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Nicolau IA, Moineddin R, Brooks JD, Antoniou T, Gillis JL, Kendall CE, Cooper C, Cotterchio M, Salters K, Smieja M, Kroch AE, Price C, Mohamed A, Burchell AN. Associations of CD4 Cell Count Measures With Infection-Related and Infection-Unrelated Cancer Risk Among People With HIV. J Acquir Immune Defic Syndr 2024; 96:447-456. [PMID: 38985442 DOI: 10.1097/qai.0000000000003452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/09/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND People with HIV are at higher risk of infection-related cancers than the general population, which could be due, in part, to immune dysfunction. Our objective was to examine associations between 4 CD4 count measures as indicators of immune function and infection-related and infection-unrelated cancer risk. SETTING We conducted a cohort study of adults with HIV who were diagnosed with cancer in Ontario, Canada. Incident cancers were identified from January 1, 1997 to December 31, 2020. METHODS We estimated adjusted hazard ratios (aHR) for the associations between CD4 measures (baseline CD4, nadir CD4, time-updated CD4, time-updated CD4:CD8) and cancer incidence rates using competing risk analyses, adjusted for socio-demographic factors, history of hepatitis B or C infection, baseline viral load, smoking, and alcohol use. RESULTS Among 4771 people with HIV, contributing 59,111 person-years of observation, a total of 549 cancers were observed. Low baseline CD4 (<200 cells/µL) (aHR 2.08 [95% CI: 1.38 to 3.13], nadir (<200 cells/µL) (aHR 2.01 [95% CI: 1.49 to 2.71]), low time-updated CD4 (aHR 3.52 [95% CI: 2.36 to 5.24]) and time-updated CD4:CD8 ratio (<0.4) (aHR 2.02 [95% CI: 1.08 to 3.79]) were associated with an increased rate of infection-related cancer. No associations were observed for infection-unrelated cancers. CONCLUSIONS Low CD4 counts and indices were associated with increased rates of infection-related cancers among people with HIV, irrespective of the CD4 measure used. Early diagnosis and linkage to care and high antiretroviral therapy uptake may lead to improved immune function and could add to cancer prevention strategies such as screening and vaccine uptake.
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Affiliation(s)
- Ioana A Nicolau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tony Antoniou
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Claire E Kendall
- ICES, Toronto, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Curtis Cooper
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michelle Cotterchio
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | | | - Abigail E Kroch
- Ontario HIV Treatment Network, Toronto, Ontario, Canada; and
| | - Colleen Price
- Canadian HIV/AIDS and Chronic Pain Society, Ottawa, Ontario, Canada
| | - Anthony Mohamed
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ann N Burchell
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Lurain K, Zarif TE, Ramaswami R, Nassar AH, Adib E, Abdel-Wahab N, Chintapally N, Drolen CE, Feldman T, Haykal T, Nebhan CA, Kambhampati S, Li M, Mittra A, Lorentsen M, Kim C, Drakaki A, Morse M, Johnson DB, Mangla A, Dittus C, Ravi P, Baiocchi RA, Chiao EY, Rubinstein PG, Yellapragada SV, LaCasce AS, Sonpavde GP, Naqash AR, Herrera AF. Real-World Multicenter Study of PD-1 Blockade in HIV-Associated Classical Hodgkin Lymphoma Across the United States. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:523-530. [PMID: 38714474 PMCID: PMC11283942 DOI: 10.1016/j.clml.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND Despite a higher risk of classical Hodgkin lymphoma (cHL) in people with HIV and the demonstrated safety and efficacy of PD-1 blockade in cHL, there are limited data on the use of these agents in HIV-associated cHL (HIV-cHL). PATIENTS/METHODS We retrospectively identified patients with HIV-cHL from the "Cancer Therapy using Checkpoint inhibitors in People with HIV-International (CATCH-IT)" database who received nivolumab or pembrolizumab, alone or in combination with other agents, and reviewed records for demographics, disease characteristics, immune-mediated adverse events (imAEs), and treatment outcomes. Changes in CD4+ T-cell counts with treatment were measured via Wilcoxon signed-rank tests. Overall response rate (ORR) was defined as the proportion of patients with partial or complete response (PR/CR) per 2014 Lugano classification. RESULTS We identified 23 patients with HIV-cHL who received a median of 6 cycles of PD-1 blockade: 1 as 1st-line, 6 as 2nd-line, and 16 as ≥3rd-line therapy. Seventeen (74%) patients received monotherapy, 5 (22%) received nivolumab plus brentuximab vedotin, and 1 received nivolumab plus ifosfamide, carboplatin, and etoposide. The median baseline CD4+ T-cell count was 155 cells/µL, which increased to 310 cells/µL at end-of-treatment (P = .009). Three patients had grade 3 imAEs; none required treatment discontinuation. The ORR was 83% with median duration of response of 19.7 months. The median progression-free survival was 21.2 months and did not differ between patients with <200 versus ≥200 CD4+ cells/µL (P = .95). CONCLUSION Our findings support the use of PD-1 blockade in HIV-cHL for the same indications as the general population with cHL.
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Affiliation(s)
- Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | | | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Elio Adib
- Brigham and Women's Hospital, Department of Radiation Oncology, Boston, MA
| | | | | | - Claire E Drolen
- University of California Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | | | - Tarek Haykal
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Mingjia Li
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Arjun Mittra
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Chul Kim
- Medstar Georgetown University Hospital, Washington, DC
| | - Alexandra Drakaki
- University of California Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Michael Morse
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | | | - Ankit Mangla
- University Hospital Seidman Cancer Center, Cleveland, OH
| | | | | | | | | | | | - Sarvari V Yellapragada
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine & Michael E. DeBakey VA Medical Center, Houston, TX
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Yan X, Wei S, Yang Y, Zhao Z, Wu Q, Tang H. CTSG may inhibit disease progression in HIV-related lung cancer patients by affecting immunosuppression. Infect Agent Cancer 2024; 19:34. [PMID: 39080685 PMCID: PMC11290089 DOI: 10.1186/s13027-024-00599-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVES Lung cancer is an independent risk factor for pulmonary complications following HIV infection. This study aimed to examine the expression and clinical significance of Cathepsin G (CTSG) protein in both non-HIV and HIV-related lung cancers. METHODS The data related to lung adenocarcinoma (LUAD) and lung squamous carcinoma (LUSC) in the TCGA dataset and the data related to healthy individuals in the GTEx dataset, the GEPIA2 database was used to excavate the distinction in the expression of CTSG protein in non-small cell lung cancer (NSCLC) tissues versus normal non-cancerous tissues. The Ualcan database was used to compare the differences in CTSG expression at different stages of LUAD and LUSC. Immunohistochemistry (IHC) was used to detect the expression of CTSG proteins in the pathological tissues of patients with HIV-related lung cancer and patients with lung cancer without co-infection, the Kaplan-Meier method was used for survival analysis. RESULTS We observed that CTSG expression in NSCLC is lower compared to adjacent non-tumor tissues and correlates with NSCLC clinical stage. CTSG protein expression in HIV-related lung cancer tissues was lower than in adjacent tissues and lower than in lung cancer tissues without HIV infection, with a statistically significant difference (P < 0.05). It correlated with CD4 + T cell count and CD4+/CD8 + T cell ratio, as well as with the pathological type, distant metastasis, and clinical stage of HIV-related lung cancer, all with statistical significance (P < 0.05). CONCLUSIONS CTSG could potentially mitigate disease advancement in HIV-related lung cancer patients by inhibiting immune depletion, serving as a prospective immunotherapeutic target for both non-HIV and HIV-associated lung cancers.
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Affiliation(s)
- Xuan Yan
- Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, No 2901, Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Shuoyan Wei
- Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, No 2901, Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Yuexiang Yang
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhangyan Zhao
- Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, No 2901, Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Qingguo Wu
- Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, No 2901, Caolang Road, Jinshan District, Shanghai, 201508, China.
| | - Haicheng Tang
- Department of Respiratory and Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, No 2901, Caolang Road, Jinshan District, Shanghai, 201508, China.
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Lurain KA, Ramaswami R, Krug LT, Whitby D, Ziegelbauer JM, Wang HW, Yarchoan R. HIV-associated cancers and lymphoproliferative disorders caused by Kaposi sarcoma herpesvirus and Epstein-Barr virus. Clin Microbiol Rev 2024:e0002223. [PMID: 38899877 DOI: 10.1128/cmr.00022-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
SUMMARYWithin weeks of the first report of acquired immunodeficiency syndrome (AIDS) in 1981, it was observed that these patients often had Kaposi sarcoma (KS), a hitherto rarely seen skin tumor in the USA. It soon became apparent that AIDS was also associated with an increased incidence of high-grade lymphomas caused by Epstein-Barr virus (EBV). The association of AIDS with KS remained a mystery for more than a decade until Kaposi sarcoma-associated herpesvirus (KSHV) was discovered and found to be the cause of KS. KSHV was subsequently found to cause several other diseases associated with AIDS and human immunodeficiency virus (HIV) infection. People living with HIV/AIDS continue to have an increased incidence of certain cancers, and many of these cancers are caused by EBV and/or KSHV. In this review, we discuss the epidemiology, virology, pathogenesis, clinical manifestations, and treatment of cancers caused by EBV and KSHV in persons living with HIV.
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Affiliation(s)
- Kathryn A Lurain
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Ramya Ramaswami
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Laurie T Krug
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Joseph M Ziegelbauer
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Hao-Wei Wang
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert Yarchoan
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
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Mathis A, Smith UD, Crowther V, Lee T, Suther S. An Epidemiological Study of Cervical Cancer Trends among Women with Human Immunodeficiency Virus. Healthcare (Basel) 2024; 12:1178. [PMID: 38921292 PMCID: PMC11202823 DOI: 10.3390/healthcare12121178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/02/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
The purpose of this study was to examine cervical cancer among women with Human Immunodeficiency Virus (HIV) and to discuss targeted strategies to reduce the risk of developing cervical cancer. This study used retrospective data from surveillance reports collected between January 2001 and December 2012. Women with HIV/Acquired Immunodeficiency Syndrome (AIDS) were linked through a crosswalk file to Florida's cancer registry database to determine which women developed cervical cancer during this period. We examined the cervical cancer trends using age-adjusted cervical cancer rates to examine the changes over time; the geographic variations in cervical cancer and HIV across service areas using a Geographic Information System (GIS); and finally, the cervical cancer rates among women with HIV compared with the cervical cancer rates in the general population. The results show that, over time, the cervical cancer rates in women with HIV/AIDS decreased; however, we detected increases in the cervical cancer rates among women in the general population. The findings of this study show that more work is required to address cervical cancer. This growing burden of cervical cancer implies that targeted interventions are imperative to improving the health status of women with cervical cancer. If properly addressed, the potential to reduce and prevent cervical cancer is achievable.
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Affiliation(s)
- Arlesia Mathis
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA; (U.D.S.); (S.S.)
| | - Ukamaka D. Smith
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA; (U.D.S.); (S.S.)
| | - Vanessa Crowther
- Division of Health Care Management, School of Allied Health Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA;
| | - Torhonda Lee
- Department of Graduate Public Health, Tuskegee University, Tuskegee, AL 36088, USA;
| | - Sandra Suther
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL 32307, USA; (U.D.S.); (S.S.)
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Mathoma A, Sartorius B, Mahomed S. Evaluation of cancer screening services provided for people living with HIV in Botswana, 2022-2023. Health Promot Int 2024; 39:daae042. [PMID: 38742893 DOI: 10.1093/heapro/daae042] [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: 05/16/2024] Open
Abstract
People living with human immunodeficiency virus (PLHIV) have an increased risk of cancers. Currently, Botswana has no screening guidelines for common cancers in PLHIV except cervical cancer. Also, the proportion of PLHIV who are screened for cancer is unknown. This study aimed to evaluate cancer screening services for PLHIV receiving care in the human immunodeficiency virus (HIV) clinics. Resources for cancer screening were assessed and medical records of adults initiating antiretroviral therapy (ART) from 2020 to 2021 in 20 high-volume HIV clinics in Gaborone and Francistown were reviewed. Questionnaires assessing knowledge and practices of cancer screening were administered to health workers. The majority of clinics had the required resources for cancer screening (specifically cervical cancer). Of the 62 health workers working at the HIV clinics, 57 (91.9%) completed the questionnaire: 35 (62.5%) nurses and 22 (37.5%) doctors. Only 26.3% of the health workers were trained in cervical cancer screening. Doctors were more likely to report practicing routine screening of other cancers (e.g. breast) (p = 0.003) while more nurses reported assessing patients for cancer history during follow-up visits (p = 0.036). Most health workers did not perform physical examinations to detect cancer at initial or follow-up visits. Of the 1000 records of PLHIV reviewed, 57.3% were females, and only 38% of these were screened for cervical cancer. Besides cervical cancer, almost all (97.8%) were not screened for any cancer at ART initiation and during follow-up. These findings highlight the need to improve cancer screening services of PLHIV in Botswana through the training of health workers, and the development and enhanced use of screening guidelines.
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Affiliation(s)
- Anikie Mathoma
- Division of Research and Innovation, University of Botswana, Corner of Notwane and Mabuto Road, Plot 4775, Gaborone, Botswana
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 236 George Campbell Building, King George V Avenue, Durban 4001, South Africa
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 236 George Campbell Building, King George V Avenue, Durban 4001, South Africa
- Faculty of Medicine, UQ Centre for Clinical Research (UQCCR), University of Queensland, Brisbane, St Lucia QLD 4072, Australia
- Centre for Tropical Medicine and Global Health, University of Oxford, New Richards Building, Roosevelt Dr, Headington, Oxford OX3 7LG, UK
- Department of Health Metric Sciences, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Saajida Mahomed
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 236 George Campbell Building, King George V Avenue, Durban 4001, South Africa
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Mutetwa T, Liu Y, Silvera R, Evans M, Yurich M, Tripodi J, Leonard I, Houldsworth J, Gümüş Z, Bowcock AM, Sigel K, Gaisa M, Polak P. Host Nuclear Genome Copy Number Variations Identify High-Risk Anal Precancers in People Living With HIV. J Acquir Immune Defic Syndr 2024; 96:190-195. [PMID: 38630441 PMCID: PMC11108747 DOI: 10.1097/qai.0000000000003409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/07/2023] [Indexed: 05/22/2024]
Abstract
BACKGROUND People living with HIV (PLWH) have substantially increased incidence of anal precancer and cancer. There are very little data regarding genomic disturbances in anal precancers among PLWH. In this study, specific chromosomal variants were identified in anal squamous intraepithelial lesions. METHODS Overall, 63 anal biopsy specimens (27 low-grade intraepithelial lesions [LSIL] and 36 high-grade intraepithelial lesions [HSIL]) were collected from PLWH obtained as part of anal cancer screening in our NYC-based health system. Data on patient demographics, anal cytological, and high-risk human papillomavirus (HR-HPV) diagnoses were collected. Specimens were tested for a panel of chromosomal alterations associated with HPV-induced oncogenesis using fluorescence in situ hybridization, and analyses compared the associations of these alterations with clinical characteristics. RESULTS Gains of 3q26, 5p15, 20q13, and cen7 were detected in 42%, 31%, 31%, and 19% of HSIL compared with 7%, 0%, 4%, and 0% of LSIL, respectively. If at least 1 abnormality was observed, 89% had a 3q26 gain. In lesions with 5p15 gains, 20q13 gains co-occurred in 91% of cases, while cen7 gain only co-occurred with the other 3 alterations. The sensitivity and specificity of any alteration to predict HSIL were 47% (95% CI: 30%-65%) and 93% (95% CI: 76%-99%), respectively. CONCLUSIONS Genomic alterations seen in HPV-associated cancers may help distinguish anal LSIL from HSIL. 3q26 amplification may be an early component of anal carcinogenesis, preceding 5p16, 20q13, and/or chr7. IMPACT Insights into potential genomic biomarkers for discriminating high-risk anal precancers are shared.
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Affiliation(s)
- Tinaye Mutetwa
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yuxin Liu
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard Silvera
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Evans
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Yurich
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph Tripodi
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Issa Leonard
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane Houldsworth
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zeynep Gümüş
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne M. Bowcock
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Gaisa
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paz Polak
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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McGee-Avila JK, Suneja G, Engels EA, Rositch AF, Horner MJ, Luo Q, Shiels MS, Islam JY. Cancer Treatment Disparities in People With HIV in the United States, 2001-2019. J Clin Oncol 2024; 42:1810-1820. [PMID: 38513161 PMCID: PMC11095899 DOI: 10.1200/jco.23.02366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE People with HIV (PWH) have worse cancer outcomes, partially because of inequities in cancer treatment. We evaluated cancer treatment disparities among PWH, including an assessment of changes in disparities over time. METHODS We used data from the HIV/AIDS Cancer Match Study, a population-based HIV and cancer registry linkage to examine diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and cancers of the cervix, lung, anus, prostate, colon, and female breast. Outcomes included receipt of (1) any cancer treatment and (2) standard therapy among patients with local-stage cancer. We assessed associations between HIV and each outcome by estimating adjusted prevalence odds ratios (aORs) with 95% CI and trends over time. We identified predictors of nonreceipt of cancer treatment in PWH. RESULTS From 2001 to 2019, compared with people with cancer without HIV (n = 2,880,955), PWH (n = 16,334) were more likely to not receive cancer treatment for cervical cancer (aOR, 2.03 [95% CI, 1.52 to 2.70]), DLBCL (aOR, 1.53 [95% CI, 1.38 to 1.70]), HL (aOR, 1.39 [95% CI, 1.19 to 1.63]), lung cancer (aOR, 1.79 [95% CI, 1.65 to 1.93]), prostate cancer (aOR, 1.32 [95% CI, 1.21 to 1.44]), colon cancer (aOR, 1.73 [95% CI, 1.43 to 2.08]), and breast cancer (aOR, 1.38 [95% CI, 1.07 to 1.77]). Similar associations were observed in PWH with local-stage cancers although no difference was observed for anal cancers. The association between HIV and nonreceipt of cancer treatment significantly decreased over time for breast, colon, and prostate cancers (all P trend <.0001), but PWH remained less likely to receive treatment in 2014-2019 for DLBCL, cervix, and lung cancers. Among PWH, Black individuals, people who inject drugs, and those 65 years and older were less likely to receive cancer treatment. CONCLUSION Disparities in receipt of cancer treatment persist for PWH in the United States in contemporary time periods. Solutions to address inequitable receipt of cancer treatment among PWH are urgently needed.
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Affiliation(s)
- Jennifer K. McGee-Avila
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, School of Medicine, Salt Lake City, UH
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Anne F. Rositch
- Deparment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marie-Josephe Horner
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Qianlai Luo
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Meredith S. Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Jessica Y. Islam
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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9
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Dickey BL, Yanik EL, Thompson Z, Burkholder G, Kitahata MM, Moore RD, Jacobson J, Mathews WC, Christopoulos KA, Fleming J, Napravnik S, Achenbach C, Coghill AE. The Association of HIV Control and Immunosuppression With Risk of Non-AIDS-Defining Cancer Risk Among Patients on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2024; 95:275-282. [PMID: 37977197 PMCID: PMC11146681 DOI: 10.1097/qai.0000000000003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND People living with HIV (PWH) are experiencing an increased prevalence of non-AIDS-defining cancers (NADCs). Our study investigated the association of immunosuppression and HIV control with NADCs among PWH on antiretroviral therapy (ART) in the United States. METHODS Among patients across 8 clinical cohorts on ART between 1996 and 2016, we assessed immune function and HIV control using 3 parameterizations of CD4 count and HIV-RNA viral load (VL): (1) CD4 or VL at ART initiation; (2) change in CD4 or VL after ART initiation; and (3) proportion of follow-up time at CD4 >500 cells/µL or VL <50 copies/mL. Cox models were used to ascertain the association of these measures with risk of a viral NADC or nonviral NADC. RESULTS Among 29,568 patients on ART, there were 410 nonviral NADCs and 213 viral NADCs. PWH with a CD4 <200 cells/µL at ART initiation had an 80% elevated risk for developing a viral NADC. Each increase of 100 cells/µL in CD4 after ART initiation decreased risk by 14%. For viral and nonviral NADCs, 10% more follow-up time spent with a CD4 >500 cells/µL was associated with decreased risk [viral, adjusted hazard ratio (aHR): 0.82; 95% confidence intervals (CI): 0.78 to 0.86; nonviral, aHR: 0.88; 95% CI: 0.86 to 91], even after accounting for CD4 at ART initiation. When examining HIV control only, 10% more time with VL <50 copies/mL was significantly associated with decreased viral (aHR: 0.85; 95% CI: 0.82 to 0.89) and nonviral NADC risk (aHR: 0.88; 95% CI: 0.85 to 0.90). CONCLUSIONS This study demonstrates that even for PWH on ART therapy, maintaining HIV control is associated with lower risk of both viral and nonviral NADCs.
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Affiliation(s)
- Brittney L. Dickey
- Center for Immunization and Infection Research in Cancer & Department of Cancer Epidemiology, Moffitt Cancer Center
| | | | - Zachary Thompson
- Center for Immunization and Infection Research in Cancer & Department of Cancer Epidemiology, Moffitt Cancer Center
| | | | | | | | | | | | | | | | | | | | - Anna E. Coghill
- Center for Immunization and Infection Research in Cancer & Department of Cancer Epidemiology, Moffitt Cancer Center
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10
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Engels EA, Shiels MS, Barnabas RV, Bohlius J, Brennan P, Castilho J, Chanock SJ, Clarke MA, Coghill AE, Combes JD, Dryden-Peterson S, D'Souza G, Gopal S, Jaquet A, Lurain K, Makinson A, Martin J, Muchengeti M, Newton R, Okuku F, Orem J, Palefsky JM, Ramaswami R, Robbins HA, Sigel K, Silver S, Suneja G, Yarchoan R, Clifford GM. State of the science and future directions for research on HIV and cancer: Summary of a joint workshop sponsored by IARC and NCI. Int J Cancer 2024; 154:596-606. [PMID: 37715370 PMCID: PMC11133517 DOI: 10.1002/ijc.34727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 09/17/2023]
Abstract
An estimated 38 million people live with human immunodeficiency virus (HIV) worldwide and are at excess risk for multiple cancer types. Elevated cancer risks in people living with HIV (PLWH) are driven primarily by increased exposure to carcinogens, most notably oncogenic viruses acquired through shared transmission routes, plus acceleration of viral carcinogenesis by HIV-related immunosuppression. In the era of widespread antiretroviral therapy (ART), life expectancy of PLWH has increased, with cancer now a leading cause of co-morbidity and death. Furthermore, the types of cancers occurring among PLWH are shifting over time and vary in their relative burden in different parts of the world. In this context, the International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI) convened a meeting in September 2022 of multinational and multidisciplinary experts to focus on cancer in PLWH. This report summarizes the proceedings, including a review of the state of the science of cancer descriptive epidemiology, etiology, molecular tumor characterization, primary and secondary prevention, treatment disparities and survival in PLWH around the world. A consensus of key research priorities and recommendations in these domains is also presented.
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Affiliation(s)
- Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Ruanne V Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia Bohlius
- University of Basel, Basel, Switzerland
- Department for Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Jessica Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Anna E Coghill
- Department of Cancer Epidemiology and Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jean-Damien Combes
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Scott Dryden-Peterson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Antoine Jaquet
- National Institute for Health and Medical Research (INSERM), UMR, 1219, Research Institute for Sustainable Development (IRD), EMR 271, Bordeaux Population, Health Centre, University of Bordeaux, Bordeaux, France
| | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alain Makinson
- Infectious Disease Department, CHU La Colombière, Montpellier & Inserm U1175, University of Montpellier, Montpellier, France
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York, UK
| | - Fred Okuku
- Uganda Cancer Institute, Kampala, Uganda
| | | | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California, USA
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Keith Sigel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Gary M Clifford
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
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11
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Matsunaga A, Ando N, Yamagata Y, Shimura M, Gatanaga H, Oka S, Ishizaka Y. Identification of viral protein R of human immunodeficiency virus-1 (HIV) and interleukin-6 as risk factors for malignancies in HIV-infected individuals: A cohort study. PLoS One 2024; 19:e0296502. [PMID: 38166062 PMCID: PMC10760899 DOI: 10.1371/journal.pone.0296502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/14/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Despite effective antiretroviral therapy, patients with human immunodeficiency virus type-1 (HIV) suffer from a high frequency of malignancies, but related risk factors remain elusive. Here, we focused on blood-circulating viral protein R (Vpr) of HIV, which induces proinflammatory cytokine production and genotoxicity by exogenous functions. METHODS AND FINDINGS A total 404 blood samples of HIV patients comprising of 126 patients with malignancies (tumor group) and 278 patients without malignancies (non-tumor group), each of 96 samples was first selected by one-to-one propensity score matching. By a detergent-free enzyme-linked immunosorbent assays (detection limit, 3.9 ng/mL), we detected Vpr at a higher frequency in the matched tumor group (56.3%) than in the matched non-tumor group (39.6%) (P = 0.030), although there was no different distribution of Vpr levels (P = 0.372). We also detected anti-Vpr immunoglobulin (IgG), less frequently in the tumor group compared with the tumor group (22.9% for tumor group vs. 44.8% for non-tumor group, P = 0.002), and the proportion of patients positive for Vpr but negative of anti-Vpr IgG was significantly higher in the tumor group than in the non-tumor group (38.6% vs. 15.6%, respectively, P < 0.001). Additionally, Interleukin-6 (IL-6), the levels of which were high in HIV-1 infected patients (P < 0.001) compared to non-HIV-infected individuals, was significantly higher in advanced cases of tumors (P < 0.001), and IL-6 level was correlated with Vpr in the non-tumor group (P = 0.010). Finally, multivariate logistic regression analysis suggested a positive link of Vpr with tumor occurrence in HIV patients (P = 0.002). CONCLUSION Vpr and IL-6 could be risk factors of HIV-1 associated malignancies, and it would be importance to monitor these molecules for well managing people living with HIV-1.
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Affiliation(s)
- Akihiro Matsunaga
- Department of Intractable Diseases, Research Institute, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
| | - Naokatsu Ando
- AIDS Clinical Center, Hospital, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
| | - Yuko Yamagata
- Department of Intractable Diseases, Research Institute, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
- RIKEN SPring-8 Center, Koto, Sayo, Hyogo, Japan
| | - Mari Shimura
- Department of Intractable Diseases, Research Institute, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
- RIKEN SPring-8 Center, Koto, Sayo, Hyogo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, Hospital, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, Hospital, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
| | - Yukihito Ishizaka
- Department of Intractable Diseases, Research Institute, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
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12
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Morales AE, Gumenick R, Genovese CM, Jang YY, Ouedraogo A, Ibáñez de Garayo M, Pannellini T, Patel S, Bott ME, Alvarez J, Mun SS, Totonchy J, Gautam A, Delgado de la Mora J, Chang S, Wirth D, Horenstein M, Dao T, Scheinberg DA, Rubinstein PG, Semeere A, Martin J, Godfrey CC, Moser CB, Matining RM, Campbell TB, Borok MZ, Krown SE, Cesarman E. Wilms' tumor 1 (WT1) antigen is overexpressed in Kaposi Sarcoma and is regulated by KSHV vFLIP. PLoS Pathog 2024; 20:e1011881. [PMID: 38190392 PMCID: PMC10898863 DOI: 10.1371/journal.ppat.1011881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/27/2024] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
In people living with HIV, Kaposi Sarcoma (KS), a vascular neoplasm caused by KS herpesvirus (KSHV/HHV-8), remains one of the most common malignancies worldwide. Individuals living with HIV, receiving otherwise effective antiretroviral therapy, may present with extensive disease requiring chemotherapy. Hence, new therapeutic approaches are needed. The Wilms' tumor 1 (WT1) protein is overexpressed and associated with poor prognosis in several hematologic and solid malignancies and has shown promise as an immunotherapeutic target. We found that WT1 was overexpressed in >90% of a total 333 KS biopsies, as determined by immunohistochemistry and image analysis. Our largest cohort from ACTG, consisting of 294 cases was further analyzed demonstrating higher WT1 expression was associated with more advanced histopathologic subtypes. There was a positive correlation between the proportion of infected cells within KS tissues, assessed by expression of the KSHV-encoded latency-associated nuclear antigen (LANA), and WT1 positivity. Areas with high WT1 expression showed sparse T-cell infiltrates, consistent with an immune evasive tumor microenvironment. We show that major oncogenic isoforms of WT1 are overexpressed in primary KS tissue and observed WT1 upregulation upon de novo infection of endothelial cells with KSHV. KSHV latent viral FLICE-inhibitory protein (vFLIP) upregulated total and major isoforms of WT1, but upregulation was not seen after expression of mutant vFLIP that is unable to bind IKKƴ and induce NFκB. siRNA targeting of WT1 in latent KSHV infection resulted in decreased total cell number and pAKT, BCL2 and LANA protein expression. Finally, we show that ESK-1, a T cell receptor-like monoclonal antibody that recognizes WT1 peptides presented on MHC HLA-A0201, demonstrates increased binding to endothelial cells after KSHV infection or induction of vFLIP expression. We propose that oncogenic isoforms of WT1 are upregulated by KSHV to promote tumorigenesis and immunotherapy directed against WT1 may be an approach for KS treatment.
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Affiliation(s)
- Ayana E. Morales
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Ruby Gumenick
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Caitlyn M. Genovese
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Yun Yeong Jang
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Ariene Ouedraogo
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Maite Ibáñez de Garayo
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Tania Pannellini
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Sanjay Patel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Matthew E. Bott
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Julio Alvarez
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Sung Soo Mun
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Jennifer Totonchy
- School of Pharmacy, Chapman University, Irvine, California, United States of America
| | - Archana Gautam
- Department of Allergy and Immunology, Icahn School of Medicine, New York, New York, United States of America
| | - Jesus Delgado de la Mora
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Stephanie Chang
- Cornell University, Ithaca, New York, United States of America
| | - Dagmar Wirth
- Model Systems for Infection and Immunity, Helmholtz Centre for Infection Research Braunschweig, Germany
| | - Marcelo Horenstein
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Tao Dao
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - David A. Scheinberg
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Paul G. Rubinstein
- Section of Hematology/Oncology, John H. Stroger Jr Hospital of Cook County (Cook County Hospital), Ruth M. Rothstein Core Center, University of Illinois, Chicago, Illinois, United States of America
| | - Aggrey Semeere
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Catherine C. Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington, DC, United States of America
| | - Carlee B. Moser
- Center for Biostatistics in AIDS Research, Harvard T H Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Roy M. Matining
- Center for Biostatistics in AIDS Research, Harvard T H Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Thomas B. Campbell
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Margaret Z. Borok
- Department of Internal Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Susan E. Krown
- Memorial Sloan Kettering Cancer Center (emerita), New York, New York, United States of America
| | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
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13
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O’Neil DS, Martei YM, Crew KD, Castillo BS, Costa P, Lim T, Michel A, Rubin E, Goel N, Hurley J, Lopes G, Antoni MH. Time to Cancer Treatment and Chemotherapy Relative Dose Intensity for Patients With Breast Cancer Living With HIV. JAMA Netw Open 2023; 6:e2346223. [PMID: 38051529 PMCID: PMC10698616 DOI: 10.1001/jamanetworkopen.2023.46223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023] Open
Abstract
Importance Patients with breast cancer and comorbid HIV experience higher mortality than other patients with breast cancer. Objective To compare time to cancer treatment initiation and relative dose intensity (RDI) of neoadjuvant and adjuvant chemotherapy among patients with breast cancer with vs without HIV. Design, Setting, and Participants A retrospective, matched cohort study enrolled women who received a diagnosis of breast cancer from January 1, 2000, through December 31, 2018. The electronic medical records of 3 urban, academic cancer centers were searched for women with confirmed HIV infection prior to or simultaneous with diagnosis of stage I to III breast cancer. Tumor registry data were used to identify 2 control patients with breast cancer without HIV for each participant with HIV, matching for study site, stage, and year of cancer diagnosis. Statistical analysis was performed from December 2022 to October 2023. Exposure HIV infection detected before or within 90 days of participants' breast cancer diagnosis. Main Outcomes and Measures The primary outcome was time to breast cancer treatment initiation, defined as the number of days between cancer diagnosis and first treatment. The secondary outcome was overall RDI for patients who received chemotherapy. These outcomes were compared by HIV status using Cox proportional hazards regression and linear regression modeling, respectively, adjusting for confounding demographic and clinical factors. Exploratory outcomes included instances of anemia, neutropenia, thrombocytopenia, and liver function test result abnormalities during chemotherapy, which were compared using Fisher exact tests. Results The study enrolled 66 women with comorbid breast cancer and HIV (median age, 51.1 years [IQR, 45.7-58.2 years]) and 132 with breast cancer alone (median age, 53.9 years [IQR, 47.0-62.5 years]). The median time to first cancer treatment was not significantly higher among patients with HIV than those without (48.5 days [IQR, 32.0-67.0 days] vs 42.5 days [IQR, 25.0-59.0 days]; adjusted hazard ratio, 0.78, 95% CI, 0.55-1.12). Among the 36 women with HIV and 62 women without HIV who received chemotherapy, the median overall RDI was lower for those with HIV vs without HIV (0.87 [IQR, 0.74-0.97] vs 0.96 [IQR, 0.88-1.00]; adjusted P = .01). Grade 3 or higher neutropenia during chemotherapy occurred among more women with HIV than those without HIV (13 of 36 [36.1%] vs 5 of 58 [8.6%]). Conclusions and Relevance This matched cohort study suggests that patients with breast cancer and HIV may have experienced reduced adjuvant chemotherapy RDI, reflecting greater dose reductions, delays, or discontinuation. Strategies for supporting this vulnerable population during chemotherapy treatment are necessary.
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Affiliation(s)
- Daniel S. O’Neil
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Yehoda M. Martei
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia
- Abramson Cancer Center, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Katherine D. Crew
- Division of Hematology/Oncology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Brenda S. Castillo
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Philippos Costa
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Tristan Lim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alissa Michel
- Division of Hematology/Oncology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York
| | - Elizabeth Rubin
- Memorial Cancer Institute, Memorial Healthcare System, Hollywood, Florida
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
| | - Judith Hurley
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
- Division of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
- Division of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael H. Antoni
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
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14
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Senthil P, Kuhan S, Potter AL, Jeffrey Yang CF. Update on Lung Cancer Screening Guideline. Thorac Surg Clin 2023; 33:323-331. [PMID: 37806735 DOI: 10.1016/j.thorsurg.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Lung cancer screening has been shown to reduce lung cancer mortality and is recommended for individuals meeting age and smoking history criteria. Despite the expansion of lung cancer screening guidelines in 2021, racial/ethnic and sex disparities persist. High-risk racial minorities and women are more likely to be diagnosed with lung cancer at younger ages and have lower smoking histories when compared with White and male counterparts, resulting in higher rates of ineligibility for screening. Risk prediction models, biomarkers, and deep learning may help refine the selection of individuals who would benefit from screening.
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Affiliation(s)
- Priyanka Senthil
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sangkavi Kuhan
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Alexandra L Potter
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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15
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Qian B, Qian Y, Xiao P, Guo L. Prognostic analysis of cutaneous Kaposi sarcoma based on a competing risk model. Sci Rep 2023; 13:17572. [PMID: 37845261 PMCID: PMC10579376 DOI: 10.1038/s41598-023-44800-5] [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: 03/21/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023] Open
Abstract
The data regarding the prognosis of cutaneous Kaposi sarcoma (KS) was limited. The current study aimed to explore the risk factors and develop a predictive model for the prognosis of cutaneous KS patients. Data were extracted from Surveillance, Epidemiology, and End Results database from 2000 to 2018 and randomly divided into training and validation cohort. The Kaplan-Meier analysis, cumulative incidence function based on the competing risk model and Fine-Gray multivariable regression model was used to identify the prognostic factors and then construct a 5-, 10-, and 15-year KS-specific death (KSSD) nomogram for patients. The concordance index (C-index), area under the curve (AUC) of operating characteristics and calibration plots were used to evaluate the performance of the model. The clinical utility of the model was measured by decision curve analysis (DCA). In 2257 cutaneous KS patients identified from database, the overall median survival time was about 13 years. Radiotherapy (p = 0.013) and surgery (p < 0.001) could lower the KSSD, while chemotherapy (p = 0.042) and surgery (p < 0.001) could increase the overall survival (OS) of patients with metastatic and localized lesions, respectively. Race, number of lesions, surgery, extent of disease, year of diagnosis and age were identified as risk factors associated with cutaneous KS-specific survival. Performance of the nomogram was validated by calibration and discrimination, with C-index values of 0.709 and AUC for 5-, 10-, and 15-year-KSSD of 0.739, 0.728 and 0.725 respectively. DCA indicated that the nomogram had good net benefits in clinical scenarios. Using a competing-risk model, this study firstly identified the prognostic factors, and constructed a validated nomogram to provide individualized assessment and reliable prognostic prediction for cutaneous KS patients.
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Affiliation(s)
- Bei Qian
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Ying Qian
- Department of Pharmacy, Jingzhou Hospital, Yangtze University, Jingzhou, 434020, Hubei, China
| | - Peng Xiao
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Liang Guo
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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16
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O’Neil DS, Ayeni OA, Farrow HA, Chen WC, Demetriou G, Buccimazza I, Čačala S, Stopforth LW, Joffe M, Antoni MH, Lopes G, Pumpalova YS, Mapanga W, Jacobson JS, Crew KD, Neugut AI, Ruff P, Cubasch H. The Impact of HIV Infection on Neoadjuvant and Adjuvant Chemotherapy Relative Dose Intensity in South African Patients with Breast Cancer. Oncologist 2023; 28:e921-e929. [PMID: 36943395 PMCID: PMC10546819 DOI: 10.1093/oncolo/oyad056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/07/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION In the South African Breast Cancer and HIV Outcomes (SABCHO) study, we previously found that breast cancer patients living with HIV and treated with neoadjuvant chemotherapy achieve lower rates of complete pathologic response than patients without HIV. We now assess the impact of comorbid HIV on receipt of timely and complete neoadjuvant and adjuvant chemotherapy. MATERIALS AND METHODS Since June 2015, the SABCHO study has collected data on women diagnosed with breast cancer at 6 South African hospitals. We selected a sample of participants with stages I-III cancer who received ≥2 doses of neoadjuvant or adjuvant chemotherapy. Data on chemotherapies prescribed and received, filgrastim receipt, and laboratory values measured during treatment were captured from patients' medical records. We calculated the mean relative dose intensity (RDI) for all prescribed chemotherapies. We tested for association between full regimen RDI and HIV status, using linear regression to control for demographic and clinical covariates, and for association of HIV with laboratory abnormalities. RESULTS The 166 participants living with HIV and 159 without HIV did not differ in median chemotherapy RDI: 0.89 (interquartile range (IQR) 0.77-0.95) among those living with HIV and 0.87 (IQR 0.77-0.94) among women without HIV. Patients living with HIV experienced more grade 3+ anemia and leukopenia than those without HIV (anemia: 10.8% vs. 1.9%, P = .001; leukopenia: 8.4% vs. 1.9%, P = .008) and were more likely to receive filgrastim (24.7% vs. 10.7%, P = .001). CONCLUSIONS HIV status did not impact neoadjuvant or adjuvant chemotherapy RDI, although patients with breast cancer living with HIV experienced more myelotoxicity during treatment.
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Affiliation(s)
- Daniel S O’Neil
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, Yale University, New Haven, CT, USA
| | - Oluwatosin A Ayeni
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hayley A Farrow
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Wenlong Carl Chen
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Georgia Demetriou
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ines Buccimazza
- Department of Specialized Surgery, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu-Natal, Empangeni, South Africa
| | - Sharon Čačala
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Department of Surgery, Ngwelezana Hospital, University of KwaZulu-Natal, Empangeni, South Africa
| | - Laura W Stopforth
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Maureen Joffe
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Michael H Antoni
- Department of Psychology and Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yoanna S Pumpalova
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Witness Mapanga
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine D Crew
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Paul Ruff
- Strengthening Oncology Services Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Islam JY, Yang S, Schabath M, Vadaparampil ST, Lou X, Wu Y, Bian J, Guo Y. Lung cancer screening adherence among people living with and without HIV: An analysis of an integrated health system in Florida, United States (2012-2021). Prev Med Rep 2023; 35:102334. [PMID: 37546581 PMCID: PMC10403735 DOI: 10.1016/j.pmedr.2023.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023] Open
Abstract
Although lung cancer is a leading cause of death among people living with HIV (PLWH), limited research exists characterizing real-world lung cancer screening adherence among PLWH. Our objective was to compare low-dose computed tomography (LDCT) adherence among PLWH to those without HIV treated at one integrated health system. Using the University of Florida's Health Integrated Data Repository (01/01/2012-10/31/2021), we identified PLWH with at least one LDCT procedure, using Current Procedural Terminology codes(S8032/G0297/71271). Lung cancer screening adherence was defined as a second LDCT based on the Lung Imaging Reporting and Data System (Lung-RADS®). Lung-RADS categories were extracted from radiology reports using a natural language processing system. PLWH were matched with 4 randomly selected HIV-negative patients based on (+/- 1 year) age, Lung-RADS category, and calendar year. Seventy-three PLWH and 292 matched HIV-negative adults with at least one LDCT were identified. PLWH were more likely to be male (66% vs.52%,p < 0.04), non-Hispanic Black (53% vs.23%,p < 0.001), and live in an area of high poverty (45% vs.31%,p < 0.001). PLWH were more likely to be diagnosed with lung cancer after first LDCT (8% vs.0%,p < 0.001). Seventeen percent of HIV-negative and 12% of PLWH were adherent to LDCT screenings. Only 25% of PLWH diagnosed with category 4A were adherent compared to 44% of HIV-negative. On multivariable analyses, those with older age (66-80 vs.50-64 years) and with either Medicaid, charity-based, or other government insurance (vs. Medicare) were less likely to be adherent to LDCT screenings. PLWH may have poorer adherence to LDCT compared to their HIV-negative counterparts.
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Affiliation(s)
- Jessica Y. Islam
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer Research, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Shuang Yang
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Matthew Schabath
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer Research, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Susan T. Vadaparampil
- Health Outcomes and Behavior, The Office of Community Outreach, Engagement, and Equity (COEE), H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Xiwei Lou
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
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Nicolau IA, Moineddin R, Antoniou T, Brooks JD, Gillis JL, Kendall CE, Cooper C, Cotterchio M, Salters K, Smieja M, Kroch AE, Lindsay JD, Price C, Mohamed A, Burchell AN. Trends in infection-related and infection-unrelated cancer incidence among people with and without HIV infection in Ontario, Canada, 1996-2020: a population-based matched cohort study using health administrative data. CMAJ Open 2023; 11:E894-E905. [PMID: 37816545 PMCID: PMC10569814 DOI: 10.9778/cmajo.20220230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND People with HIV infection are at higher risk for certain cancers than the general population. We compared trends in infection-related and infection-unrelated cancers among people with and without HIV infection. METHODS We conducted a retrospective population-based matched cohort study of adults with and without HIV infection using linked health administrative databases in Ontario, Canada. Participants were matched on birth year, sex, census division (rurality), neighbourhood income quintile and region of birth. We followed participants from cohort entry until the earliest of date of cancer diagnosis, date of death, Nov. 1, 2020, or date of loss to follow-up. Incident cancers identified from Jan. 1, 1996, to Nov. 1, 2020, were categorized as infection-related or-unrelated. We examined calendar periods 1996-2003, 2004-2011 and 2012-2020, corresponding to the early combination antiretroviral therapy (cART), established cART and contemporary cART eras, respectively. We used competing risk analyses to examine trends in cumulative incidence by calendar period, age and sex, and cause-specific hazard ratios (HRs). RESULTS We matched 20 304 people with HIV infection to 20 304 people without HIV infection. A total of 2437 cancers were diagnosed, 1534 (62.9%) among infected people and 903 (37.0%) among uninfected people. The risk of infection-related cancer by age 65 years for people with HIV infection decreased from 19.0% (95% confidence interval [CI] 15.6%-22.3%) in 1996-2011 to 10.0% (95% CI 7.9%-12.1%) in 2012-2020. Compared to uninfected people, those with HIV infection had similar HRs of infection-unrelated cancer but increased rates of infection-related cancer, particularly among younger age groups (25.1 [95% CI 13.2-47.4] v. 1.9 [95% CI 1.0-3.7] for age 18-39 yr v. ≥ 70 yr); these trends were consistent when examined by sex.Interpretation: We observed significantly higher rates of infection-related, but not infection-unrelated, cancer among people with HIV infection than among uninfected people. The elevated rate of infection-related cancer in 2012-2020 highlights the importance of early and sustained antiretroviral therapy along with cancer screening and prevention measures.
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Affiliation(s)
- Ioana A Nicolau
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Rahim Moineddin
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Tony Antoniou
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Jennifer D Brooks
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Jennifer L Gillis
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Claire E Kendall
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Curtis Cooper
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Michelle Cotterchio
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Kate Salters
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Marek Smieja
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Abigail E Kroch
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Joanne D Lindsay
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Colleen Price
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Anthony Mohamed
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont
| | - Ann N Burchell
- Dalla Lana School of Public Health (Nicolau, Brooks, Cotterchio, Kroch), University of Toronto; Li Ka Shing Knowledge Institute (Nicolau, Antoniou, Lindsay, Mohamed, Burchell), St. Michael's Hospital, Unity Health Toronto; Department of Family and Community Medicine (Moineddin, Antoniou, Burchell), University of Toronto; ICES Central (Moineddin, Antoniou, Burchell); Canadian Cancer Society (Gillis), Toronto, Ont.; Bruyère Research Institute (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute; ICES uOttawa (Kendall); Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University, Hamilton, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; Canadian HIV/AIDS and Chronic Pain Society (Price), Ottawa, Ont.
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19
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Silver S, Schmelz M. The AIDS and Cancer Specimen Resource (ACSR): HIV malignancy specimens and data available at no cost. AIDS Res Ther 2023; 20:61. [PMID: 37641153 PMCID: PMC10464020 DOI: 10.1186/s12981-023-00558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
The goal of the AIDS and Cancer Specimen Resource (ACSR) is to play a major role in the advancement of HIV/AIDS cancer-related research/treatment by providing richly annotated biospecimens and data to researchers at no cost. The ACSR acquires, stores, and equitably distributes these samples and associated clinical data to investigators conducting HIV/AIDS-related research, at no costs. Currently, it is the only biorepository of human biospecimens from people with HIV and cancer available to eligible researchers globally who are studying HIV associated malignancies.This review describes the history and organizational structure of the ACSR, its types of specimens in its inventory, and the process of requesting specimens. In addition, the review provides an overview of research that was performed over the last 5 years with its support and gives a summary of important new findings acquired by this research into the development of cancers in people with HIV, including both Aids-related and non-Aids-related malignancies.
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Affiliation(s)
- Sylvia Silver
- Department of Microbiology, Immunology and Tropical Medicine, George Washington University, Washington, DC, USA
| | - Monika Schmelz
- Department of Pathology, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA.
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Rubinstein PG, Moore PC, Bimali M, Lee JY, Rudek MA, Chadburn A, Ratner L, Henry DH, Cesarman E, DeMarco CE, Costagliola D, Taoufik Y, Ramos JC, Sharon E, Reid EG, Ambinder RF, Mitsuyasu R, Mounier N, Besson C, Noy A. Brentuximab vedotin with AVD for stage II-IV HIV-related Hodgkin lymphoma (AMC 085): phase 2 results from an open-label, single arm, multicentre phase 1/2 trial. Lancet Haematol 2023; 10:e624-e632. [PMID: 37532416 PMCID: PMC10859222 DOI: 10.1016/s2352-3026(23)00157-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Brentuximab vedotin in combination with doxorubicin, vinblastine, and dacarbazine (AVD) is approved in the upfront setting for advanced stage classical Hodgkin lymphoma (cHL). People living with HIV have been excluded from these studies. We aimed to understand the activity and safety of brentuximab vedotin-AVD in people living with HIV diagnosed with Hodgkin lymphoma, while focusing on HIV disease parameters and antiretroviral therapy (ART) interactions. METHODS We present the phase 2 portion of a multicentre phase 1/2 study. Eligible patients were 18 years or older, had untreated stage II-IV HIV-associated cHL (HIV-cHL), a Karnofsky performance status of more than 30%, a CD4+ T-cell count of 50 cells per μL or more, were required to take ART, and were not on strong CYP3A4 or P-glycoprotein inhibitors. Patients were treated intravenously with 1·2 mg/kg of brentuximab vedotin (recommended phase 2 dose) with standard doses of AVD for six cycles on days 1 and 15 of a 28-day cycle. The primary endpoint of the phase 2 portion was 2-year progression-free survival (PFS), assessed in all eligible participants who began treatment. Accrual has been completed. This trial is registered at ClinicalTrials.gov, NCT01771107. FINDINGS Between March 8, 2013, and March 7, 2019, 41 patients received study therapy with a median follow up of 29 months (IQR 16-38). 34 (83%) of 41 patients presented with stage III-IV and seven (17%) with stage II unfavourable HIV-cHL. 37 (90%) of 41 patients completed therapy, all 37 of whom achieved complete response. The 2-year PFS was 87% (95% CI 71-94) and the overall survival was 92% (78-97). The most common grade 3 or worse adverse events were peripheral sensory neuropathy (four [10%] of 41 patients), neutropenia (18 [44%]), and febrile neutropenia (five [12%]). One treatment-related death was reported, due to infection. INTERPRETATION Brentuximab vedotin-AVD was highly active and had a tolerable adverse event rate in HIV-cHL and is an important therapeutic option for people with HIV-cHL. The complete reponse rate is encouraging and is possibly related to a unique aspect of HIV-cHL biology. Upcoming 5-year data will evaluate the sustainability of the outcomes obtained. FUNDING National Institutes of Health and National Cancer Institute.
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Affiliation(s)
- Paul G Rubinstein
- John H Stroger Jr Hospital of Cook County (Cook County Hospital), Section of Hematology/Oncology, Department of Medicine, Chicago, IL, USA; Ruth M Rothstein CORE Center, Chicago, IL, USA; University of Illinois, Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, IL, USA.
| | - Page C Moore
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Milan Bimali
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanette Y Lee
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Amy Chadburn
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Lee Ratner
- Washington University School of Medicine, St Louis, MO, USA
| | - David H Henry
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Ethel Cesarman
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | | | - Dominique Costagliola
- INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Yassine Taoufik
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicétre, France; Service d'imunologie biologique, Hôpitaux Paris Sud, AP-HP, Le Kremlin-Bicétrse, France
| | - Juan Carlos Ramos
- University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Elad Sharon
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Erin G Reid
- Moores Cancer Center, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | | | - Ronald Mitsuyasu
- University of California Los Angeles, Center for Clinical AIDS Research and Education, Los Angeles, CA, USA
| | | | - Caroline Besson
- CH Versailles, Le Chesnay, France; Inserm U1018, CESP, UVSQ, University Paris-Saclay, Villejuif, France
| | - Ariela Noy
- Weill Cornell Medical College, Cornell University, New York, NY, USA; Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
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21
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Cook M, Williams M, Law JY, Riedel DJ. Fulminant Hepatic Failure as the Initial Presentation of Hodgkin Lymphoma in 4 Patients With Human Immunodeficiency Virus. Open Forum Infect Dis 2023; 10:ofad273. [PMID: 37404950 PMCID: PMC10316689 DOI: 10.1093/ofid/ofad273] [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: 02/27/2023] [Indexed: 07/06/2023] Open
Abstract
In the era of antiretroviral therapy (ART), Hodgkin Lymphoma (HL) is a common non-AIDS-defining cancer with increasing incidence in people with human immunodeficiency virus (PWH). Through review of these cases, we identify clinical patterns such as declining CD4 count despite ART, hyperbilirubinemia and recurrent fever, which preceded diagnosis. Identifying these important signs and symptoms may lead to earlier diagnosis and initiation of therapy. Fulminant hepatic failure limits the ability to give standard of care chemotherapy, likely jeopardizing outcomes in this patient population. Alternative bridging therapies should be considered until hepatic function improves.
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Affiliation(s)
- Mary Cook
- Correspondence: Mary Cook, MD, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, 22 S Greene St, Room N9E17, Baltimore, MD 21201 ()
| | - Matthew Williams
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jennie Y Law
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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22
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Wu Q, Deng L, Cao Y, Lian S. Preoperative Biomarkers and Survival in Chinese Breast Cancer Patients with HIV: A Propensity-Score-Matched-Cohort Study. Viruses 2023; 15:1490. [PMID: 37515177 PMCID: PMC10383696 DOI: 10.3390/v15071490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND China initiated its national free antiretroviral therapy program in 2004 and saw a dramatic decline in mortality among the population with HIV. However, the morbidity of non-AIDS-defining cancers such as breast cancer is steadily growing as life expectancy improves. The aim of this study was to investigate the clinical characteristics and prognosis of breast cancer patients with HIV in China. MATERIALS AND METHODS Data from 21 breast cancer patients with HIV and 396 breast cancer patients without HIV treated at the Shanghai public health clinical center from 2014-2022 was collected. After propensity score matching, 21 paired patients in the two groups were obtained and compared. The optimal cut-off value of preoperative biomarkers for recurrence was determined via maximally selected log-rank statistics. Preoperative biomarkers were categorized into high and low groups, based on the best cut-off values and compared using Kaplan-Meier survival curves and the log-rank test. The Cox proportional hazards regression model was used to perform univariate and multivariate analyses. RESULTS The median follow-up time was 38 months (IQR: 20-68 months) for the propensity-score-matching cohort. The progression-free survival at 1, 2 and 3 years for patients with and without HIV were 74.51%, 67.74%, and 37.63% and 95.24%, 95.24%, and 90.48%, respectively. The overall survival for patients with HIV at 1, 2 and 3 years were 94.44%, 76.74%, and 42.63%. After multivariate analysis, Only HIV status (hazard ratios (HRs) = 6.83, 95% [confidence intervals (CI)] 1.22-38.12) were associated with progression-free survival. Based on the best cut-off value, CD8 showed discriminative value for overall survival (p = 0.04), whereas four variables, the lymphocyte-to-monocyte ratio (p = 0.02), platelet-to-lymphocyte ratio (p = 0.03), CD3 (p = 0.01) and CD8 (p < 0.01) were suggested be significant for progression-free survival. The univariate analysis suggested that CD3 (HRs = 0.10, 95% [CI] 0.01-0.90) and lymphocyte-to-monocyte ratio (HRs = 0.22, 95% [CI] 0.05-0.93) were identified as significant predictors for progression-free survival. CONCLUSION In this study, breast cancer in patients with HIV in China reflected a more aggressive nature with a more advanced diagnostic stage and worse prognosis. Moreover, preoperative immune and inflammatory biomarkers might play a role in the prognosis of breast cancer patients with HIV.
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Affiliation(s)
- Qian Wu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai 200040, China
| | - Li Deng
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Ye Cao
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Shixian Lian
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
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23
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Souza TFD, Sym YV, Chehter EZ. HIV and neoplasms: What do we know so far? EINSTEIN-SAO PAULO 2023; 21:eRW0231. [PMID: 37341221 DOI: 10.31744/einstein_journal/2023rw0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/18/2022] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION The human immunodeficiency virus (HIV) pandemic remains an important issue. In 2020, approximately 37.7 million people were living with the disease and there were more than 680 thousand deaths due to complications linked to the disease. Despite these exorbitant numbers, the introduction of highly active antiretroviral therapy has marked a new era, changing the epidemiological profile of the infection and related pathologies, including neoplasms. OBJECTIVE We performed a literature review to assess the role of neoplasms in patients with HIV after the introduction of antiretroviral therapy. METHODS A literature review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, searching the MEDLINE, LILACS, and COCHRANE databases for articles published from 2010 onwards. RESULTS Using specific key terms, 1,341 articles were identified; two were duplicates, 107 were selected for full-text evaluation, and 20 were included in the meta-analysis. The selected studies included 2,605,869 patients. Fifteen of the 20 articles indicated a reduction in the global incidence of AIDS-defining neoplasms and 12 indicated an overall increase in non-AIDS-defining cancers after the introduction of antiretrovirals. This growth trend could be explained by a range of factors including the aging population with HIV, risky behaviors, and coinfection with oncogenic viruses. CONCLUSIONS There was a decreasing trend in the incidence of AIDS-defining neoplasms and increasing trend in non-AIDS-defining neoplasms. However, the carcinogenic effect of antiretrovirals could not be confirmed. In addition, studies focusing on the oncogenic role of HIV and screening for neoplasms in individuals with HIV are required.
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Arwood ML, Liu Y, Harkins SK, Weinstock DM, Yang L, Stevenson KE, Plana OD, Dong J, Cirka H, Jones KL, Virtanen AT, Gupta DG, Ceas A, Lawney B, Yoda A, Leahy C, Hao M, He Z, Choi HG, Wang Y, Silvennoinen O, Hubbard SR, Zhang T, Gray NS, Li LS. New scaffolds for type II JAK2 inhibitors overcome the acquired G993A resistance mutation. Cell Chem Biol 2023; 30:618-631.e12. [PMID: 37290440 PMCID: PMC10495080 DOI: 10.1016/j.chembiol.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 02/07/2023] [Accepted: 05/18/2023] [Indexed: 06/10/2023]
Abstract
Recurrent JAK2 alterations are observed in myeloproliferative neoplasms, B-cell acute lymphoblastic leukemia, and other hematologic malignancies. Currently available type I JAK2 inhibitors have limited activity in these diseases. Preclinical data support the improved efficacy of type II JAK2 inhibitors, which lock the kinase in the inactive conformation. By screening small molecule libraries, we identified a lead compound with JAK2 selectivity. We highlight analogs with on-target biochemical and cellular activity and demonstrate in vivo activity using a mouse model of polycythemia vera. We present a co-crystal structure that confirms the type II binding mode of our compounds with the "DFG-out" conformation of the JAK2 activation loop. Finally, we identify a JAK2 G993A mutation that confers resistance to the type II JAK2 inhibitor CHZ868 but not to our analogs. These data provide a template for identifying novel type II kinase inhibitors and inform further development of agents targeting JAK2 that overcome resistance.
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Affiliation(s)
- Matthew L Arwood
- Molecular and Translational Cancer Biology Program, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Yao Liu
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Shannon K Harkins
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - David M Weinstock
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Cancer Biology Program, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Biological and Biomedical Sciences Program, Harvard Medical School, Boston, MA 02115, USA
| | - Lei Yang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Kristen E Stevenson
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
| | - Olivia D Plana
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jingyun Dong
- Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA; Skirball Institute of Biomolecular Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Haley Cirka
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Kristen L Jones
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Anniina T Virtanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Institute of Biotechnology, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Dikshat G Gupta
- Molecular and Translational Cancer Biology Program, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Amanda Ceas
- Molecular and Translational Cancer Biology Program, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Brian Lawney
- Center for Cancer Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Akinori Yoda
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Catharine Leahy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Mingfeng Hao
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Zhixiang He
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Hwan Geun Choi
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Yaning Wang
- Department of Chemical and Systems Biology, ChEM-H, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Olli Silvennoinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Institute of Biotechnology, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Stevan R Hubbard
- Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA; Skirball Institute of Biomolecular Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Tinghu Zhang
- Department of Chemical and Systems Biology, ChEM-H, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nathanael S Gray
- Department of Chemical and Systems Biology, ChEM-H, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Loretta S Li
- Molecular and Translational Cancer Biology Program, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; Department of Pediatrics, Division of Hematology, Oncology, and Stem Cell Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Panda K, Chinnapaiyan S, Rahman MS, Santiago MJ, Black SM, Unwalla HJ. Circadian-Coupled Genes Expression and Regulation in HIV-Associated Chronic Obstructive Pulmonary Disease (COPD) and Lung Comorbidities. Int J Mol Sci 2023; 24:9140. [PMID: 37298092 PMCID: PMC10253051 DOI: 10.3390/ijms24119140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
People living with HIV (PLWH) have an elevated risk of chronic obstructive pulmonary disease (COPD) and are at a higher risk of asthma and worse outcomes. Even though the combination of antiretroviral therapy (cART) has significantly improved the life expectancy of HIV-infected patients, it still shows a higher incidence of COPD in patients as young as 40 years old. Circadian rhythms are endogenous 24 h oscillations that regulate physiological processes, including immune responses. Additionally, they play a significant role in health and diseases by regulating viral replication and its corresponding immune responses. Circadian genes play an essential role in lung pathology, especially in PLWH. The dysregulation of core clock and clock output genes plays an important role in chronic inflammation and aberrant peripheral circadian rhythmicity, particularly in PLWH. In this review, we explained the mechanism underlying circadian clock dysregulation in HIV and its effects on the development and progression of COPD. Furthermore, we discussed potential therapeutic approaches to reset the peripheral molecular clocks and mitigate airway inflammation.
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Affiliation(s)
- Kingshuk Panda
- Department of Immunology and Nanomedicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA; (K.P.); (S.C.); (M.S.R.); (M.J.S.)
| | - Srinivasan Chinnapaiyan
- Department of Immunology and Nanomedicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA; (K.P.); (S.C.); (M.S.R.); (M.J.S.)
| | - Md. Sohanur Rahman
- Department of Immunology and Nanomedicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA; (K.P.); (S.C.); (M.S.R.); (M.J.S.)
| | - Maria J. Santiago
- Department of Immunology and Nanomedicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA; (K.P.); (S.C.); (M.S.R.); (M.J.S.)
| | - Stephen M. Black
- Department of Cellular Biology & Pharmacology, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA;
| | - Hoshang J. Unwalla
- Department of Immunology and Nanomedicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA; (K.P.); (S.C.); (M.S.R.); (M.J.S.)
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Schulze AB, Mohr M, Sackarnd J, Schmidt LH, Tepasse PR, Rosenow F, Evers G. Risk Factors in HIV-1 Positive Patients on the Intensive Care Unit: A Single Center Experience from a Tertiary Care Hospital. Viruses 2023; 15:v15051164. [PMID: 37243250 DOI: 10.3390/v15051164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
HIV-positive patients with acquired immunodeficiency syndrome (AIDS) often require treatment on intensive care units (ICUs). We aimed to present data from a German, low-incidence region cohort, and subsequently evaluate factors measured during the first 24 h of ICU stay to predict short- and long-term survival, and compare with data from high-incidence regions. We documented 62 patient courses between 2009 and 2019, treated on a non-operative ICU of a tertiary care hospital, mostly due to respiratory deterioration and co-infections. Of these, 54 patients required ventilatory support within the first 24 h with either nasal cannula/mask (n = 12), non-invasive ventilation (n = 16), or invasive ventilation (n = 26). Overall survival at day 30 was 77.4%. While ventilatory parameters (all p < 0.05), pH level (c/o 7.31, p = 0.001), and platelet count (c/o 164,000/µL, p = 0.002) were significant univariate predictors of 30-day and 60-day survival, different ICU scoring systems, such as SOFA score, APACHE II, and SAPS 2 predicted overall survival (all p < 0.001). Next to the presence or history of solid neoplasia (p = 0.026), platelet count (HR 6.7 for <164,000/µL, p = 0.020) and pH level (HR 5.8 for <7.31, p = 0.009) remained independently associated with 30-day and 60-day survival in multivariable Cox regression. However, ventilation parameters did not predict survival multivariably.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Lars Henning Schmidt
- Medical Department IV, Pneumology, Respiratory Medicine and Thoracic Oncology, Klinikum Ingolstadt, 85049 Ingolstadt, Germany
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B, Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
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Nkwonta CA, Zhang J, Chen S, Weissman S, Olatosi B, Li X. Prevalence and trend of AIDS-defining cancers and non-AIDS-defining cancers and their association with antiretroviral therapy among people living with HIV in South Carolina: a population-based cohort study. AIDS Care 2023; 35:753-763. [PMID: 35578401 PMCID: PMC9666704 DOI: 10.1080/09540121.2022.2074957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
ABSTRACTMonitoring cancer trends and risk is critical as cancer remains a growing problem in persons living with HIV (PLWH). Recent population-based data are limited regarding the cancer trends among PLWH. Our study examined the prevalence and trends in the rate of AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC) and their risk factors in PLWH in South Carolina. Utilizing linked population-based HIV data (2005-2020), time-dependent proportional hazards model was used to identify associated risk predictors of developing cancer in PLWH. Among 11,238 PLWH, 250 individuals developed ADC and 454 developed NADC. The median time from HIV diagnosis to cancer diagnosis was 1.9 years for ADC and 3.8 years for NADC. Individuals who developed ADC or NADC were more likely to be older, male, use substances, have hepatitis infection, hypothyroidism, hypertension, and renal disease. Individuals with viral load >100,000 copies/ml were more likely to develop ADC while those with CD4 count >350 cells/mm3 were less likely to develop ADC or NADC. Our findings suggest that long-term viral suppression may contribute to risk reduction for cancer in PLWH. Early HIV diagnosis along with viral load suppression should be a part of ongoing cancer prevention efforts.
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Affiliation(s)
- Chigozie A. Nkwonta
- Rory Meyers College of Nursing, New York University, New York, NY, USA, 10010
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Shujie Chen
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Sharon Weissman
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA, 29208
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
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28
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Di Ciaccio PR, Van Leeuwen MT, Amin J, Vajdic CM, McGregor S, Poynten IM, Templeton DJ, Law M, Grulich AE, Polizzotto MN, Jin F. Second Primary Cancers in People With HIV/AIDS: A National Data Linkage Study of Incidence and Risk Factors. J Acquir Immune Defic Syndr 2023; 93:25-33. [PMID: 36804500 PMCID: PMC10484748 DOI: 10.1097/qai.0000000000003172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/27/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Evidence regarding the characteristics of second primary cancer (SPC) in people living with HIV (PLWHIV) is limited. SETTING We performed a national population-based data linkage study to determine the incidence and risk factors of SPC in PLWHIV in Australia between 1982 and 2012. METHODS We conducted a probabilistic data linkage study to compare the incidence of SPC over time, defined using HIV treatment eras, for SPCs related to oncogenic viral infection in comparison with non-infection-related SPCs. Risk factors considered included age at diagnosis of cancer, sex, HIV exposure modality, and CD4 + count. RESULTS Of 29,383 individuals diagnosed with HIV, 3123 individuals who developed a first primary cancer were included in the analysis. Among them, 229 cases of SPC were identified across 27,398 person-years of follow-up. The most common SPCs were non-Hodgkin lymphomas (n = 71, 31%). The incidence of SPC overall did not change over time; however, there was an increase in individuals diagnosed with HIV in later eras ( P trend =0.001). The incidence of non-infection-related SPC increased over time and was associated with older age ( P trend = 0.005) and the acquisition of HIV in later eras ( P trend <0.001). Conversely, the incidence of infection-related SPC decreased ( P trend <0.001), but this was no longer significant after adjustment for age ( P trend = 0.14). CONCLUSIONS The risk of SPC in PLWHIV in Australia remains high, with a temporal increase observed in non-infection-related cancer, likely due to aging of the population. Optimal screening and prevention strategies for SPC in PLWHIV are increasingly important.
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Affiliation(s)
- Pietro R. Di Ciaccio
- Department of Haematology, Sydney Adventist Hospital, Sydney, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Marina T. Van Leeuwen
- Cancer Epidemiology Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Janaki Amin
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Claire M. Vajdic
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Skye McGregor
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Isobel M. Poynten
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - David J. Templeton
- Department of Sexual Health Medicine and Sexual Assault Medicine, Sydney Local Health District, Sydney, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Matthew Law
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Andrew E. Grulich
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Mark N. Polizzotto
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
- Clinical Hub for Interventional Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Fengyi Jin
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
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Salahuddin S, Cohen O, Wu M, Perez Irizarry J, Vega T, Gan G, Deng Y, Isaeva N, Prasad M, Schalper KA, Mehra S, Yarbrough WG, Emu B. Human Immunodeficiency Virus Is Associated With Poor Overall Survival Among Patients With Head and Neck Cancer. Clin Infect Dis 2023; 76:1449-1458. [PMID: 36520995 PMCID: PMC10319962 DOI: 10.1093/cid/ciac924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Head and neck squamous cell cancer (HNSCC) occurs at higher rates among persons with HIV (PWH). This study compares the impact of sociodemographic and clinicopathologic characteristics on outcomes among PWH-HNSCC compared with HNSCC patients without HIV. METHODS Patient data from HNSCC individuals were collected at a single academic hospital center between 2002 and 2018. Forty-eight patients with HIV (HIV-HNSCC) and 2894 HNSCC patients without HIV were included. Multivariate analysis determined predictors of survival using Cox proportional hazards regression model. HIV-positive and -negative tumors were analyzed by quantitative immunofluorescence for expression of CD4, CD8, CD20 and PD-L1. RESULTS HIV-HNSCC patients had a lower median overall survival than HNSCC patients without HIV (34 [18-84] vs 94 [86-103] months; P < .001). In multivariate analysis that included age, sex, race/ethnicity, stage, site, tobacco use, time to treatment initiation, and insurance status, HIV was an independent predictor of poorer survival, with a hazard ratio of 1.98 (95% CI: 1.32-2.97; P < .001). PWH with human papillomavirus (HPV)-positive oropharyngeal tumors also had worse prognosis than HPV-positive oropharyngeal tumors in the population without HIV (P < .001). The tumor microenvironment among HIV-HNSCC patients revealed lower intratumoral CD8 infiltration among HIV+ HPV+ tumors compared with HIV- HPV+ tumors (P = .04). CONCLUSIONS HIV-HNSCC patients had worse prognosis than the non-HIV population, with HIV being an independent predictor of poor clinical outcomes when accounting for important sociodemographic and clinicopathologic factors. Our findings highlight differences in tumor biology that require further detailed characterization in large cohorts and increased inclusion of PWH in immunotherapy trials.
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Affiliation(s)
- Syim Salahuddin
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Scarsdale, New York, USA
| | - Margaret Wu
- Department of Pediatrics, Northwestern University, Chicago, Illinois, USA
| | | | - Teresita Vega
- Yale Cancer Center, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Geliang Gan
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Natalia Isaeva
- Department of Otolaryngology/Head and Neck Surgery and Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Manju Prasad
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kurt A Schalper
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery and Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brinda Emu
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
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Ruffieux Y, Muchengeti M, Olago V, Dhokotera T, Bohlius J, Egger M, Rohner E. Age and Cancer Incidence in 5.2 Million People With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study. Clin Infect Dis 2023; 76:1440-1448. [PMID: 36461916 PMCID: PMC10319970 DOI: 10.1093/cid/ciac925] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Old age is an important risk factor for developing cancer, but few data exist on this association in people with human immunodeficiency virus (HIV, PWH) in sub-Saharan Africa. METHODS The South African HIV Cancer Match study is a nationwide cohort of PWH based on a linkage between HIV-related laboratory records from the National Health Laboratory Service and cancer diagnoses from the National Cancer Registry for 2004-2014. We included PWH who had HIV-related tests on separate days. Using natural splines, we modeled cancer incidence rates as a function of age. RESULTS We included 5 222 827 PWH with 29 580 incident cancer diagnoses-most commonly cervical cancer (n = 7418), Kaposi sarcoma (n = 6380), and breast cancer (n = 2748). In young PWH, the incidence rates for infection-related cancers were substantially higher than for infection-unrelated cancers. At age 40 years, the most frequent cancer was cervical cancer in female and Kaposi sarcoma in male PWH. Thereafter, the rates of infection-unrelated cancers increased steeply, particularly among male PWH, where prostate cancer became the most frequent cancer type at older age. Whereas Kaposi sarcoma rates peaked at 34 years (101/100 000 person-years) in male PWH, cervical cancer remained the most frequent cancer among older female PWH. CONCLUSIONS Infection-related cancers are common in PWH in South Africa, but rates of infection-unrelated cancers overtook those of infection-related cancers after age 54 years in the overall study population. As PWH in South Africa live longer, prevention and early detection of infection-unrelated cancers becomes increasingly important. Meanwhile, control strategies for infection-related cancers, especially cervical cancer, remain essential.
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Affiliation(s)
- Yann Ruffieux
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Olago
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Tafadzwa Dhokotera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Julia Bohlius
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Eliane Rohner
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Head and neck squamous cell carcinoma in HIV patients. Curr Opin Otolaryngol Head Neck Surg 2023; 31:78-82. [PMID: 36912219 DOI: 10.1097/moo.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW The introduction of antiretroviral therapy has significantly impacted the incidence of head and neck squamous cell carcinoma (HNSCC) in people living with HIV (PLWH). This manuscript aims to give an overview of the evidence in the literature about this population. RECENT FINDINGS PLWH have an increased incidence of HNSCC, with earlier age and more advanced stage at diagnosis. This epidemiologic trend may be explained by combining traditional and HIV-related risk factors. With the improvement of global health status, more patients are candidate for complex therapeutic strategies with curative intent. To date, it is still debated whether HIV-infected patients possess a profile of increased risk regarding treatment-related toxicity and survival outcomes, with the literature still lacking substantial evidence. Among the prognostic factors that can guide the clinician in selecting the most appropriate treatment strategy, age, site/subsite, stage, HIV viral load, and CD4+ T-cell count at diagnosis are the most relevant. SUMMARY Pathogenesis, treatment characteristics, oncologic outcomes, and prognostic factors of HNSCC in PLWH are still debated. Given the increasing incidence of HNSCC in PLWH, the need for dedicated evidence-based studies represents a significant research gap to be addressed.
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Waters AV, Dorsey KA, Allston A, Woods A, Furness BW, Doshi RK. Risk Factors for Human Papillomavirus-Associated Cancers Among People Living with HIV in Washington, District of Columbia. AIDS Res Hum Retroviruses 2023; 39:195-203. [PMID: 36656664 PMCID: PMC10958483 DOI: 10.1089/aid.2022.0128] [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: 01/20/2023] Open
Abstract
District of Columbia (DC) has high rates of HIV infection and human papillomavirus (HPV)-associated cancers. People living with HIV (PLWH) are at risk for developing HPV-associated cancers. Previous studies identified factors that may further increase the risk of HPV-associated cancer among PLWH such as age, race/ethnicity, sex, risk factor for HIV transmission, stage of HIV infection, and age at HIV diagnosis. The extent to which PLWH in DC are affected by HPV-associated cancers has not previously been well described, and to our knowledge, the relationship between bacterial sexually transmitted infections (STIs) and subsequent development of HPV-associated cancer among PLWH in DC has not been explored. This was a retrospective case-control analysis of surveillance data on cancer, STIs, and HIV in Washington, DC from 1996 to 2015. There were 20,744 PLWH included in this study, of whom 335 (1.6%) had been diagnosed with an HPV-associated cancer. Among males living with HIV (MLWH), for every additional STI per 10 person-years, risk of developing an HPV-associated cancer increased by 11%. Exposure to STIs was not a significant risk factor for HPV-associated cancer among females. Ever being diagnosed with stage three HIV infection increased risk of HPV-associated cancers among males by 109% and females living with HIV by 111%. STI exposures were associated with HPV-associated cancers among MLWH in DC and ever being diagnosed with advanced HIV infection was associated with HPV-associated cancers among all PLWH. Clinicians treating MLWH should ensure their patients receive primary HPV infection prevention and HPV-associated cancer screenings.
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Affiliation(s)
- Ansley V. Waters
- Department of Epidemiology, Milken School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Kerri A. Dorsey
- Department of Epidemiology, Milken School of Public Health, George Washington University, Washington, District of Columbia, USA
- HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Washington, District of Columbia, USA
| | - Adam Allston
- HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Washington, District of Columbia, USA
| | - Alfreda Woods
- District of Columbia Cancer Registry, District of Columbia Department of Health, Washington, District of Columbia, USA
| | - Bruce W. Furness
- HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Washington, District of Columbia, USA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rupali K. Doshi
- Department of Epidemiology, Milken School of Public Health, George Washington University, Washington, District of Columbia, USA
- HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Washington, District of Columbia, USA
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Muturi D, Mwanzi SN, Riunga FM, Shah J, Shah R. HIV Prevalence and Characteristics Among Patients With AIDS-Defining and Non-AIDS-Defining Cancers in a Tertiary Hospital in Kenya. JCO Glob Oncol 2023; 9:e2200360. [PMID: 37018633 DOI: 10.1200/go.22.00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
PURPOSE Antiretroviral therapy (ART) has resulted in a higher life expectancy of persons living with HIV. This has led to an aging population at risk for both non-AIDS-defining cancers (NADCs) and AIDS-defining cancers (ADCs). HIV testing among patients with cancer in Kenya is not routinely performed, making its prevalence undefined. The aim of our study was to determine the prevalence of HIV and the spectrum of malignancies among HIV-positive and HIV-negative patients with cancer attending a tertiary hospital in Nairobi, Kenya. MATERIALS AND METHODS We conducted a cross-sectional study between February 2021 and September 2021. Patients with a histologic cancer diagnosis were enrolled. Demographic data and HIV- and cancer-related clinical variables were obtained. HIV pretest counseling and consent were done, and testing was performed using a fourth-generation assay. Positive results were confirmed using a third-generation assay. RESULTS We enrolled 301 patients with cancer; 67.8% (204 of 301) were female; the mean age was 50.7 ± 12.5 years. From our cohort, 10.6% (95% CI, 7.4 to 14.7, n = 32 of 301) of patients were HIV-positive with the prevalence of a new HIV diagnosis of 0.7% (n = 2 of 301). Of the HIV-positive patients, 59.4% (19 of 32) had a NADC. The commonest NADC was breast cancer (18.8%; 6 of 32), whereas non-Hodgkin lymphoma (18.8%; 6 of 32) and cervical cancer (18.8%; 6 of 32) were the most prevalent ADCs among HIV-positive patients. CONCLUSION The prevalence of HIV infection among patients with cancer was twice the Kenya national HIV prevalence. NADCs comprised a larger percentage of the cancer burden. Universal opt-out HIV testing of patients attending for cancer care regardless of cancer type may facilitate early recognition of HIV-infected patients and aid in appropriate selection of ART and cancer therapies and preventive strategies.
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Affiliation(s)
- Diana Muturi
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Sitna N Mwanzi
- Department of Haemato-Oncology, Aga Khan University, Nairobi, Kenya
| | - Felix M Riunga
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
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Wang RJ, Nouraie M, Kunisaki KM, Huang L, Tien PC, Anastos K, Bhandari N, Bhatt SP, Bolivar H, Cribbs SK, Foronjy R, Gange SJ, Lazarous D, Morris A, Drummond MB. Lung Function in Women With and Without Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:e727-e735. [PMID: 35604821 PMCID: PMC9907549 DOI: 10.1093/cid/ciac391] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/07/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prior studies have found that human immunodeficiency virus (HIV) infection is associated with impaired lung function and increased risk of chronic lung disease, but few have included large numbers of women. In this study, we investigate whether HIV infection is associated with differences in lung function in women. METHODS This was a cross-sectional analysis of participants in the Women's Interagency HIV Study, a racially and ethnically diverse multicenter cohort of women with and without HIV. In 2018-2019, participants at 9 clinical sites were invited to perform spirometry. Single-breath diffusing capacity for carbon monoxide (DLCO) was also measured at selected sites. The primary outcomes were the post-bronchodilator forced expiratory volume in 1 second (FEV1) and DLCO. Multivariable regression modeling was used to analyze the association of HIV infection and lung function outcomes after adjustment for confounding exposures. RESULTS FEV1 measurements from 1489 women (1062 with HIV, 427 without HIV) and DLCO measurements from 671 women (463 with HIV, 208 without HIV) met standards for quality and reproducibility. There was no significant difference in FEV1 between women with and without HIV. Women with HIV had lower DLCO measurements (adjusted difference, -0.73 mL/min/mm Hg; 95% confidence interval, -1.33 to -.14). Among women with HIV, lower nadir CD4 + cell counts and hepatitis C virus infection were associated with lower DLCO measurements. CONCLUSIONS HIV was associated with impaired respiratory gas exchange in women. Among women with HIV, lower nadir CD4 + cell counts and hepatitis C infection were associated with decreased respiratory gas exchange.
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Affiliation(s)
- Richard J Wang
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Mehdi Nouraie
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ken M Kunisaki
- Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laurence Huang
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Phyllis C Tien
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Neha Bhandari
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Surya P Bhatt
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hector Bolivar
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Sushma K Cribbs
- Department of Medicine, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert Foronjy
- Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deepa Lazarous
- Department of Medicine, Georgetown University, Washington, D.C., USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - M Bradley Drummond
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Zerangian N, Erabi G, Poudineh M, Monajjem K, Diyanati M, Khanlari M, Khalaji A, Allafi D, Faridzadeh A, Amali A, Alizadeh N, Salimi Y, Ghane Ezabadi S, Abdi A, Hasanabadi Z, ShojaeiBaghini M, Deravi N. Venous thromboembolism in viral diseases: A comprehensive literature review. Health Sci Rep 2023; 6:e1085. [PMID: 36778773 PMCID: PMC9900357 DOI: 10.1002/hsr2.1085] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/25/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023] Open
Abstract
Venous thromboembolism (VTE) is known to be a common respiratory and/or cardiovascular complication in hospitalized patients with viral infections. Numerous studies have proven human immunodeficiency virus infection to be a prothrombotic condition. An elevated VTE risk has been observed in critically ill H1N1 influenza patients. VTE risk is remarkably higher in patients infected with the Hepatitis C virus in contrast to uninfected subjects. The elevation of D-dimer levels supported the association between Chikungunya and the Zika virus and the rise of clinical VTE risk. Varicella-zoster virus is a risk factor for both cellulitis and the consequent invasive bacterial disease which may take part in thrombotic initiation. Eventually, hospitalized patients infected with the coronavirus disease of 2019 (COVID-19), the cause of the ongoing worldwide pandemic, could mainly suffer from an anomalous risk of coagulation activation with enhanced venous thrombosis events and poor quality clinical course. Although the risk of VTE in nonhospitalized COVID-19 patients is not known yet, there are a large number of guidelines and studies on thromboprophylaxis administration for COVID-19 cases. This study aims to take a detailed look at the effect of viral diseases on VTE, the epidemiology of VTE in viral diseases, and the diagnosis and treatment of VTE.
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Affiliation(s)
- Nasibeh Zerangian
- Health Education and Health Promotion, Department of Health Education and Health Promotion, School of HealthMashhad University of Medical SciencesMashhadIran
| | - Gisou Erabi
- Student Research CommitteeUrmia University of Medical SciencesUrmiaIran
| | | | - Kosar Monajjem
- Student Research CommitteeTabriz University of Medical SciencesTabrizIran
| | - Maryam Diyanati
- Student Research CommitteeRafsanjan University of Medical SciencesRafsanjanIran
| | - Maryam Khanlari
- Student Research CommitteeTabriz University of Medical SciencesTabrizIran
| | | | - Diba Allafi
- Student Research CommitteeUrmia University of Medical SciencesUrmiaIran
| | - Arezoo Faridzadeh
- Department of Immunology and Allergy, School of MedicineMashhad University of Medical SciencesMashhadIran,Immunology Research CenterMashhad University of Medical SciencesMashhadIran
| | - Arian Amali
- Student Research Committee, Paramedical DepartmentIslamic Azad University, Mashhad BranchMashhadIran
| | - Nilufar Alizadeh
- Doctor of Medicine (MD), School of MedicineIran University of Medical SciencesTehranIran
| | - Yasaman Salimi
- Student Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Sajjad Ghane Ezabadi
- Student's Scientific Research Center, School of MedicineTehran University of Medical SciencesTehranIran
| | - Amir Abdi
- Student Research Committee, School of Medicine, Tehran Medical SciencesIslamic Azad UniversityTehranIran
| | - Zahra Hasanabadi
- Doctor of Medicine (MD), School of MedicineQazvin University of Medical ScienceQazvinIran
| | - Mahdie ShojaeiBaghini
- Medical Informatics Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Niloofar Deravi
- Student Research Committee, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
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Lee SO, Lee JE, Sim YK, Lee S, Ko WS, Kim J, Kang JS, Son H, Lee SH. Changing trends in the incidence and spectrum of cancers between 1990 and 2021 among HIV-infected patients in Busan, Korea. J Infect Chemother 2023; 29:571-575. [PMID: 36716862 DOI: 10.1016/j.jiac.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/11/2023] [Accepted: 01/25/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Long-term follow-up data on cancer incidence and spectrum among human immunodeficiency virus (HIV)-infected individuals in Korea have been scarce. MATERIAL AND METHODS This retrospective cohort study included HIV-infected individuals visiting a tertiary care hospital in Busan, South Korea between 1990 and 2021. The observation was divided into 4 periods. The incidence rate was calculated using direct standardization on age and sex, stratified by calendar period. RESULTS Of the 1,297 patients, 92 patients (7.1%) were diagnosed with 97 cancers. Excluding 37 patients with prevalent cancer, 1,260 patients were followed for a total of 8,803.7 person-years (PYs), and 55 patients developed 60 incident cancers including 5 second primary incident cancers. In men, the AIDS-defining cancer (ADC) incidence decreased from 294.7 per 100,000 PYs in 1990-1997 to 124.8 per 100,000 PYs in 2014-2021, while the non-AIDS-defining cancer (NADC) incidence increased from 0 per 100,000 PYs to 316.5 per 100,000 PYs during the same period. The proportion of virus-unrelated NADCs (VU-NADCs) increased from 33.3% in 1998-2005 to 49% in 2014-2021. The proportion of human papillomavirus-associated cancers (HPVACs) has recently increased in both ADCs and NADCs. The median time from HIV diagnosis to their first cancer was 1.48 years for ADCs, 6.11 years for VR-NADCs, 8.3 years for VU-NADCs, and 11.5 years for HPVACs. CONCLUSION The incidence of NADCs is increasing with the aging of HIV-infected patients, and thus, it is necessary to promote cancer screening and prevention programs.
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Affiliation(s)
- Soon Ok Lee
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong Eun Lee
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Yong Ki Sim
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Shinwon Lee
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Woo Seog Ko
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jinmi Kim
- Department of Statistics, Biomedical Institution, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin Suk Kang
- Division of Infectious Disease, Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - Hyunjin Son
- Department of Prevention Medicine, Donga University School of Medicine, Donga University Hospital, Busan, Republic of Korea
| | - Sun Hee Lee
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Brandão M, Durieux V, Auprih M, Fozza A, Dauby N, Cuccia F, Aspeslagh S, Verhaert M, Giaj-Levra N. Systemic treatment and radiotherapy for patients with non-small cell lung cancer (NSCLC) and HIV infection - A systematic review. Lung Cancer 2023; 178:75-86. [PMID: 36806897 DOI: 10.1016/j.lungcan.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
Lung cancer is the most common non-AIDS defining cancer among people living with HIV (PLWH), but there is a paucity of data regarding the efficacy and toxicity of radiotherapy and systemic regimens, including immunotherapy, in the treatment of these patients. In order to answer this question, we have performed a systematic search of the literature in Ovid Medline until March 17, 2022. We included 21 publications, enrolling 513 PLWH with non-small cell lung cancer (NSCLC), mostly male (75-100%), (ex-)smokers (75-100%) and with stage III-IV at diagnosis (65-100%). The overall response rate (ORR) to chemotherapy (n = 186 patients, mostly receiving platinum-based regimens) was highly variable (17 %-83 %), with a substantial hematological toxicity. ORR varied between 13 % and 50 % with single-agent immunotherapy (n = 68), with median overall survival between 9 and 11 months and a very acceptable toxicity profile, in line with studies in the HIV non-infected population. All five patients receiving tyrosine kinase inhibitors (TKIs; gefitinib or erlotinib) showed a partial response and long overall survival. Yet, combination of TKIs with antiretroviral therapy using pharmacological boosters, such as ritonavir, should be avoided. Radiotherapy was evaluated among 42 patients, showing high ORR (55 %-100 %), but 18 % of patients had a pneumonitis. This systematic review shows that radiotherapy and systemic therapy are effective and safe among PLWH with controlled infection diagnosed with NSCLC. Nonetheless, most reports were small and heterogeneous and larger studies are needed to confirm these encouraging findings. Moreover, clinical trials should not restrict the inclusion of PLWH, as more data is needed regarding the long-term efficacy and safety of treatments among this underserved population, especially of immunotherapy.
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Affiliation(s)
- Mariana Brandão
- Medical Oncology Department, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Rue Meylemeersch 90, 1070 Brussels, Belgium.
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (U.L.B.), Route de lennik 808, 1070 Brussels, Belgium.
| | - Maša Auprih
- Medical Oncology Department, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Rue Meylemeersch 90, 1070 Brussels, Belgium
| | - Alessandra Fozza
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy.
| | - Nicolas Dauby
- Department of Infectious Diseases, CHU Saint-Pierre, Rue haute 322, 1000 Brussels, Belgium; School of Public Health, Université Libre de Bruxelles (U.L.B.), Route de lennik 808, 1070 Brussels, Belgium.
| | - Francesco Cuccia
- Radiotherapy Unit, ARNAS Civico Hospital - Piazza Nicola Leotta 4, 90100 Palermo, Italy.
| | - Sandrine Aspeslagh
- Vrije Universiteit Brussel (V.U.B.), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Medical Oncology, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Marthe Verhaert
- Vrije Universiteit Brussel (V.U.B.), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Medical Oncology, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A.Sempreboni, 37124 Negrar di Valpolicella, Italy.
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Ozdemir ES, Nussinov R. Pathogen-driven cancers from a structural perspective: Targeting host-pathogen protein-protein interactions. Front Oncol 2023; 13:1061595. [PMID: 36910650 PMCID: PMC9997845 DOI: 10.3389/fonc.2023.1061595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Host-pathogen interactions (HPIs) affect and involve multiple mechanisms in both the pathogen and the host. Pathogen interactions disrupt homeostasis in host cells, with their toxins interfering with host mechanisms, resulting in infections, diseases, and disorders, extending from AIDS and COVID-19, to cancer. Studies of the three-dimensional (3D) structures of host-pathogen complexes aim to understand how pathogens interact with their hosts. They also aim to contribute to the development of rational therapeutics, as well as preventive measures. However, structural studies are fraught with challenges toward these aims. This review describes the state-of-the-art in protein-protein interactions (PPIs) between the host and pathogens from the structural standpoint. It discusses computational aspects of predicting these PPIs, including machine learning (ML) and artificial intelligence (AI)-driven, and overviews available computational methods and their challenges. It concludes with examples of how theoretical computational approaches can result in a therapeutic agent with a potential of being used in the clinics, as well as future directions.
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Affiliation(s)
- Emine Sila Ozdemir
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Ruth Nussinov
- Cancer Innovation Laboratory, Frederick National Laboratory for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States.,Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Coburn SB, Lang R, Zhang J, Palella FJ, Horberg MA, Castillo-Mancilla J, Gebo K, Galaviz KI, Gill MJ, Silverberg MJ, Hulgan T, Elion RA, Justice AC, Moore RD, Althoff KN. Statins Utilization in Adults With HIV: The Treatment Gap and Predictors of Statin Initiation. J Acquir Immune Defic Syndr 2022; 91:469-478. [PMID: 36053091 PMCID: PMC9649872 DOI: 10.1097/qai.0000000000003083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND We characterized trends in statin eligibility and subsequent statin initiation among people with HIV (PWH) from 2001 to 2017 and identified predictors of statin initiation between 2014 and 2017. SETTING PWH participating in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) enrolled in 12 US cohorts collecting data on statin eligibility criteria/prescriptions from 2001 to 2017. METHODS We determined the annual proportion eligible for statins, initiating statins, and median waiting time (from statin eligibility to initiation). Eligibility was defined using ATP III guidelines (2001-2013) and ACC/AHA guidelines (2014-2017). We assessed initiation predictors in 2014-2017 among statin-eligible PWH using Poisson regression, estimating adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs). RESULTS Among 16,409 PWH, 7386 (45%) met statin eligibility criteria per guidelines (2001-2017). From 2001 to 2013, statin eligibility ranged from 22% to 25%. Initiation increased from 13% to 45%. In 2014, 51% were statin-eligible, among whom 25% initiated statins, which increased to 32% by 2017. Median waiting time to initiation among those we observed declined over time. Per 10-year increase in age, initiation increased 46% (aPR 1.46, 95% CI: 1.29 to 1.67). Per 1-year increase in calendar year from 2014 to 2017, there was a 41% increase in the likelihood of statin initiation (aPR 1.41, 95% CI: 1.25 to 1.58). CONCLUSIONS There is a substantial statin treatment gap, amplified by the 2013 ACC/AHA guidelines. Measures are warranted to clarify reasons we observe this gap, and if necessary, increase statin use consistent with guidelines including efforts to help providers identify appropriate candidates.
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Affiliation(s)
- Sally B. Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
| | - Raynell Lang
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
- Cumming School of Medicine, University of Calgary,
Calgary, Alberta, Canada
| | - Jinbing Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
| | - Frank Joseph Palella
- Division of Infectious Diseases, Northwestern University
Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Jose Castillo-Mancilla
- Division of Infectious Disease, School of Medicine,
University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kelly Gebo
- School of Medicine, Johns Hopkins University, Baltimore,
Maryland, USA
| | - Karla I. Galaviz
- Department of Applied Health Science, Indiana University
School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary,
Canada
| | | | - Todd Hulgan
- Department of Medicine, Division of Infectious Diseases,
Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard A. Elion
- Department of Medicine, George Washington University
School of Medicine and Health Sciences, Washington, DC, USA
| | - Amy C. Justice
- Yale University Schools of Medicine and Public Health
and the Veterans Affairs Connecticut Healthcare System, New Haven, CT, USA
| | - Richard D. Moore
- School of Medicine, Johns Hopkins University, Baltimore,
Maryland, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
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Tong Y, Orang’o E, Nakalembe M, Tonui P, Itsura P, Muthoka K, Titus M, Kiptoo S, Mwangi A, Ong’echa J, Tonui R, Odongo B, Mpamani C, Rosen B, Moormann A, Cu-Uvin S, Bailey JA, Oduor CI, Ermel A, Yiannoutsos C, Musick B, Sang E, Ngeresa A, Banturaki G, Kiragga A, Zhang J, Song Y, Chintala S, Katzenellenbogen R, Loehrer P, Brown DR. The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS. Ann Med 2022; 54:1202-1211. [PMID: 35521812 PMCID: PMC9090376 DOI: 10.1080/07853890.2022.2067897] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 12/24/2022] Open
Abstract
The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety. KEY MESSAGESThe East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.Collaborations have been established between researchers in North America and East African countries for these studies.Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.
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Affiliation(s)
- Y. Tong
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - M. Nakalembe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | | | - M. Titus
- Maseno University, Kisumu, Kenya
| | | | | | - J. Ong’echa
- Kenya Medical Research Institute, Eldoret, Kenya
| | | | | | - C. Mpamani
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - B. Rosen
- Beaumont Gynecology Oncology, Royal Oak, MI, USA
| | - A. Moormann
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | | | - A. Ermel
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - C. Yiannoutsos
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - B. Musick
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - G. Banturaki
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - A. Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - J. Zhang
- Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Y. Song
- Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - S. Chintala
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - P. Loehrer
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - D. R. Brown
- Indiana University School of Medicine, Indianapolis, IN, USA
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Mills K, Sobukonla T, Bilal M, Surapaneni P, Yan F, Bakinde N, Chan A, Jamorabo DS, Renelus BD. Young-onset colon cancer among people living with HIV in metropolitan Atlanta. Int J Colorectal Dis 2022; 37:2303-2308. [PMID: 36278999 DOI: 10.1007/s00384-022-04273-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Colon cancer is a leading cause of cancer-related morbidity and mortality in the USA. We sought to better characterize colon cancer among a predominantly Black cohort with and without HIV. METHODS We retrospectively reviewed all patients (n = 1482) diagnosed with colon cancer between 2015 and 2019 at a large urban tertiary teaching hospital using ICD-9 and ICD-10 codes. In this cohort, 114 (7.7%) of the patients also had HIV. Descriptive summaries were performed for gender, age, race/ethnicity, insurance status, tobacco/alcohol use, and BMI. RESULTS Among patients with colon cancer only, 50.51% (n = 691) were men and 49.49% (n = 677) were women. Among patients with both HIV and colon cancer, 78.95% (n = 90) were men and 21.05% (n = 24) were women (p-value < 0.001). The mean age of the colon cancer patient sample was 61.62 years for those without HIV and 51.31 years for those with HIV (p-value < 0.001). Persons with both HIV and colon cancer were more likely to have a lower BMI (p-value < 0.001) and a history of smoking and alcohol use (p-value < 0.001), compared to patients with colon cancer only. When accounting for BMI, tobacco, and alcohol use, those with HIV were 10 years younger than those without HIV, 95% CI, 7.3-13; p < 0.001. CONCLUSIONS In this study, HIV positive status was a risk factor for developing colon cancer at a younger age. Larger observational studies with multivariable analysis should be done to better describe the risk of colon cancer and HIV.
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Affiliation(s)
- Krystal Mills
- Department of Internal Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA.
| | - Timothy Sobukonla
- Department of Internal Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Muhammad Bilal
- Department of Internal Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Phani Surapaneni
- Department of Internal Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Fengxia Yan
- Department of Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Nicolas Bakinde
- Department of Internal Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Austin Chan
- Department of Infectious Disease, Morehouse School of Medicine, Atlanta, GA, USA
| | - Daniel S Jamorabo
- Department of Gastroenterology, Stony Brook Medicine, Stony Brook, NY, USA
| | - Benjamin D Renelus
- Department of Gastroenterology, Morehouse School of Medicine, Atlanta, GA, USA
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Islam JY, Nogueira L, Suneja G, Coghill A, Akinyemiju T. Palliative Care Use Among People Living With HIV and Cancer: An Analysis of the National Cancer Database (2004-2018). JCO Oncol Pract 2022; 18:e1683-e1693. [PMID: 35867956 PMCID: PMC9663140 DOI: 10.1200/op.22.00181] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE People living with HIV (PLWH) diagnosed with cancer are less likely to receive quality cancer treatment compared with HIV-negative patients. Timely provision of palliative care (PC) during cancer treatment can increase patient's survival and improve quality of life. Our objective was to compare the use of PC by HIV status among adults diagnosed with cancer in the United States. METHODS More than 19 million individuals age 18-90 years diagnosed with the 11 most common cancers among PLWH were selected from the National Cancer Database (2004-2018). The National Cancer Database defined PC as any surgery, radiation, systemic therapy, or pain management treatment with noncurative intent. Multivariable logistic regression was used to examine associations between HIV status and PC receipt by cancer site and stage after adjustment for covariates. RESULTS The study population included 52,306 HIV-positive (average age: 56.5 years) and 19,115,520 HIV-negative (average age: 63.7 years) cancer cases. PLWH diagnosed with stage I-III cancer were more likely to receive PC compared with their HIV-negative counterparts (adjusted odds ratio [aO]: 1.96; 95% CI, 1.80 to 2.14); however, they were also less likely to receive curative cancer treatment (aOR, 0.48; 95% CI, 0.40 to 0.59). PLWH diagnosed with stage IV cancer were less likely to receive PC (aOR, 0.70; 95% CI, 0.66 to 0.74) compared with HIV-negative patients. When evaluated by cancer site, PLWH diagnosed with stage IV lung (aOR, 0.80; 95% CI, 0.73 to 0.87) and colorectal (aOR, 0.72, 95% CI, 0.54 to 0.95) cancers were less likely to receive PC than HIV-negative patients. CONCLUSION PLWH diagnosed with stage IV cancer, particularly lung and colorectal cancers, were less likely to receive PC compared with cancer patients without HIV. PLWH with nonmetastatic disease were more likely to receive PC but less likely to receive curative treatment, reinforcing that clinical strategies are needed to improve the quality of care among PLWH.
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Affiliation(s)
- Jessica Y. Islam
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Population Health Sciences, Duke University, Durham, NC
| | | | - Gita Suneja
- Deparment of Radiation Oncology, University of Utah, Salt Lake City, Utah
| | - Anna Coghill
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University, Durham, NC
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43
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Womack JA, Murphy TE, Leo-Summers L, Bates J, Jarad S, Smith AC, Gill TM, Hsieh E, Rodriguez-Barradas MC, Tien PC, Yin MT, Brandt CA, Justice AC. Predictive Risk Model for Serious Falls Among Older Persons Living With HIV. J Acquir Immune Defic Syndr 2022; 91:168-174. [PMID: 36094483 PMCID: PMC9470988 DOI: 10.1097/qai.0000000000003030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older (older than 50 years) persons living with HIV (PWH) are at elevated risk for falls. We explored how well our algorithm for predicting falls in a general population of middle-aged Veterans (age 45-65 years) worked among older PWH who use antiretroviral therapy (ART) and whether model fit improved with inclusion of specific ART classes. METHODS This analysis included 304,951 six-month person-intervals over a 15-year period (2001-2015) contributed by 26,373 older PWH from the Veterans Aging Cohort Study who were taking ART. Serious falls (those falls warranting a visit to a health care provider) were identified by external cause of injury codes and a machine-learning algorithm applied to radiology reports. Potential predictors included a fall within the past 12 months, demographics, body mass index, Veterans Aging Cohort Study Index 2.0 score, substance use, and measures of multimorbidity and polypharmacy. We assessed discrimination and calibration from application of the original coefficients (model derived from middle-aged Veterans) to older PWH and then reassessed by refitting the model using multivariable logistic regression with generalized estimating equations. We also explored whether model performance improved with indicators of ART classes. RESULTS With application of the original coefficients, discrimination was good (C-statistic 0.725; 95% CI: 0.719 to 0.730) but calibration was poor. After refitting the model, both discrimination (C-statistic 0.732; 95% CI: 0.727 to 0.734) and calibration were good. Including ART classes did not improve model performance. CONCLUSIONS After refitting their coefficients, the same variables predicted risk of serious falls among older PWH nearly and they had among middle-aged Veterans.
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Affiliation(s)
- Julie A Womack
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Nursing, West Haven, CT
| | | | | | - Jonathan Bates
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | | | | | - Evelyn Hsieh
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Maria C Rodriguez-Barradas
- Michael E DeBakey VA Medical Center, Infectious Diseases Section and Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Phyllis C Tien
- University of California, San Francisco, CA
- Department of Veterans Affairs, San Francisco, CA
| | | | - Cynthia A Brandt
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
| | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University Schools of Medicine and Public Health, New Haven, CT
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O'Brien KK, Solomon P, Carusone SC, Erlandson KM, Bergin C, Bayoumi AM, Hanna SE, Harding R, Brown DA, Vera JH, Boffito M, Murray C, Aubry R, O'Shea N, St Clair-Sullivan N, Boyd M, Swinton M, Torres B, Davis AM. Assessing the sensibility and utility of a short-form version of the HIV Disability Questionnaire in clinical practice settings in Canada, Ireland and the USA: a mixed methods study. BMJ Open 2022; 12:e062008. [PMID: 36175103 PMCID: PMC10098270 DOI: 10.1136/bmjopen-2022-062008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The Short-Form HIV Disability Questionnaire (SF-HDQ) was developed to measure the presence, severity and episodic nature of health challenges across six domains. Our aim was to assess the sensibility, utility and implementation of the SF-HDQ in clinical practice. DESIGN Mixed methods study design involving semistructured interviews and questionnaire administration. PARTICIPANTS We recruited adults living with HIV and HIV clinicians in Canada, Ireland and the USA. METHODS We electronically administered the SF-HDQ followed by a Sensibility Questionnaire (face and content validity, ease of usage, format) and conducted semistructured interviews to explore the utility and implementation of the SF-HDQ in clinical practice. The threshold for sensibility was a median score of >5/7 (adults living with HIV) and>4/7 (HIV clinicians) for ≥80% of items. Qualitative interview data were analysed using directed content analysis. RESULTS Median sensibility scores were >5 (adults living with HIV; n=29) and >4 (HIV clinicians; n=16) for 18/19 (95%) items. Interview data indicated that the SF-HDQ represents the health-related challenges of living with HIV and other concurrent health conditions; captures the daily episodic nature of HIV; and is easy to use. Clinical utility included measuring health challenges and change over time, guiding referral to specialists and services, setting goals, facilitating communication and fostering a multidisciplinary approach to care. Considerations for implementation included flexible, person-centred approaches to administration, and communicating scores based on personal preferences. CONCLUSIONS The SF-HDQ possesses sensibility and utility for use in clinical settings with adults living with HIV and HIV clinicians in three countries.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Instiute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Casey House, Toronto, Ontario, Canada
| | | | - Colm Bergin
- Department of Genitourinary and Infectious Diseases (GUIDE) Clinic, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steven E Hanna
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Rachel Aubry
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Noreen O'Shea
- Department of Genitourinary and Infectious Diseases (GUIDE) Clinic, St James's Hospital, Dublin, Ireland
| | | | - Mallory Boyd
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marilyn Swinton
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Aileen M Davis
- Department of Physical Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Clutton GT, Weideman AMK, Goonetilleke NP, Maurer T. An expanded population of CD8dim T cells with features of mitochondrial dysfunction and senescence is associated with persistent HIV-associated Kaposi’s sarcoma under ART. Front Cell Dev Biol 2022; 10:961021. [PMID: 36247006 PMCID: PMC9557199 DOI: 10.3389/fcell.2022.961021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
HIV-associated Kaposi’s sarcoma (KS), which is caused by Kaposi’s sarcoma-associated herpesvirus, usually arises in the context of uncontrolled HIV replication and immunosuppression. However, disease occasionally occurs in individuals with durable HIV viral suppression and CD4 T cell recovery under antiretroviral therapy (ART). The underlying mechanisms associated with this phenomenon are unclear. Suppression of viral infections can be mediated by CD8 T cells, which detect infected cells via their T cell receptor and the CD8 coreceptor. However, CD8 T cells exhibit signs of functional exhaustion in untreated HIV infection that may not be fully reversed under ART. To investigate whether KS under ART was associated with phenotypic and functional perturbations of CD8 T cells, we performed a cross-sectional study comparing HIV-infected individuals with persistent KS under effective ART (HIV+ KS+) to HIV-infected individuals receiving effective ART with no documented history of KS (HIV+ KSneg). A subset of T cells with low cell surface expression of CD8 (“CD8dim T cells”) was expanded in HIV+ KS+ compared with HIV+ KSneg participants. Relative to CD8bright T cells, CD8dim T cells exhibited signs of senescence (CD57) and mitochondrial alterations (PGC-1α, MitoTracker) ex vivo. Mitochondrial activity (MitoTracker) was also reduced in proliferating CD8dim T cells. These findings indicate that an expanded CD8dim T cell population displaying features of senescence and mitochondrial dysfunction is associated with KS disease under ART. CD8 coreceptor down-modulation may be symptomatic of ongoing disease.
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Affiliation(s)
- Genevieve T. Clutton
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Genevieve T. Clutton,
| | - Ann Marie K. Weideman
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nilu P. Goonetilleke
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Toby Maurer
- Department of Dermatology, Indiana University, Indianapolis, IN, United States
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Mazul AL, Hartman CM, Mowery YM, Kramer JR, White DL, Royse KE, Raychaudhury S, Sandulache VC, Ahmed ST, Zevallos JP, Richardson PA, Sikora AG, Chiao EY. Risk and incidence of head and neck cancers in veterans living with HIV and matched HIV-negative veterans. Cancer 2022; 128:3310-3318. [PMID: 35867552 PMCID: PMC10650941 DOI: 10.1002/cncr.34387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Persons living with HIV/AIDS have a higher incidence of virus-related and tobacco/alcohol-related cancers. This study is the first to estimate the effect of HIV versus HIV-negative veterans on the risk of head and neck squamous cell carcinoma incidence in a large retrospective cohort study. METHODS The authors constructed a retrospective cohort study using patient data from 1999 to 2016 from the National Veterans Administration Corporate Data Warehouse and the VA Central Cancer Registry. This cohort study included 45,052 veterans living with HIV/AIDS and 162,486 HIV-negative patients matched by age, sex, and index visit (i.e., HIV diagnosis date or clinic visit date). The age-standardized incidence rates and estimated adjusted hazard ratios were calculated with a Cox proportional hazards regression for oropharyngeal and nonoropharyngeal head and neck cancer squamous cell carcinoma (HNSCC). The authors also abstracted human papillomavirus (HPV) status from oropharyngeal HNSCC diagnosed after 2010. RESULTS Veterans living with HIV/AIDS (VLWH) have 1.71 (95% confidence interval [CI], 1.36, 2.14) times the risk of oropharyngeal cancer and 2.06 (95% CI, 1.76, 2.42) times the hazard of nonoropharyngeal cancer compared with HIV-negative veterans. VLWH with oropharyngeal squamous cell carcinoma (OPSCC) were more likely to be HPV-positive (N = 30 [81.1%]) than the HIV-negative veterans with OPSCC (N = 50 [67.6%]), although this difference was not significant (p = .135). For nonoropharyngeal cancer, the increased risk of oral cavity cancer among VLWH drove the increased risk. CONCLUSIONS The study results suggest that HIV may play a role in virally mediated and nonvirally mediated HNSCC. As the HIV prevalence rises in the United States due to better survival and the incidence of HPV-positive oropharyngeal HNSCC increases, the interaction between HPV and HIV becomes increasingly relevant.
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Affiliation(s)
- Angela L Mazul
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Division of Public Health Science, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christine M Hartman
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Yvonne M Mowery
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer R Kramer
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Donna L White
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kathryn E Royse
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Vlad C Sandulache
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Sarah T Ahmed
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jose P Zevallos
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Peter A Richardson
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Andrew G Sikora
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth Y Chiao
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Sirera G, Videla S, Saludes V, Castellà E, Sanz C, Ariza A, Clotet B, Martró E. Prevalence of HPV-DNA and E6 mRNA in lung cancer of HIV-infected patients. Sci Rep 2022; 12:13196. [PMID: 35915124 PMCID: PMC9343353 DOI: 10.1038/s41598-022-17237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 07/22/2022] [Indexed: 11/27/2022] Open
Abstract
HIV-infected individuals could be at a greater risk for developing lung cancer than the general population due to the higher prevalence in the former of human papillomavirus (HPV) in the oral cavity and higher smoking rates. Our aim was to assess HPV prevalence and E6 viral oncogene transcription in lung cancer samples from HIV-infected individuals. This was a single-center, retrospective study of a cohort of HIV-1-infected patients diagnosed with and treated for lung cancer. Pathological lung samples archived as smears or formalin-fixed paraffin-embedded blocks were subjected to HPV genotyping, detection of human p16 protein and assessment for HPV E6 mRNA expression. Lung cancer samples from 41 patients were studied, including squamous cell carcinoma (32%), adenocarcinoma (34%), non-small cell cancer (27%), and small cell cancer (7%). HPV DNA was detected in 23 out of 41 (56%, 95% CI 41–70%) of samples and high-risk (HR)-HPV types were detected in 16 out of 41 (39%, 95% CI 26–54%), HPV-16 being the most prevalent [13/16 (81.3%, 95% CI 57.0–93%]. In samples with sufficient material left: expression of p16 was detected in 3 out of 10 (30%) of HR-HPV DNA-positive tumors and in 3 out of 7 (43%) of the negative ones; and E6 mRNA was detected in 2 out of 10 (20%) of HPV-16-positive samples (squamous lung cancers). These two patients had a background of a previous HPV-related neoplasia and smoking. HR-HPV DNA detection was prevalent in lung cancers in HIV-infected patients. However, viral oncogene expression was limited to patients with previous HPV-related cancers.
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Affiliation(s)
- Guillem Sirera
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Infectious Diseases Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Sebastián Videla
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Clinical Research Support Unit (HUB-IDIBELL: Bellvitge University Hospital & Bellvitge Biomedical Research Institute), Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain.,Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Verónica Saludes
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Eva Castellà
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Carolina Sanz
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Aurelio Ariza
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Bonaventura Clotet
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Elisa Martró
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain. .,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
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A comparison of lung cancer in HIV-positive and HIV-negative populations. Afr J Thorac Crit Care Med 2022; 28:10.7196/AJTCCM.2022.v28i2.162. [PMID: 35991342 PMCID: PMC9366453 DOI: 10.7196/ajtccm.2022.v28i2.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/08/2022] Open
Abstract
Background Lung cancer is the most common cancer worldwide and is the greatest contributor to malignancy-associated deaths. Human immunodeficiency virus (HIV) is an epidemic in many developing countries and South Africa carries the largest burden of this disease in the world. With the introduction of antiretroviral therapy (ART), acquired immune deficiency syndrome (AIDS)-defining malignancies (ADMs) are on the decline and non-AIDS-defining malignancies (NADMs) are becoming more common, with lung cancer being the most common among these. Objectives To describe and compare a cohort of HIV-positive lung cancer patients and a cohort of HIV-negative lung cancer patients. Methods A retrospective study of 188 patients with histologically confirmed bronchogenic carcinoma was conducted. Smoking history, cancer sub-type, cancer stage, HIV parameters and demographic data were collected. Results There were 31 (16.94%) HIV-positive patients. They presented at a younger age (53.94 years) than the HIV-negative group (61.64 years) (p=0.0001). Adenocarcinoma was the most common sub-type in the HIV-negative cohort while squamous cell carcinoma was slightly more common in the HIV-positive cohort. Both groups predominantly presented with locally advanced or metastatic disease. Conclusion HIV-positive patients present at a younger age than HIV-negative patients and both groups show a male-predominant pattern.
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Chen L, Wu M, Zheng X, Zhang Y, Zhao J. Long-term outcome of renal cell carcinoma in patients with HIV who undergo surgery. BMC Infect Dis 2022; 22:605. [PMID: 35804319 PMCID: PMC9270790 DOI: 10.1186/s12879-022-07592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background People living with HIV (PLWH) have a higher risk for cancer compared to the general population. The prevalence of renal cell carcinoma (RCC) in PLWH has gradually increased in recent years, but relevant data on outcomes after surgery are scarce. We thus evaluated long-term outcomes after surgery in RCC patients with and without HIV. Methods This retrospective study included 67 patients with RCC, both HIV positive or negative, who underwent surgical treatment in our hospital between January 2012 and January 2021. Demographic details, clinical data, and cancer status were collected. We set the day of surgery as the baseline. The co-primary end points in this time-to-event analysis were overall survival and progression-free survival. We used a multivariate Cox model to compare the prognosis of PLWH and HIV-negative patients and present Kaplan–Meier curves for the co-primary end points. Results Of 261 consecutive patients, 18 patients who forwent treatment before surgery, 133 cases with incomplete data, 16 patients classified as clinical stage IV, 11 PLWH patients did not received antiretroviral therapy and 16 patients with metastasis were excluded from the main analysis. Of the remaining 67 patients, 33 individuals had HIV and the other 34 did not. The median overall survival was 74.9 months (95% confidence interval [CI] = 64.6 to 85.2) in PLWH and 96.4 months (95% CI = 90.0 to 102.9) in the HIV-negative group. Progression-free survival was 66.4 months (95% CI = 53.5 to 79.3) and 90.6 months (95% CI = 81.1 to 100.1), respectively. RCC patients with HIV who underwent surgery had a shorter survival time (hazard ratio [HR] = 2.8, 95% CI = 1.1 to 7.0, p = 0.016) and an increased incidence of tumor progression (HR = 2.7, 95% CI = 1.1 to 6.8, p = 0.028). Univariate and multivariate Cox regression analyses showed that a lower ratio of CD4+ T cells to CD8+ T cells (adjusted odds ratio = 0.092, 95% CI = 0.01 to 0.70, p = 0.022) was associated with worse survival among PLWH. Conclusion In this retrospective analysis of RCC patients who underwent surgery, PLWH had worse overall survival and shorter progression-free survival compared to HIV-negative cases. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07592-z. First Chinese study of HIV and RCC. Prognostic risk factor in PLWH with RCC.
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Affiliation(s)
- Liang Chen
- Department of Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China
| | - Menghua Wu
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xin Zheng
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yu Zhang
- Department of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jimao Zhao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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HIV-1 mutants expressing B cell clonogenic matrix protein p17 variants are increasing their prevalence worldwide. Proc Natl Acad Sci U S A 2022; 119:e2122050119. [PMID: 35763571 PMCID: PMC9271197 DOI: 10.1073/pnas.2122050119] [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] [Indexed: 12/03/2022] Open
Abstract
In the combined antiretroviral therapy era, lymphomas still represent the most frequent cause of death in HIV-1-infected patients. We expand previous observations dealing with the prevalence of HIV-1 matrix protein p17 variants (vp17s), characterized by peculiar amino acid insertions and endowed of B cell clonogenic activity, in HIV-1 patients with lymphoma as compared with patients without lymphoma. We show that the prevalence of HIV-1 mutants expressing vp17s is increasing worldwide over time. Moreover, we describe a cluster of HIV-1 mutants expressing a B cell clonogenic vp17 and highlight that insertions can be fixed and that viruses displaying clonogenic vp17s are actively spreading. This knowledge advocates for an extensive genomic surveillance program to monitor the evolution of such mutant virions worldwide. AIDS-defining cancers declined after combined antiretroviral therapy (cART) introduction, but lymphomas are still elevated in HIV type 1 (HIV-1)–infected patients. In particular, non-Hodgkin’s lymphomas (NHLs) represent the majority of all AIDS-defining cancers and are the most frequent cause of death in these patients. We have recently demonstrated that amino acid (aa) insertions at the HIV-1 matrix protein p17 COOH-terminal region cause protein destabilization, leading to conformational changes. Misfolded p17 variants (vp17s) strongly impact clonogenic B cell growth properties that may contribute to B cell lymphomagenesis as suggested by the significantly higher frequency of detection of vp17s with COOH-terminal aa insertions in plasma of HIV-1–infected patients with NHL. Here, we expand our previous observations by assessing the prevalence of vp17s in large retrospective cohorts of patients with and without lymphoma. We confirm the significantly higher prevalence of vp17s in lymphoma patients than in HIV-1–infected individuals without lymphoma. Analysis of 3,990 sequences deposited between 1985 and 2017 allowed us to highlight a worldwide increasing prevalence of HIV-1 mutants expressing vp17s over time. Since genomic surveillance uncovered a cluster of HIV-1 expressing a B cell clonogenic vp17 dated from 2011 to 2019, we conclude that aa insertions can be fixed in HIV-1 and that mutant viruses displaying B cell clonogenic vp17s are actively spreading.
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