic
- aClinic of Infectious Diseases, Clinical Centre Nis, Nis, Serbia
| | | | | | | |
Collapse
|
20
|
Gloghini A, Volpi CC, Gualeni AV, Dolcetti R, Bongarzone I, De Paoli P, Carbone A. Multiple viral infections in primary effusion lymphoma: a model of viral cooperation in lymphomagenesis. Expert Rev Hematol 2017; 10:505-514. [PMID: 28468596 DOI: 10.1080/17474086.2017.1326815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary effusion lymphoma (PEL) is a rare B-cell lymphoid neoplasm mainly associated with HIV infection, presenting as pleural, peritoneal, and pericardial effusions. A defining property of PEL is its consistent association with Kaposi sarcoma associated herpesvirus (KSHV) infection, and, in most cases, Epstein Barr virus (EBV) co-infection. On these grounds, a review of the literature related to viral cooperation and lymphomagenesis can help to understand the complex interplay between KSHV and EBV in PEL pathogenesis. Areas covered: In this review, the authors highlight clinical, pathologic, genetic and proteomic features of PEL, in the context of viral cooperation in PEL lymphomagenesis. Expert commentary: Tumour cells are characterized by the overexpression of genes that are involved in inflammation and invasion. Coherently, PEL secretomes are enriched in proteins probably responsible for the particular tropism (cell adhesion and migration) of PEL cells. The development of PEL in HIV+ patients is multifactorial and involves a complex interplay among co-infection with oncogenic viruses (EBV and KSHV), inflammatory factors, and environmental conditions.
Collapse
Affiliation(s)
- Annunziata Gloghini
- a Molecular Pathology, Department of Diagnostic Pathology and Laboratory Medicine , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Chiara C Volpi
- a Molecular Pathology, Department of Diagnostic Pathology and Laboratory Medicine , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Ambra V Gualeni
- a Molecular Pathology, Department of Diagnostic Pathology and Laboratory Medicine , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Riccardo Dolcetti
- b University of Queensland Diamantina Institute, Translational Research Institute , University of Queensland , Brisbane , Australia
| | - Italia Bongarzone
- c Proteomics Laboratory, Department of Experimental Oncology and Molecular Medicine , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Paolo De Paoli
- d Molecular Virology , Centro di Riferimento Oncologico - IRCCS, National Cancer Institute , Aviano , Italy
| | - Antonino Carbone
- e Department of Pathology , Centro di Riferimento Oncologico - IRCCS, National Cancer Institute , Aviano , Italy
| |
Collapse
|
21
|
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
|
22
|
Abstract
PURPOSE OF REVIEW To review the newest research about the effects of combination antiretroviral therapy (cART) on cancer risk. RECENT FINDINGS HIV+ persons are at increased risk of cancer. As this risk is higher for malignancies driven by viral and bacterial coinfections, classifying malignancies into infection-related and infection-unrelated has been an emerging trend. Cohorts have detected major reductions in the incidence of Kaposi sarcoma and non-Hodgkin lymphoma (NHL) following cART initiation among immunosuppressed HIV+ persons. However, recent randomized data indicate that cART reduces risk of Kaposi sarcoma and NHL also during early HIV infection before overt immunosuppression occurs. Long-term effects of cART exposure on cancer risk are not well defined; according to basic and epidemiological research, there might be specific associations of each cART class with distinct patterns of cancer risk. SUMMARY The relationship between cART exposure and cancer risk is complex and nuanced. It is an intriguing fact that, whether initiated during severe immunosuppression or not, cART reduces risk of Kaposi sarcoma and NHL. Further research should identify mediators of the benefit of immediate cART initiation in reducing cancer risk, understand the relationship between long-term cART exposure and cancer incidence and assess whether adjuvant anti-inflammatory therapies can reduce cancer risk during treated HIV infection.
Collapse
Affiliation(s)
- Álvaro H Borges
- Centre for Health and Infectious Diseases Research, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
23
|
Yuan KH, Zhang M, Luo YJ. [Palliative radiotherapy for AIDS related diffuse large B cell lymphoma: a report of six cases with literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:1082-1084. [PMID: 28088975 PMCID: PMC7348490 DOI: 10.3760/cma.j.issn.0253-2727.2016.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 11/24/2022]
Affiliation(s)
- K H Yuan
- Department of Oncology, Kunming Yan'an Hospital, Kunming Medical University, Kunming 650051, China
| | | | | |
Collapse
|
24
|
Yanik EL, Achenbach CJ, Gopal S, Coghill AE, Cole SR, Eron JJ, Moore RD, Mathews WC, Drozd DR, Hamdan A, Ballestas ME, Engels EA. Changes in Clinical Context for Kaposi's Sarcoma and Non-Hodgkin Lymphoma Among People With HIV Infection in the United States. J Clin Oncol 2016; 34:3276-83. [PMID: 27507879 DOI: 10.1200/jco.2016.67.6999] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The biology of HIV-associated cancers may differ depending on immunologic and virologic context during development. Therefore, an understanding of the burden of Kaposi's sarcoma (KS) and non-Hodgkin lymphoma (NHL) relative to antiretroviral therapy (ART), virologic suppression, and CD4 count is important. PATIENTS AND METHODS KS and NHL diagnoses during 1996 to 2011 were identified among patients with HIV infection in eight clinical cohorts in the United States. Among patients in routine HIV clinical care, the proportion of cases in categories of ART use, HIV RNA, and CD4 count at diagnosis were described across calendar time. Person-time and incidence rates were calculated for each category. RESULTS We identified 466 patients with KS and 258 with NHL. In recent years, KS was more frequently diagnosed after ART initiation (55% in 1996 to 2001 v 76% in 2007 to 2011; P-trend = .02). The proportion of patients with NHL who received ART was higher but stable over time (83% overall; P-trend = .81). An increasing proportion of KS and NHL occurred at higher CD4 counts (P < .05 for KS and NHL) and with undetectable HIV RNA (P < .05 for KS and NHL). In recent years, more person-time was contributed by patients who received ART, had high CD4 counts and had undetectable HIV RNA, whereas incidence rates in these same categories remained stable or declined. CONCLUSION Over time, KS and NHL occurred at higher CD4 counts and lower HIV RNA values, and KS occurred more frequently after ART initiation. These changes were driven by an increasing proportion of patients with HIV who received effective ART, had higher CD4 counts, and had suppressed HIV RNA and not by increases in cancer risk within these subgroups. An improved understanding of HIV-associated cancer pathogenesis and outcomes in the context of successful ART is therefore important.
Collapse
Affiliation(s)
- Elizabeth L Yanik
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL.
| | - Chad J Achenbach
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Satish Gopal
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Anna E Coghill
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Stephen R Cole
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Joseph J Eron
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Richard D Moore
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - W Christopher Mathews
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Daniel R Drozd
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Ayad Hamdan
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Mary E Ballestas
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| | - Eric A Engels
- Elizabeth L. Yanik, Anna E. Coghill, and Eric A. Engels, National Cancer Institute, Rockville; Richard D. Moore, Johns Hopkins University, Baltimore, MD; Chad J. Achenbach, Northwestern University, Chicago, IL; Satish Gopal, Stephen R. Cole, and Joseph J. Eron, University of North Carolina at Chapel Hill, Chapel Hill, NC; W. Christopher Mathews, University of California, San Diego, San Diego, CA; Daniel R. Drozd, University of Washington, Seattle, WA; Ayad Hamdan, Beth Israel Deaconess Medical Center, Boston, MA; and Mary E. Ballestas, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
25
|
Wada NI, Bream JH, Martínez-Maza O, Macatangay B, Galvin SR, Margolick JB, Jacobson LP. Inflammatory Biomarkers and Mortality Risk Among HIV-Suppressed Men: A Multisite Prospective Cohort Study. Clin Infect Dis 2016; 63:984-990. [PMID: 27343547 DOI: 10.1093/cid/ciw409] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/10/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-induced inflammation and immune activation persist after initiation of combination antiretroviral therapy (cART) and HIV suppression and may contribute to mortality risks that exceed those in HIV-uninfected populations, though associations are unclear. METHODS In the prospective Multicenter AIDS Cohort Study, comprising men who have sex with men from Baltimore, Chicago, Los Angeles, and Pittsburgh, concentrations of 24 biomarkers of inflammation and immune activation were measured in stored serum from HIV-positive men obtained after cART-induced HIV suppression between 1996 and 2009. The outcome was nonaccidental death, with follow-up until 2014. We used Cox proportional hazards models to test whether biomarker concentrations predict time from HIV suppression to death and adjusted for multiple tests. Exploratory factor analysis (EFA) was employed to identify groupings of biomarkers that predict mortality risk. RESULTS Of 670 men followed up from HIV suppression, 54 died by the end of 2013. After adjustment for age, CD4(+) cell count, hepatitis B or C virus infection, and smoking, concentrations in the highest quartile of 4 biomarkers were significantly associated with mortality risk after controlling the false discovery rate at 5%: interleukin (IL) 6 (hazard ratio, 3.54; 95% confidence interval, 2.06-6.10), soluble IL 2Rα (3.29, 1.85-5.85), soluble CD14 (2.67, 1.55-4.61), and chemokine (CXC motif) ligand 13 (CXCL13; 2.26; 1.29-3.95). EFA yielded 2 biomarker groupings that were independent predictors of mortality risk. CONCLUSIONS Despite having undetectable HIV RNA levels during cART, men with higher concentrations of several biomarkers (particularly IL 6, soluble IL 2Rα, soluble CD14, and CXCL13) had higher hazards of long-term mortality. Correlations observed among biomarker concentrations may represent underlying inflammatory processes that contribute to mortality risk.
Collapse
Affiliation(s)
| | - Jay H Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Shannon R Galvin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | |
Collapse
|
26
|
A lymphomagenic role for HIV beyond immune suppression? Blood 2016; 127:1403-9. [PMID: 26773045 DOI: 10.1182/blood-2015-11-681411] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/11/2016] [Indexed: 12/26/2022] Open
Abstract
Despite the immune reconstitution promoted by combined antiretroviral therapy (cART), lymphomas still represent the most common type of cancer in HIV-infected individuals. Cofactors related to immunodeficiency such as oncogenic viruses, chronic antigenic stimulation, and cytokine overproduction are thought to be the main drivers of HIV lymphomagenesis, although the current scenario does not convincingly explain the still-high incidence of lymphomas and the occurrence of peculiar lymphoma histotypes in HIV-infected patients under cART. Recent findings are challenging the current view of a mainly indirect role of HIV in lymphoma development and support the possibility that HIV may directly contribute to lymphomagenesis. In fact, mechanisms other than immune suppression involve biologic effects mediated by HIV products that are secreted and accumulate in lymphoid tissues, mainly within lymph node germinal centers. Notably, HIV-infected patients with lymphomas, but not those not affected by these tumors, were recently shown to carry HIV p17 protein variants with enhanced B-cell clonogenic activity. HIV p17 protein variants were characterized by the presence of distinct insertions at the C-terminal region of the protein responsible for a structural destabilization and the acquisition of novel biologic properties. These data are changing the current paradigm assuming that HIV is only indirectly related to lymphomagenesis. Furthermore, these recent findings are consistent with a role of HIV as a critical microenvironmental factor promoting lymphoma development and pave the way for further studies that may lead to the design of more effective strategies for an early identification and improved control of lymphomas in the HIV setting.
Collapse
|
27
|
High rate of lymphoma among a UK cohort of adolescents with vertically acquired HIV-1 infection transitioning to adult care in the era of antiretroviral therapy. AIDS 2016; 30:153-6. [PMID: 26558727 DOI: 10.1097/qad.0000000000000942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Among an inner London UK cohort of 147 adolescents transitioning from paediatric into adult care between 2007 and 2015, a new diagnosis of lymphoma was made in five patients; incidence rate = 0.425/100 person-years (95% confidence interval = 0.424-0.426). Previously described risk factors, including low nadir CD4 cell count and ongoing HIV-1 viraemia, appeared to be important. These data suggest that careful surveillance and a low threshold for investigating relevant symptoms continue to be essential for such patients.
Collapse
|
28
|
Riedel DJ, Rositch AF, Redfield RR. Patterns of HIV viremia and viral suppression before diagnosis of non-AIDS-defining cancers in HIV-infected individuals. Infect Agent Cancer 2015; 10:38. [PMID: 26535055 PMCID: PMC4631102 DOI: 10.1186/s13027-015-0033-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/11/2015] [Indexed: 12/30/2022] Open
Abstract
Background The association between HIV viremia and non-AIDS-defining cancers (NADCs) is not well characterized. Viremia may contribute directly or indirectly to cancer development and may have a differential impact on various cancer types. Our objective was to characterize patterns of HIV viremia in a retrospective, urban, clinical cohort (N = 320) of patients diagnosed with NADCs. Findings The most common NADC’s were lung (n = 60), prostate (n = 47), oropharyngeal (n = 32), liver (n = 29), and anal cancer (n = 20) and Hodgkin lymphoma (n = 18). In the year before cancer diagnosis, 66 % of all patients were virally suppressed. Patients with oropharyngeal (70 %) and prostate cancer (78 %) had a higher proportion of visits with suppressed viral loads. Patients diagnosed with anal cancer and Hodgkin lymphoma were infrequently virally suppressed and more frequently had viral loads ≥5 log10 copies/ml in the ten years prior to cancer diagnosis. Conclusions In this cohort of HIV-infected patients diagnosed with NADCs, there were important differences in the patterns and levels of viremia between the different NADCs in the ten years prior to cancer diagnosis. Patients with anal cancer and Hodgkin lymphoma had the highest proportion of high level viremia in the ten years before cancer and the lowest frequency of viral load suppression at cancer diagnosis.
Collapse
Affiliation(s)
- David J Riedel
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD USA.,Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Cancer Center, 725 W. Lombard St., N552, Baltimore, MD 21201 USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Robert R Redfield
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD USA
| |
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW Since the discovery of Epstein-Barr virus in Burkitt's lymphoma 50 years ago, only one other virus, namely Kaposi's sarcoma-associated herpesvirus/human herpesvirus-8, has been confirmed to be a direct cause of B-cell lymphoma. Here we will review the evidence for Epstein-Barr virus and Kaposi's sarcoma-associated herpesvirus as causal lymphoma agents. RECENT FINDINGS A deeper understanding of specific mechanisms by which Epstein-Barr virus and Kaposi's sarcoma-associated herpesvirus cause B-cell lymphomas has been acquired over the past years, in particular with respect to viral protein interactions with host cell pathways, and microRNA functions. Specific therapies based on knowledge of viral functions are beginning to be evaluated, mostly in preclinical models. SUMMARY Understanding the causal associations of specific infectious agents with certain B-cell lymphomas has allowed more accurate diagnosis and classification. A deeper knowledge of the specific mechanisms of transformation is essential to begin assessing whether virus-targeted treatment modalities may be used in the future.
Collapse
Affiliation(s)
- Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
30
|
Crum-Cianflone NF, Wang X, Ganesan A, Okulicz J, Weintrob A, Lalani T, Agan B. Short Communication: HIV RNA Levels Predict AIDS-Defining and Non-AIDS-Defining Cancers After Antiretroviral Therapy Initiation Among HIV-Infected Adults. AIDS Res Hum Retroviruses 2015; 31:514-8. [PMID: 25417712 DOI: 10.1089/aid.2014.0279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Whether poor virologic control is associated with incident cancers after initiation of combination antiretroviral therapy (ART) remains unclear. In a large cohort, time-updated HIV RNA levels ≥1,000 copies/ml predicted AIDS-defining cancers (ADCs), non-AIDS-defining cancers (NADCs), and skin cancers. Virologic control may be an important strategy in reducing cancer events among HIV-infected persons.
Collapse
Affiliation(s)
- Nancy F. Crum-Cianflone
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Xun Wang
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Jason Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Amy Weintrob
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| |
Collapse
|
31
|
Complete heart block and persistent lactic acidosis as an initial presentation of non-hodgkin lymphoma in a critically ill newly diagnosed AIDS patient. Case Rep Crit Care 2014; 2014:214970. [PMID: 25431684 PMCID: PMC4241285 DOI: 10.1155/2014/214970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/13/2014] [Accepted: 10/19/2014] [Indexed: 11/18/2022] Open
Abstract
A 66-year-old male with newly diagnosed untreated acquired immunodeficiency syndrome (AIDS) presented with chronic nonspecific complaints of weakness, fatigue, myalgia, and weight loss. His initial EKG showed complete heart block necessitating temporary pacemaker placement. He had no previous history of cardiac disease. He was also found to have a persistent lactic acidosis and imaging studies showed abdominal lymphadenopathy. The patient underwent biopsy of these lymph nodes and was found to have diffuse large B-cell lymphoma. The hospital course was complicated by respiratory failure requiring mechanical ventilator support and cardiac arrest. Patient remained critically ill; he was not a candidate for chemotherapy and, after a month of hospitalization, he died. Lactic acidosis and heart block as an initial presentation of non-Hodgkin lymphoma in an AIDS patient are an unusual and unique presentation.
Collapse
|
32
|
Abstract
In human immunodeficiency virus (HIV)-infected persons, the incidence of hematologic malignancies, including leukemia and lymphoma, is increased despite the use of successful antiretroviral therapy. Hematopoietic stem cell transplantation (SCT) is emerging as a safe and effective therapy for HIV-infected persons with hematologic malignancies. Management of these patients is complicated by drug-drug interactions involving antiretroviral therapy (ART) that may impact conditioning agent efficacy and metabolism of immunosuppressive medications and potentiate drug toxicities. As such, optimal strategies for ART remain controversial. We discuss recent advances, controversies, and future directions related to SCT in HIV-infected persons, including the investigation of allogeneic SCT as a strategy for HIV cure.
Collapse
Affiliation(s)
- Ignacio A Echenique
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 900, Chicago, IL, 60611, USA,
| | | | | | | |
Collapse
|
33
|
Simpson KN, Hanson KA, Harding G, Haider S, Tawadrous M, Khachatryan A, Pashos CL, Wu AW. Patient reported outcome instruments used in clinical trials of HIV-infected adults on NNRTI-based therapy: a 10-year review. Health Qual Life Outcomes 2013; 11:164. [PMID: 24090055 PMCID: PMC3852266 DOI: 10.1186/1477-7525-11-164] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 09/05/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) may provide valuable information to clinicians and patients when choosing initial antiretroviral therapy. OBJECTIVE To identify and classify PRO instruments used to measure treatment effects in clinical trials evaluating NNRTIs. METHODS We conducted a structured literature review using PubMed to identify NNRTI trials published from March 2003 to February 2013. Studies identified--based on disease, instrument, PRO, and NNRTI medication terms were reviewed--to identify PRO instruments. Domains measured within each instrument were recorded to understand key areas of interest in NNRTIs. RESULTS Of 189 articles reviewed, 27 validated instruments were administered in 26 unique trials, with a mean of 1.9 instruments (median: 1; range: 1-7) per trial. The Medical Outcomes Study HIV Health Survey (MOS-HIV) was the most commonly used instrument (n = 8 trials). Seventeen trials (65%) included at least one multidimensional health-related quality of life (HRQL) instrument (HIV-targeted, n = 11; general, n = 8). Other validated instruments measured sleep (n = 5), depression (n = 5), anxiety (n = 4), psychiatric symptoms (n = 2), beliefs about HIV medications (n = 2), HIV symptoms (n = 1), and stress (n = 1). CONCLUSIONS Although review of recent NNRTI trials suggests a lack of consensus on the optimal PRO instruments, a typical battery is comprised of a multidimensional HRQL measure coupled with one or more symptom measures. Further work is needed to clarify advantages and disadvantages of using specific PRO instruments to measure relevant constructs and to identify the most useful batteries of instruments for NNRTI trials.
Collapse
Affiliation(s)
- Kit N Simpson
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Kristin A Hanson
- UBC: An Express Scripts Company, 185 Dorval Ave, Suite 500, Dorval, QC H9S 5J9, Canada
| | - Gale Harding
- Evidera, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA
| | - Seema Haider
- Pfizer Inc., 558 Eastern Point Road, Groton, CT 06340, USA
| | | | | | - Chris L Pashos
- UBC: An Express Scripts Company, 430 Bedford Street, Lexington, MA 02420, USA
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| |
Collapse
|