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Suk-Ouichai C, Coghill AE, Schabath MB, Sanchez JA, Chahoud J, Necchi A, Giuliano AR, Spiess PE. A clinical overview of people living with HIV and genitourinary cancer care. Nat Rev Urol 2024; 21:373-383. [PMID: 38238527 DOI: 10.1038/s41585-023-00846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 06/10/2024]
Abstract
The number of people living with HIV infection has been increasing globally. Administration of antiretroviral therapy is effective in controlling the infection for most patients and, as a consequence, people living with HIV (PLWH) now often have a long life expectancy. However, their risk of developing cancer - most notably virus-related cancers - has been increasing. To date, few studies have assessed the risk of genitourinary cancers in PLWH, and robust scientific data on their treatment-related outcomes are lacking. Previous studies have noted that PLWH are at a reduced risk of prostate cancer; however, low adoption and/or availability of prostate cancer screening among these patients might be confounding the validity of this finding. In genitourinary cancers, advanced stage at diagnosis and reduced cancer-specific mortality have been reported in PLWH. These data likely reflect, at least in part, the inequity of health care access for PLWH. Notably, systemic chemotherapy and/or radiotherapy could decrease total CD4+ cell counts, which could, therefore, increase the risk of morbidity and mortality from cancer treatments in PLWH. Immune checkpoint inhibitors have become the therapeutic backbone for many advanced malignancies in the general population; however, most studies validating their efficacy have excluded PLWH owing to concerns of severe adverse effects from immune checkpoint inhibitors themselves and/or related to their immunosuppressed status. To our knowledge, no genitourinary cancer survivorship programme exists that specifically caters to the needs of PLWH. By including PLWH in ongoing cancer trials, we can gain invaluable insights that will help to improve cancer care specifically for PLWH.
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Affiliation(s)
- Chalairat Suk-Ouichai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anna E Coghill
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Julian A Sanchez
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Andrea Necchi
- Department of Medical Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
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Abstract
PURPOSE OF REVIEW As people living with human immunodeficiency virus (HIV, PLWH) age, aging-related comorbidities have come into focus as major challenges to their overall health. In this review, an in-depth overview of the two most commonly encountered chronic lung diseases in PLWH, chronic obstructive pulmonary disease (COPD) and lung cancer, is provided. RECENT FINDINGS The risk for both COPD and lung cancer remains significantly higher in PLWH compared to the HIV-uninfected population, although fortunately rates of lung cancer appear to be declining over the last two decades. Outcomes for PLWH with these conditions, though, continue to be poor with worse survival rates in comparison to the general population. PLWH still face major barriers in accessing care for these conditions, including a higher likelihood of being underdiagnosed with COPD and a lower likelihood of being referred for lung cancer screening or treatment. A lack of evidence for optimal treatment strategies for both COPD and lung cancer still hampers the care of PLWH with these conditions. SUMMARY COPD and lung cancer represent substantial burdens of disease in PLWH. Improved access to standard-of-care screening and treatment and greater investigation into therapeutic responses specifically in this population are recommended.
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Affiliation(s)
- Janice M Leung
- Division of Respiratory Medicine, Department of Medicine
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Yuan T, Hu Y, Zhou X, Yang L, Wang H, Li L, Wang J, Qian HZ, Clifford GM, Zou H. Incidence and mortality of non-AIDS-defining cancers among people living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101613. [PMID: 35990580 PMCID: PMC9386399 DOI: 10.1016/j.eclinm.2022.101613] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-AIDS-defining cancers (NADCs) are now becoming a rising cause of morbidity among people living with HIV (PLHIV) in the highly active antiretroviral therapy (HAART) era. We conducted a systematic review and meta-analysis to estimate the summary risk of incidence and mortality of a wide range of NADCs among PLHIV compared with the general population. Methods This systematic review and meta-analysis was registered in the PROSPERO (registration number CRD42020222020). We searched PubMed, EMBASE, Cochrane library, and Web of Science for relevant studies published before Jan 24, 2022. Cohort or registry linkage studies comparing the incidence or mortality of individual NADCs in PLHIV with that in the general population were included. Studies simply reporting outcomes of cancer precursor lesions or combined NADCs were excluded. We calculated pooled standardised incidence (SIRs) and standardised mortality ratios (SMRs) and their 95% confidence intervals (CIs) using random-effects models, and used robust variance estimation to account for non-independence in study-level effect sizes. Findings We identified 92 publications arising from 46 independent studies including 7 articles out of 7 studies from developing countries. Among the 40 types of NADCs investigated, all of the 20 infection-related NADCs, cancers related with human papillomavirus infection in particular, and half of the 20 non-infection-related NADCs occurred in excess in PLHIV compared with the general population. This risk pattern was consistent in most WHO regions and in both high-income and low-and middle-income countries. The increased SIRs for various NADCs were more evident among PLHIV with advanced immunodeficiency, and was explored by HIV transmission route, and use of HAART. PLHIV had increased mortality for anal cancer (SMR 124·07, 95% CI 27·31-563·72), Hodgkin lymphoma (41·03, 2·91-577·88), liver cancer (8·36, 3·86-18·11), lung cancer (3·95, 1·52-10·26), and skin melanoma (3·95, 1·28-12·2). Interpretation PLHIV had increased incidence and mortality for a wide spectrum of NADCs. Primary prevention and effective treatment for NADCs in this population is urgently needed. Funding Natural Science Foundation of China Excellent Young Scientists Fund, Natural Science Foundation of China International/Regional Research Collaboration Project, National Science and Technology Major Project of China, Sanming Project of Medicine in Shenzhen, High Level Project of Medicine in Longhua, Shenzhen, Shenzhen Science and Technology Innovation Commission Basic Research Program, Special Support Plan for High-Level Talents of Guangdong Province, the Guangzhou Basic Research Program on People's Livelihood Science and Technology, the National Natural Science Foundation of China.
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Affiliation(s)
- Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuqing Hu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xinyi Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Luoyao Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- National Clinical Research Center for Infectious Diseases, Shenzhen, China
- The Third People's Hospital of Shenzhen, Shenzhen, China
- The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou, China
- Guangzhou Medical University, Guangzhou, China
| | - Junfeng Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT USA
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, the University of New South Wales, Sydney, Australia
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New Insights into the Epidemiology of Vulvar Cancer: Systematic Literature Review for an Update of Incidence and Risk Factors. Cancers (Basel) 2022; 14:cancers14020389. [PMID: 35053552 PMCID: PMC8773873 DOI: 10.3390/cancers14020389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Vulvar cancer incidence data were sought from official sources (WHO Cancer Incidence in Five Continents) and studies reporting comparable data. With respect to risk factors, a systematic PubMed search of articles published since 1980 identified 69 original cohort and case-control studies. Information was extracted using a PRISMA predesigned data collection form. Recent advances have provided further evidence in support of the carcinogenic model centred on human papillomavirus infection with different defects of the immune function. Conversely, the model centred on the role of vulvar lichen sclerosus and the often-associated differentiated vulva intraepithelial neoplasia has continued to be understudied. Abstract The aim of this review was an update of vulvar cancer incidence rates and trends and of all known and putative risk factors for the disease. The most recent incidence data were sought from official sources (WHO Cancer Incidence in Five Continents). To obtain an estimate of time trends in some areas, we compared data from Cancer Incidence in Five Continents with the few available studies that measured incidence using comparable methods. With respect to risk factors, a systematic PubMed search identified 1585 relevant articles published between 1980 and 2021. Abstracts and full texts were screened. Sixty-nine eligible original cohort and case-control studies were selected. Information was extracted using a PRISMA predesigned form. Nineteen risk factors, or risk factor categories, were investigated by two or more original studies. Solitary, unreplicated studies addressed the putative role of eight more factors. Recent advances have provided further evidence supporting the carcinogenic model centred on human papillomavirus infection with different defects of the immune function. Conversely, the model centred on the role of vulvar lichen sclerosus and the often associated differentiated vulvar intraepithelial neoplasia has continued to be epidemiologically understudied. More research on the association between these two conditions and vulvar cancer is a priority.
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Geng H, Xing Y, Zhang J, Cao K, Ye M, Wang G, Liu C. Association between viral infection other than human papillomavirus and risk of esophageal carcinoma: a comprehensive meta-analysis of epidemiological studies. Arch Virol 2022; 167:1-20. [PMID: 34636955 DOI: 10.1007/s00705-021-05268-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/27/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Infection with viruses such as human papillomavirus (HPV) is known to induce carcinomas, including esophageal carcinoma (EC). However, the possible role of viruses other than HPV in EC carcinogenesis is unclear in many studies. Here, we aimed to explore the association between infection with viruses other than HPV and EC risk by integrating existing studies of epidemiology in a meta-analysis. METHODS The PubMed, Web of Science, Cochrane Library and China National Knowledge Infrastructure databases were searched. The Newcastle-Ottawa scale was used to assess the quality of the included studies. Odds ratios (ORs) or relative risks (RRs) (with 95% confidence intervals [CIs]) were pooled to estimate the association between virus infection and risk of EC. RESULTS We included 31 eligible studies involving nine different viruses. Overall, an increased risk of EC was associated with hepatitis B virus (HBV) infection (OR = 1.19, 95%CI 1.01-1.36) and hepatitis C virus (HCV) infection (OR = 1.77, 95%CI 1.17-2.36), but not human immunodeficiency virus (HIV) infection, according to the current evidence. The evidence for an association with Epstein-Barr virus (EBV), herpes simplex virus 1 (HSV-1), JC virus (JCV), cytomegalovirus (CMV), human T-lymphotropic virus 1 (HTLV-1) or Merkel cell polyomavirus (MCPyV) infection was insufficient. CONCLUSIONS We confirmed the relationship between HBV and HCV infection and the risk of EC, but we found no association of EC risk with HIV and EBV infection. The roles of HSV-1, JCV, CMV, HTLV-1, and MCPyV were not clear because of the limited number of studies.
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Affiliation(s)
- Hui Geng
- Department of Preventive Medicine, Shantou University Medical College, No. 22, Xinling Rd., Shantou, 515041, Guangdong, China
| | - Yaqi Xing
- Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China
| | - Jingbing Zhang
- Department of Preventive Medicine, Shantou University Medical College, No. 22, Xinling Rd., Shantou, 515041, Guangdong, China
| | - Kexin Cao
- Department of Preventive Medicine, Shantou University Medical College, No. 22, Xinling Rd., Shantou, 515041, Guangdong, China
| | - Meijie Ye
- Department of Preventive Medicine, Shantou University Medical College, No. 22, Xinling Rd., Shantou, 515041, Guangdong, China
| | - Geng Wang
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Caixia Liu
- Department of Preventive Medicine, Shantou University Medical College, No. 22, Xinling Rd., Shantou, 515041, Guangdong, China
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Chiao EY, Coghill A, Kizub D, Fink V, Ndlovu N, Mazul A, Sigel K. The effect of non-AIDS-defining cancers on people living with HIV. Lancet Oncol 2021; 22:e240-e253. [PMID: 34087151 PMCID: PMC8628366 DOI: 10.1016/s1470-2045(21)00137-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
Non-AIDS-defining cancers are a growing source of morbidity for people with HIV globally. Although people living with HIV have a disproportionately increased risk of developing virally mediated cancers, cancer burden for common non-AIDS-defining cancers that are not virally associated and are linked to ageing, such as prostate cancer, is becoming higher than for virally mediated cancers. Ageing, behavioural, and HIV-specific factors drive the incidence and affect the outcomes of non-AIDS-defining cancers, presenting different challenges for addressing global morbidity and mortality from non-AIDS-defining cancer. Although large population-based studies have shown that people living with HIV with non-AIDS-defining cancers have poorer cancer outcomes than do people without HIV, current guidelines emphasise that people living with HIV with non-AIDS-defining cancers should receive standard, guideline-based treatment, and infectious disease and oncology providers should work closely to address potential drug interactions between antiretroviral therapy and antineoplastic treatment. Most trials target preventive measures focusing on non-AIDS-defining cancers. However, treatment trials for the optimal management of people living with HIV and non-AIDS-defining cancer, including interventions such as immunotherapies, are needed to improve non-AIDS-defining cancer outcomes.
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Affiliation(s)
- Elizabeth Y Chiao
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Anna Coghill
- Cancer Epidemiology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Center for Immunization and Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Darya Kizub
- Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valeria Fink
- Clinical Research, Fundación Huésped, Buenos Aires, Argentina
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Angela Mazul
- Department of Otolaryngology, Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sun D, Cao M, Li H, Ren J, Shi J, Li N, Chen W. Risk of prostate cancer in men with HIV/AIDS: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2020; 24:24-34. [PMID: 32801354 DOI: 10.1038/s41391-020-00268-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although previous studies have shown a decreased incidence of prostate cancer in men with HIV/AIDS, the consensus has not been reached. Our aim is to conduct a systematic review and meta-analysis to assess the risk of prostate cancer among people with HIV/AIDS. METHODS We systematically searched PubMed, Web of Science, Embase, and Cochrane Library until March 2020. Cohort studies were included if they compared the prostate cancer risk between people with HIV/AIDS and uninfected controls or the general population. The summary standardized incidence ratio (SIR) and 95% confidence interval (CI) were calculated using a random-effects model. RESULTS A total of 27 studies were included for analysis, with more than 2780 males with HIV/AIDS developing prostate cancer. The results showed that HIV infection was associated with a decreased risk of prostate cancer incidence (SIR, 0.76; 95% CI, 0.64-0.91; P = 0.003), with significant heterogeneity (P < 0.001; I2 = 91.6%). A range of sensitivity analyzes did not significantly change the results. CONCLUSIONS Our study shows that people with HIV/AIDS have a lower incidence of prostate cancer compared with the general population. However, significant heterogeneity exists among the included studies. Further prospective studies with better designs are needed to elucidate the association between HIV infection and prostate cancer.
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Affiliation(s)
- Dianqin Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Maomao Cao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - He Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Jiansong Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Jufang Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Ni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
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Smith AJB, Varma S, Rositch AF, Levinson K. Gynecologic cancer in HIV-positive women: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221:194-207.e5. [PMID: 30771344 DOI: 10.1016/j.ajog.2019.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/17/2019] [Accepted: 02/07/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND While there is a significant body of literature on cervical cancer in HIV-positive women, little is known about other gynecologic cancers in this population. OBJECTIVE The objective of this systematic review and meta-analysis is to describe the incidence, presentation, treatment, and outcomes for HIV-positive women with non-acquired immunodeficiency syndrome-defining gynecologic cancers. STUDY DESIGN We searched MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for English-language studies published from 2000 to May 1, 2017. Studies containing 1 or more HIV-positive women with endometrial, ovarian, or vulvovaginal cancer and reporting incidence, treatment regimen, or survival were included. Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality (details of the review protocol were registered as PROSPERO-CRD42017064525). Pooled estimates of incidence were calculated using random-effects models. Pooled estimates of cancer presentation and outcomes were averaged from case studies. RESULTS Of 5744 abstracts screened, we identified 70 articles on 58 studies on 292,202 women with HIV and 528 women with HIV and gynecologic cancer for inclusion. Most articles (53%) focused on incidence, and only 3, 4, and 20 articles focused on treatment and outcomes of endometrial, ovarian, and vulvovaginal cancers, respectively. The standardized incidence ratios for endometrial, ovarian, and vulvovaginal cancers were 4.38 (95% confidence interval 0.26-8.49) for endometrial cancer, 3.21 (95% confidence interval 2.29-4.13) for ovarian cancer, and 21.93 (95% confidence interval 13.50-30.35) for vulvovaginal cancer. Fifty-seven percent of women were diagnosed at an early stage, and all received cancer treatment. CONCLUSION In women with HIV, the incidence of ovarian and vulvovaginal cancer were higher than the general population, while incidence of endometrial cancer was similar. However, there was a paucity of data on treatment and outcomes for non-acquired immunodeficiency syndrome-defining gynecologic cancers. Given the increased incidence of gynecologic cancer, specific research on this population is essential to improve treatment and outcomes for HIV-positive women.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sanskriti Varma
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kimberly Levinson
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
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Fink VI, Jenkins CA, Castilho JL, Person AK, Shepherd BE, Grinsztejn B, Netto J, Crabtree-Ramirez B, Cortés CP, Padgett D, Jayathilake K, McGowan C, Cahn P. Survival after cancer diagnosis in a cohort of HIV-positive individuals in Latin America. Infect Agent Cancer 2018; 13:16. [PMID: 29760767 PMCID: PMC5941620 DOI: 10.1186/s13027-018-0188-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/25/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study aimed to evaluate trends and predictors of survival after cancer diagnosis in persons living with HIV in the Caribbean, Central, and South America network for HIV epidemiology cohort. METHODS Demographic, cancer, and HIV-related data from HIV-positive adults diagnosed with cancer ≤ 1 year before or any time after HIV diagnosis from January 1, 2000-June 30, 2015 were retrospectively collected. Cancer cases were classified as AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC). The association of mortality with cancer- and HIV-related factors was assessed using Kaplan-Meier curves and Cox proportional hazards models stratified by clinic site and cancer type. RESULTS Among 15,869 patients, 783 had an eligible cancer diagnosis; 82% were male and median age at cancer diagnosis was 39 years (interquartile range [IQR]: 32-47). Patients were from Brazil (36.5%), Argentina (19.9%), Chile (19.7%), Mexico (19.3%), and Honduras (4.6%). A total of 564 ADC and 219 NADC were diagnosed. Patients with NADC had similar survival probabilities as those with ADC at one year (81% vs. 79%) but lower survival at five years (60% vs. 69%). In the adjusted analysis, risk of mortality increased with detectable viral load (adjusted hazard ratio [aHR] = 1.63, p = 0.02), age (aHR = 1.02 per year, p = 0.002) and time between HIV and cancer diagnoses (aHR = 1.03 per year, p = 0.01). CONCLUSION ADC remain the most frequent cancers in the region. Overall mortality was related to detectable viral load and age. Longer-term survival was lower after diagnosis of NADC than for ADC, which may be due to factors unrelated to HIV.
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Affiliation(s)
- Valeria I. Fink
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
| | - Cathy A. Jenkins
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Jessica L. Castilho
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Anna K. Person
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Bryan E. Shepherd
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
| | - Juliana Netto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
| | - Brenda Crabtree-Ramirez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: Unidad del Paciente Ambulatorio (UPA), 5to piso Vasco de Quiroga # 15 Col. Sección XVI Delegación Tlalpan; C.P, 14000 Mexico City, Mexico
| | | | - Denis Padgett
- Instituto Hondureño de Seguridad Social, Barrio la Granja, Tegucigalpa Honduras, Hospital Escuela Universitario: Av La Salud, Tegucigalpa, Honduras
| | - Karu Jayathilake
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Catherine McGowan
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Pedro Cahn
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
| | - on behalf of CCASAnet
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: Unidad del Paciente Ambulatorio (UPA), 5to piso Vasco de Quiroga # 15 Col. Sección XVI Delegación Tlalpan; C.P, 14000 Mexico City, Mexico
- Fundación Arriarán, Santa Elvira 629, Santiago, Chile
- Instituto Hondureño de Seguridad Social, Barrio la Granja, Tegucigalpa Honduras, Hospital Escuela Universitario: Av La Salud, Tegucigalpa, Honduras
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Tanaka LF, Latorre MDRDO, Gutierrez EB, Curado MP, Dal Maso L, Herbinger KH, Froeschl G, Heumann C. Cancer survival in people with AIDS: A population-based study from São Paulo, Brazil. Int J Cancer 2017; 142:524-533. [PMID: 28971480 DOI: 10.1002/ijc.31081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/11/2017] [Accepted: 09/20/2017] [Indexed: 01/21/2023]
Abstract
Cancer survival among people with AIDS (PWA) has been described in developed countries, but there is lack of data from developing countries. The aim of this study was to evaluate survival after cancer diagnosis in PWA and compare it with people without AIDS (non-PWA) in São Paulo, Brazil. A probabilistic record linkage was carried out between the databases of the Population-based Cancer Registry of São Paulo (PBCR-SP) and the AIDS registry of SP (SINAN) to identify PWA who developed cancer. For comparison, non-PWA were frequency matched from the PBCR-SP by cancer site/type, sex, age, and period. Hazard ratio (HR) stratified by matching variables was estimated using a Cox proportional hazards model. A total of 1,294 PWA (20 patients with two primary site tumors) were included in the site/type-specific analyses. AIDS-defining cancers (ADC) comprised 51.9% of cases assessed. The all-cancer 5-year overall survival in PWA was 49.4% versus 72.7% in non-PWA (HR = 2.64; 95%CI = 2.39-2.91). Survival was impaired in PWA for both ADC (HR = 2.93; 95%CI = 2.49-3.45) and non-ADC (HR = 2.51; 95%CI = 2.21-2.84), including bladder (HR = 8.11; 95% CI = 2.09-31.52), lung (HR = 2.93; 95%CI = 1.97-4.36) and anal cancer (HR = 2.53; 95%CI = 1.63-3.94). These disparities were seen mainly in the first year after cancer diagnosis. The overall survival was significantly lower in PWA in comparison with non-PWA in São Paulo, as seen in high-income countries. Efforts to enhance early diagnosis and ensure proper cancer treatment in PWA should be emphasized.
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Affiliation(s)
- Luana F Tanaka
- Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.,Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.,Population-Based Cancer Registry of São Paulo, Department of Epidemiology, University of São Paulo, São Paulo, Brazil
| | - Maria do Rosário D O Latorre
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.,Population-Based Cancer Registry of São Paulo, Department of Epidemiology, University of São Paulo, São Paulo, Brazil
| | - Eliana B Gutierrez
- Municipal STD-AIDS Program, Secretaria Municipal de Saúde, São Paulo, Brazil
| | - Maria P Curado
- A. C. Camargo Cancer Center, São Paulo, Brazil.,International Prevention Research Institute, Lyon, France
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Guenter Froeschl
- Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Christian Heumann
- Department of Statistics, University of Munich (LMU), Munich, Germany
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