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Thorat J, Sengar M, Chanana R, Kapoor A, Singh A, Bonda A, Menon H, Bagal B, Laskar S, Khanna N, Goda JS, Sridhar E, Gujral S, Agarwal A, Sawant S, Daddi A, Shet T, Ghandade N, Jain H. A Retrospective Cohort Study to Evaluate the Outcomes of HIV-Associated High-Grade B-Cell Non-Hodgkin Lymphoma (NHL) Treated with Dose Adjusted EPOCH (+/-R) Regimen. Indian J Hematol Blood Transfus 2024; 40:36-42. [PMID: 38312196 PMCID: PMC10830987 DOI: 10.1007/s12288-023-01652-3] [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: 02/11/2022] [Accepted: 03/25/2023] [Indexed: 02/06/2024] Open
Abstract
High-grade B-cell NHL's are more common in seropositive patients. They are biologically different from their seronegative counterparts. We report our analysis on our cohort of patients who were treated with DA-EPOCH(+/-R). We retrospectively analyzed treatment-naïve HIV-associated High-grade B-cell NHL patients (aged ≥ 18) treated with DA-EPOCH(+/-R) regimen from 2011 to 2015. Descriptive statistics were summarized with median and range; survival outcomes were analyzed with Kaplan-Meier method. The cohort comprised of 40 patients [DLBCL(19), Burkitt's Lymphoma(16), High-grade B-Cell Lymphoma-Unclassifiable(09), and Plasmablastic Lymphoma(01)] and the median CD4 + T cell count was 202/mm3. CNS prophylaxis was administered with intrathecal methotrexate to 90% of patients. With a median follow-up of 72 months, an estimated 5-year OS was 82.5%, and 5-PFS was 77.5%. There were 9 deaths, and 9 patients had progression. At least 4 cycles of chemotherapy were administered to 35 (93%) patients, with 28 (70%) receiving 6 cycles. Grade 3-4 toxicities were seen in 33 (83%) patients- febrile neutropenia (65%) being the most common followed by mucositis (25%) and peripheral neuropathy (13%). There was no difference in survival based on IPI, CD 4 + T cell count, CDI, or duration of HIV. DA-EPOCH(+/-R) is a highly effective regimen in seropositive high-grade B-cell lymphoma, even in the presence of adverse features. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01652-3.
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Affiliation(s)
- Jayashree Thorat
- Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Room-21, Main Building, E. Borges Road, Parel, Mumbai, 400012 India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Room-21, Main Building, E. Borges Road, Parel, Mumbai, 400012 India
| | - Raajit Chanana
- Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Room-21, Main Building, E. Borges Road, Parel, Mumbai, 400012 India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Room-21, Main Building, E. Borges Road, Parel, Mumbai, 400012 India
| | - Ajay Singh
- Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Room-21, Main Building, E. Borges Road, Parel, Mumbai, 400012 India
| | - Avinash Bonda
- Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Room-21, Main Building, E. Borges Road, Parel, Mumbai, 400012 India
| | - Hari Menon
- Department of Medical Oncology, Cytecare Cancer Hospital, Bengaluru, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Room-21, Main Building, E. Borges Road, Parel, Mumbai, 400012 India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | | | - Epari Sridhar
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Centre, Mumbai, India
| | - Sheela Sawant
- Department of General Medicine, Tata Memorial Centre, Mumbai, India
| | - Anuprita Daddi
- Department of General Medicine, Tata Memorial Centre, Mumbai, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Netra Ghandade
- Department of Clinical Research Secretariat, Tata Memorial Centre, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Room-21, Main Building, E. Borges Road, Parel, Mumbai, 400012 India
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Reddy R, Gogia A, Kumar L, Sharma A, Bakhshi S, Sharma MC, Mallick S, Sahoo R. HIV-associated hematologic malignancies: Experience from a Tertiary Cancer Center in India. Indian J Med Paediatr Oncol 2016; 37:141-5. [PMID: 27688606 PMCID: PMC5027785 DOI: 10.4103/0971-5851.190355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Context and Aim: Data on HIV associated hematologic malignancies is sparse from India. This study attempts to analyze the spectrum and features of this disease at a tertiary cancer center in India. Setting and Methods: Retrospective study from case records of patients registered with a diagnosis of hematologic malignancy and HIV infection between January 2010 and June 2015. Results: Thirteen cases of HIV associated hematologic malignancies were identified, six of them pediatric. HIV diagnosis was concurrent to diagnosis of cancer in 12 and preceded it in one of them. ECOG PS at presentation was >1 in all of them. All patients, except one, had B symptoms. Six of the patients had bulky disease and six are stage 4. Predominant extranodal disease was seen in 67% of them. NHL accounted for 10 of 13 patients and DLBCL-Germinal center was the most common subtype. Mean CD4+ cell count was 235/μL (range, 32-494). HAART could be given along with chemotherapy to 11 patients. Two-thirds of patients received standard doses of therapy. Chemo-toxicity required hospitalization in 58%. CR was achieved in 45% and 36% had progressive disease with first-line therapy. At the time of last follow up, 3 patients were alive with responsive disease, 2 in CR and 1 in PR. None of the pediatric patients were long time responders. Conclusions: These malignancies were of advanced stage and higher grade. Goal of therapy, in the HAART era, is curative. Pediatric patients had dismal outcome despite good chemotherapy and HAART. There is an urgent need to improve data collection for HIV related cancers in India.
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Affiliation(s)
- Rakesh Reddy
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
| | | | - Ranjit Sahoo
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
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Godbole SV, Nandy K, Gauniyal M, Nalawade P, Sane S, Koyande S, Toyama J, Hegde A, Virgo P, Bhatia K, Paranjape RS, Risbud AR, Mbulaiteye SM, Mitsuyasu RT. HIV and cancer registry linkage identifies a substantial burden of cancers in persons with HIV in India. Medicine (Baltimore) 2016; 95:e4850. [PMID: 27631245 PMCID: PMC5402588 DOI: 10.1097/md.0000000000004850] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We utilized computerized record-linkage methods to link HIV and cancer databases with limited unique identifiers in Pune, India, to determine feasibility of linkage and obtain preliminary estimates of cancer risk in persons living with HIV (PLHIV) as compared with the general population.Records of 32,575 PLHIV were linked to 31,754 Pune Cancer Registry records (1996-2008) using a probabilistic-matching algorithm. Cancer risk was estimated by calculating standardized incidence ratios (SIRs) in the early (4-27 months after HIV registration), late (28-60 months), and overall (4-60 months) incidence periods. Cancers diagnosed prior to or within 3 months of HIV registration were considered prevalent.Of 613 linked cancers to PLHIV, 188 were prevalent, 106 early incident, and 319 late incident. Incident cancers comprised 11.5% AIDS-defining cancers (ADCs), including cervical cancer and non-Hodgkin lymphoma (NHL), but not Kaposi sarcoma (KS), and 88.5% non-AIDS-defining cancers (NADCs). Risk for any incident cancer diagnosis in early, late, and combined periods was significantly elevated among PLHIV (SIRs: 5.6 [95% CI 4.6-6.8], 17.7 [95% CI 15.8-19.8], and 11.5 [95% CI 10-12.6], respectively). Cervical cancer risk was elevated in both incidence periods (SIRs: 9.6 [95% CI 4.8-17.2] and 22.6 [95% CI 14.3-33.9], respectively), while NHL risk was elevated only in the late incidence period (SIR: 18.0 [95% CI 9.8-30.20]). Risks for NADCs were dramatically elevated (SIR > 100) for eye-orbit, substantially (SIR > 20) for all-mouth, esophagus, breast, unspecified-leukemia, colon-rectum-anus, and other/unspecified cancers; moderately elevated (SIR > 10) for salivary gland, penis, nasopharynx, and brain-nervous system, and mildly elevated (SIR > 5) for stomach. Risks for 6 NADCs (small intestine, testis, lymphocytic leukemia, prostate, ovary, and melanoma) were not elevated and 5 cancers, including multiple myeloma not seen.Our study demonstrates the feasibility of using probabilistic record-linkage to study cancer/other comorbidities among PLHIV in India and provides preliminary population-based estimates of cancer risks in PLHIV in India. Our results, suggesting a potentially substantial burden and slightly different spectrum of cancers among PLHIV in India, support efforts to conduct multicenter linkage studies to obtain precise estimates and to monitor cancer risk in PLHIV in India.
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Affiliation(s)
- Sheela V. Godbole
- National AIDS Research Institute (ICMR), Pune, India
- Correspondence: Sheela V. Godbole, National AIDS Research Institute-ICMR, 73, G Block, MIDC Bhosari, Pune 411026, India (e-mail: , )
| | - Karabi Nandy
- School of Nursing and Department Of Biostatistics University of California, Los Angeles (UCLA), USA
| | | | | | - Suvarna Sane
- National AIDS Research Institute (ICMR), Pune, India
| | - Shravani Koyande
- Mumbai (Bombay) Cancer Registry, Indian Cancer Society, Mumbai, India
| | - Joy Toyama
- Department of Biostatistics, School of Public Health, University of California, Los Angeles (UCLA), USA
| | - Asha Hegde
- Maharashtra State AIDS Control Society, Mumbai, India
| | - Phil Virgo
- Computer Services Corporation, Rockville
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | | | | | - Sam M. Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Ronald T. Mitsuyasu
- University of California, Centre for AIDS Research and Education, David Geffen School of Medicine, Los Angeles (UCLA), USA
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Munawwar A, Singh S. Human Herpesviruses as Copathogens of HIV Infection, Their Role in HIV Transmission, and Disease Progression. J Lab Physicians 2016; 8:5-18. [PMID: 27013807 PMCID: PMC4785766 DOI: 10.4103/0974-2727.176228] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Of eight human herpesviruses (HHVs), often, only herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) find mention in medical literature as both of these viruses are commonly associated with genital lesions and oral ulcers, commonly known as cold sores. However, role of human herpesviruses as copathogens and in aggravation and in the transmission of other human diseases, especially the Acquired immunodeficiency syndrome (HIV/AIDS) has only very recently been recognized. Therefore, screening and treating subclinical HHV infections may offer slowing of HIV infection, disease progression, and its transmission. Beside HSV-1 and HSV-2, HHV-3 a causative agent of herpes zoster remained one of the first manifestations of HIV disease before the era of highly active antiretroviral therapy (HAART). HHV-5 also known as human Cytomegalovirus infection remains a significant risk factor for HIV-associated mortality and morbidity even in HAART era. It is proposed that Cytomegalovirus viremia could be a better predictor of HIV disease progression than CD4+ T-lymphocyte count. The role of HHV-4 or Epstein-Burr virus and HHV-6, HHV-7, and HHV-8 is still being investigated in HIV disease progression. This review provides insight into the current understanding about these 8 HHVs, their co-pathogenesis, and role in HIV/AIDS disease progression. The review also covers recent literature in favor and against administering anti-HHV treatment along with HAART for slower AIDS progression and interrupted sexual transmission.
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Affiliation(s)
- Arshi Munawwar
- Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India
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Epidemiological trends of cancers in AIDS patients. HIV & AIDS REVIEW 2014. [DOI: 10.1016/j.hivar.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Investigating the prevalence of high-risk human papilloma virus (HPV) genotypes in human immunodeficiency virus (HIV)-infected women is vital to generate data for formulating guidelines for prevention/screening of cervical cancer in this vulnerable group. The study was aimed to analyze the HPV genotypes in HIV-infected women. It was a prospective, hospital-based, and cross-sectional study. HIV-infected women were enrolled from the antiretroviral clinic and controls from the gynecology outpatient. The HPV genotyping array kit was used for identifying 21 HPV genotypes. Detection of HPV was confirmed by performing an HPV type-specific polymerase chain reaction. A Pap smear was collected in all women. One hundred thirty HIV-infected women and 64 controls were enrolled. All women with low CD4 counts (n=97) were receiving antiretroviral therapy. Twenty-six (20%) HIV-infected women and 12 (18.7%) women in the control group tested positive for high-risk HPV (P=1.0). HPV 16 was the most common type, detected in 42% of HPV-positive women in the HIV-infected cohort, followed by HPV 45 (15%), HPV 18/52/31/58 (11.5% each), and HPV 33 (7.6%). The corresponding figures in the control group were as follows: HPV 16 (66.6%), HPV 45/18/31 (16.6% each), and HPV 33/58/68 (8.3% each). Cervical intraepithelial neoplasia was detected in 2.3% of HIV-infected women. The prevalence of high-risk HPV in HIV-infected women (20%) was similar to the prevalence in controls (18.7%). This and the incidence of cervical intraepithelial neoplasia are lower than those in previous reports. It is plausible that administration of antiretroviral therapy contributed to the reduced prevalence. The currently available vaccine would likely be beneficial to the local HIV-infected population, as nearly half the HPV-infected women harbored genotypes 16 or 18.
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The management of primary central nervous system lymphoma related to AIDS in the HAART era. Curr Opin Oncol 2011; 23:648-53. [DOI: 10.1097/cco.0b013e32834b6adc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Logan JL, Khambaty MQ, D'Souza KM, Menezes LJ. Cervical cancer screening among HIV-infected women in a health department setting. AIDS Patient Care STDS 2010; 24:471-5. [PMID: 20653483 DOI: 10.1089/apc.2009.0295] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-infected women are at increased risk of developing invasive cervical cancer and present for care at a later stage of disease. Because of this susceptibility, the US Preventive Services Task Force and Centers for Disease Control and Prevention recommend that HIV-infected women receive two Pap smears during their first year after diagnosis, then annually thereafter. The aim of this study was to determine adherence to these screening guidelines and associations between demographic factors and receipt of Pap smears at a local health department in Florida. Demographic and Pap smear data were extracted from randomly selected medical records of 200 HIV-infected women receiving care between January 2000 and May 2006. Descriptive statistics and chi(2) associations were determined. Overall, 83% of women received at least one Pap smear in their first year after enrollment; 24.5% received the recommended two Pap smears. The women were predominantly minorities (57.4% African Americans; 22.8% Hispanics) and economically disadvantaged (mean income $8,180). First year Pap smear rate was significantly associated with type of insurance (p = 0.0185) and Pap smear facility (p < 0.0001), with a trend toward association with HIV risk behavior (p = 0.0593). First-year Pap smear rate was not associated with age, income, ethnicity, or incarceration history. Although this health department provided similar cervical cancer screening levels to those reported elsewhere, rates fall short of evidence-based guidelines. Future research must address low second Pap smear rates in the context of patient and provider barriers to improve early detection and prevention of cervical cancer in HIV-infected women.
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Affiliation(s)
- Jennifer L. Logan
- University of South Florida, Division of Infectious Disease and International Medicine, Tampa, Florida
| | - Maria Q. Khambaty
- University of South Florida, Division of Infectious Disease and International Medicine, Tampa, Florida
| | - Karina M. D'Souza
- University of South Florida, Division of Infectious Disease and International Medicine, Tampa, Florida
| | - Lynette J. Menezes
- University of South Florida, Division of Infectious Disease and International Medicine, Tampa, Florida
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Sahasrabuddhe VV, Bhosale RA, Joshi SN, Kavatkar AN, Nagwanshi CA, Kelkar RS, Jenkins CA, Shepherd BE, Sahay S, Risbud AR, Vermund SH, Mehendale SM. Prevalence and predictors of colposcopic-histopathologically confirmed cervical intraepithelial neoplasia in HIV-infected women in India. PLoS One 2010; 5:e8634. [PMID: 20072610 PMCID: PMC2798747 DOI: 10.1371/journal.pone.0008634] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 12/01/2009] [Indexed: 11/19/2022] Open
Abstract
Background Prevalence estimates of cervical intraepithelial neoplasia (CIN) among HIV-infected women in India have been based on cervical cytology, which may have underestimated true disease burden. We sought to better establish prevalence estimates and evaluate risk factors of CIN among HIV-infected women in Pune, India using colposcopy and histopathology as diagnostic tools. Methodology Previously unscreened, non-pregnant HIV-infected women underwent cervical cancer screening evaluation including standardized diagnostic colposcopy by a gynecologist. Histopathologic confirmation was conducted among consenting women with clinical suspicion of CIN. The prevalence of CIN was evaluated by a composite diagnosis based on colposcopy and histopathology results. Multivariable ordinal logistic regression analysis was conducted to determine independent predictors of increasing severity of CIN. Results The median age of the n = 303 enrolled HIV-infected women was 30 years (interquartile range, 27–34). A majority of the participants were widowed or separated (187/303, 61.7%), more than one-third (114/302, 37.7%) were not educated beyond primary school, and nearly two-thirds (196/301, 64.7%) had a family per capita income of <1,000 Indian Rupees (∼US$22) per month. Cervical high-risk HPV-DNA was detected in 41.7% (124/297) of participants. The composite colposcopic-histopathologic diagnoses revealed no evidence of CIN in 220 out of 303 (72.6%) women, CIN1 in 33/303 (10.9%), CIN2 in 31/303 (10.2%), CIN3 in 18/303 (5.9%) and 1 (0.3%) woman was diagnosed with ICC. Thus, over a quarter of the participants [83/303: 27.7% (95% CI: 22.7–33.1)] had ≥CIN1 lesions and a sixth [50/303: 16.5% (95% CI: 12.2–21.9)] had evidence of advanced (≥CIN2) neoplastic disease. The independent predictors of increasing severity of CIN as revealed by a proportional odds model using multivariable ordinal logistic regression included (i) currently receiving antiretroviral therapy [adjusted odds ratios (aOR): 2.24 (1.17, 4.26), p = 0.01] and (ii) presence of cervical high-risk HPV-DNA [aOR: 1.93 (1.13, 3.28), p = 0.02]. Conclusions HIV-infected women in Pune, India have a substantial burden of cervical precancerous lesions, which may progress to invasive cervical cancer unless appropriately detected and treated. Increased attention should focus on recognizing and addressing this entirely preventable cancer among HIV-infected women, especially in the context of increasing longevity due to antiretroviral therapy.
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