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Souza ATD, Andrade FRD, Sarmento AC, Villarim CC, Araújo-Filho I, Medeiros KSD. Clinical features in Hodgkin lymphoma patients living with human immunodeficiency virus: A meta-analysis in the antiretroviral therapy era. Int J STD AIDS 2024; 35:786-795. [PMID: 38905613 DOI: 10.1177/09564624241259512] [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: 06/23/2024]
Abstract
OBJECTIVE Evaluate the clinical features in people with Hodgkin's lymphoma living with HIV (HIV-HL) during the combination ART (cART) era. DESIGN Systematic review and meta-analysis. METHODS The study was conducted in accordance with the recommendations of 2020 PRISMA and MOOSE statements. The protocol was prospectively registered through the PROSPERO (CRD42021289520). Manuscripts published until July 2023 were systematically searched in the PubMed, EMBASE, Cochrane Library, and Web of Science databases, with no language and year of publication restriction. Meta-analysis was performed to estimate a pooled proportion of each outcome using a random-effect analysis. Quality assessment was performed by using New-Castle Ottawa scale. Certainty of evidence was graded using the GRADE. RESULTS Sixteen cohorts, representing 3.882 HIV-HL patients, were included in this review. Our findings indicate that HIV-HL patients showed a 2-year overall survival (OS) of 92% (95% CI 0.87, 0.95). However, the 5-year overall survival decreased to 79% (95% CI 0.74, 0.83), with a high certainty of evidence according to GRADE. Additionally, the 5-year progression-free survival declined to 79% and complete remission rate increased to 81%. Our meta-analysis indicates an increase for B symptoms (80%, 95% CI 0.75, 0.84) and extranodal involvement in bone marrow (43%, 95% CI 0.30, 0.47) among HIV-HL patients. CONCLUSION The HIV-HL patients showed a 2-year OS of 92%. However, the 5-year OS decreased to 79%. The reported main cause of mortality among HIV-HL patients was progression of HL. Our systematic review and meta-analysis suggest that cART is associated with improved short-term survival of HIV-HL patients.
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Affiliation(s)
- Amaxsell Tb de Souza
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Faculty of Pharmacy, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Fernanda Ra de Andrade
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Medicine, Health School, Potiguar University, Natal, Brazil
| | - Ayane Ca Sarmento
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Irami Araújo-Filho
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Medicine, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Kleyton S de Medeiros
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
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Vargas JC, Cecyn KZ, de Oliveira Marques M, Pereira J, Tobias Braga WM, Hamerschlak N, Tabacof J, de Liz CD, Abdo A, Ferreira PRA, Colleoni GWB, Baiocchi OCG. Immune reconstitution inflammatory syndrome-associated lymphoma: A retrospective Brazilian cohort. EJHAEM 2024; 5:147-152. [PMID: 38406522 PMCID: PMC10887249 DOI: 10.1002/jha2.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 02/27/2024]
Abstract
After initiating combined antiretroviral therapy (cART), individuals with human immunodeficiency virus (HIV) may develop Hodgkin/non-Hodgkin lymphoma due to immune reconstitution inflammatory syndrome (IRIS). This retrospective cohort study evaluated the incidence, clinical features and prognosis of IRIS-associated lymphomas in Brazilian patients. Incidence in 2000-2019 was 9.8% (27/276 patients with HIV and lymphoma; viral load drop >1 log). Time between HIV diagnosis and cART initiation was <1 year in 70.3% of cases. Time between cART initiation and lymphoma diagnosis was <3 months in 11 cases and 3-6 months in 16 cases. Overall and progression-free survival rates were similar between cases of non-IRIS-associated lymphoma and IRIS-associated lymphoma.
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Affiliation(s)
- Juliano Cordova Vargas
- Department of Clinical and Experimental OncologyFederal University of São PauloSão PauloSPBrazil
- Department of HematologyAméricas Oncologia e HematologiaSão PauloSPBrazil
- School of MedicineCentro Universitário São CamiloSão PauloSPBrazil
| | - Karin Zattar Cecyn
- Department of Clinical and Experimental OncologyFederal University of São PauloSão PauloSPBrazil
| | - Mariana de Oliveira Marques
- Department of Clinical and Experimental OncologyFederal University of São PauloSão PauloSPBrazil
- Department of HematologyHospital Alemão Oswaldo CruzSão PauloSPBrazil
| | - Juliana Pereira
- Department of Clinical and HematologySão Paulo State Cancer InstituteUniversity of São PauloSão PauloSPBrazil
| | | | - Nelson Hamerschlak
- Department of HematologyAméricas Oncologia e HematologiaSão PauloSPBrazil
- Department of HematologyHospital Israelita Albert EinsteinSão PauloSPBrazil
| | | | - Caina D. de Liz
- Department of HematologyHospital Sírio LibanêsSão PauloSPBrazil
| | - André Abdo
- Department of HematologyHospital Alemão Oswaldo CruzSão PauloSPBrazil
| | | | - Gisele W. Braga Colleoni
- Department of Clinical and Experimental OncologyFederal University of São PauloSão PauloSPBrazil
| | - Otavio C. G. Baiocchi
- Department of Clinical and Experimental OncologyFederal University of São PauloSão PauloSPBrazil
- Department of HematologyHospital Alemão Oswaldo CruzSão PauloSPBrazil
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3
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Sangaré MN, Baril JG, de Pokomandy A, Klein M, Thomas R, Tremblay C, Pexos C, Durand M, Chawla S, Laporte L, Trottier H. CD4/CD8 Ratio Outcome According to the Class of the Third Active Drug in Antiretroviral Therapy Regimens: Results From the Quebec Human Immunodeficiency Virus Cohort Study. Clin Infect Dis 2023; 76:1879-1888. [PMID: 36722329 DOI: 10.1093/cid/ciad056] [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: 08/23/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The impact of different therapeutic classes of drugs in antiretroviral therapy (ART) regimens on the CD4/CD8 ratio is not well documented in people treated for HIV. The objective of this study was to analyze the long-term effect of exposure to integrase strand transfer inhibitor (INSTI) on CD4/CD8 ratio compared with nonnucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) among ART-treated persons with HIV (PWH). METHODS Data from the Quebec HIV Cohort collected from 31 August 2017 were used. Our analysis included all patients in the cohort who received a first or subsequent ART regimen composed of 2 nucleoside reverse transcriptase inhibitors (NRTIs) and a third active drug of a different class (NNRTI, PI, or INSTI) for at least 16 weeks. Marginal structural Cox models were constructed to estimate the effect of different therapeutic classes on the CD4/CD8 ratio outcome. RESULTS Among the 3907 eligible patients, 972 (24.9%), 1996 (51.1%), and 939 (24.0%) were exposed to an ART regimen whose third active agent was an NNRTI, PI, or INSTI, respectively. The total follow-up time was 13 640.24 person-years. The weighted hazard ratio for the association between the third active class and CD4/CD8 ratio ≥1 was .56 (95% confidence interval [CI]: .48-.65) for patients exposed to NNRTI + 2 NRTIs and .41 (95% CI: .35-.47) for those exposed to PI + 2 NRTIs, compared with those exposed INSTI + 2 NRTIs. CONCLUSIONS For people treated for HIV, INSTI-based ART appears to be associated with a higher CD4/CD8 ratio than NNRTI and PI-based ART.
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Affiliation(s)
| | - Jean-Guy Baril
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Marina Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | | | - Cécile Tremblay
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases, and Immunology, Université de Montréal, Montreal, Canada
- Department of Microbiology and Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Costa Pexos
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Madeleine Durand
- Department of Microbiology, Infectious Diseases, and Immunology, Université de Montréal, Montreal, Canada
| | - Seerat Chawla
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Louise Laporte
- Sainte Justine University Hospital Center, Montreal, Canada
| | - Helen Trottier
- Sainte Justine University Hospital Center, Montreal, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
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Bozkurt G, Kaya F, Yildirim Y, Yildiz R, Gungor O, Dogan F, Ayozger LEO. The effect of multiple-dose ivermectin treatment on CD4 +/CD8 + and the oxidative stress index in goats with udder viral papillomatosis. Res Vet Sci 2023; 157:17-25. [PMID: 36848794 DOI: 10.1016/j.rvsc.2023.02.006] [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: 10/30/2022] [Revised: 12/31/2022] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
This study aims to reveal the therapeutic effect of ivermectin against Capra hircus papillomavirus (ChPV-1) infection and on the CD4+/CD8+ (cluster of differentiation) and oxidative stress index (OSI). Twenty hair goats naturally infected with ChPV-1 were divided into two groups with equal numbers as the ivermectin group and the control groups. Ivermectin was administered subcutaneously at a dose of 0.2 mg/kg to the goats in the ivermectin group on days 0, 7, and 21. Blood samples were collected from the vena jugularis on days 0, 21, 45, and 90. The cluster of differentiation4+/CD8+ ratio was significantly higher in the ivermectin group than in the control group on the 90th day. Furthermore, the CD8+ concentration was significantly decreased in the ivermectin group on the 90th day compared with the control group. Both total oxidant status (TOS) and OSI were found to be significantly higher in the control group on the 21st and 45th days than in the ivermectin group. On the 90th day, it was determined that the lesions in the ivermectin group improved significantly compared to those in the control group. Additionally, only in the ivermectin group was there a significant difference between the 90th day and the other days in terms of healing. As a result, it can be suggested that ivermectin has positive effects on the immune response and that its oxidative actions are of therapeutic value and do not harm the systemic oxidative status, as in untreated goats.
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Affiliation(s)
- Gokhan Bozkurt
- Burdur Mehmet Akif Ersoy University, Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology, 15100 Burdur, Turkey.
| | - Feyyaz Kaya
- Balikesir University, Faculty of Veterinary Medicine, Department of Internal Medicine, Balikesir, Turkey.
| | - Yakup Yildirim
- Burdur Mehmet Akif Ersoy University, Faculty of Veterinary Medicine, Department of Virology, 15100 Burdur, Turkey.
| | - Ramazan Yildiz
- Burdur Mehmet Akif Ersoy University, Faculty of Veterinary Medicine, Department of Internal Medicine, 15100 Burdur, Turkey.
| | - Orsan Gungor
- Burdur Mehmet Akif Ersoy University, Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology, 15100 Burdur, Turkey.
| | - Firat Dogan
- Hatay Mustafa Kemal University, Faculty of Veterinary Medicine, Department of Virology, 31060, Hatay, Turkey.
| | - Leyla Elif Ozgu Ayozger
- Burdur Mehmet Akif Ersoy University, Faculty of Veterinary Medicine, Department of Pathology, 15100 Burdur, Turkey.
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5
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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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6
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Comparison of baseline lymphoma and HIV characteristics in Malawi before and after implementation of universal antiretroviral therapy. PLoS One 2022; 17:e0273408. [PMID: 36048901 PMCID: PMC9436050 DOI: 10.1371/journal.pone.0273408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Access to antiretroviral therapy (ART) led to epidemiological changes in human immunodeficiency virus (HIV) associated lymphoma in high-income countries such as reductions in diffuse large B-cell lymphoma (DLBCL) and stable or increased Hodgkin lymphoma (HL) and Burkitt lymphoma (BL). In 2016, Malawi implemented a universal ART (UART) policy, expanding ART eligibility to all persons living with HIV (PLWH). We compare the distribution of lymphoma subtypes and baseline HIV and prognostic characteristics for lymphoma patients in Malawi before and after implementation of UART. We enrolled patients with pathologically confirmed incident lymphoproliferative disorders into a observational clinical cohort. At diagnosis, a comprehensive clinicopathological evaluation was performed. Of 412 participants, 156 (38%) were pre-UART (2013-June 2016) and 256 (62%) post-UART (July 2016–2020). HIV prevalence was 50% in both groups. The most common pre-UART diagnoses were DLBCL [75 (48%)], low-grade non-Hodgkin lymphoma (NHL) [19 (12%)], HL [17 (11%)] and, BL [13 (8%)]. For post-UART they were DLBCL [111 (43%)], NHL [28 (11%)], BL [27 11%)] and, HL [20 (8%)]. Among PLWH, 44 (57%) pre-UART initiated ART prior to lymphoma diagnosis compared to 99 (78%) post-UART (p = 0.02). HIV-ribonucleic acid was suppressed <1000 copies/mL in 56% (33/59) pre-UART and 71% (73/103) post-UART (p = 0.05). CD4 T-cell counts were similar for both groups. We observed similar findings in the subset of participants with DLBCL. Overall, there were no significant changes in incident lymphoma subtypes (p = 0.61) after implementation of UART, but HIV was better controlled. Emerging trends bear monitoring and may have implications for prognosis and health system priority setting. Trial registration: ClinicalTrials.gov identifier:NCT02835911.
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7
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Chen J, Liu X, Qin S, Ruan G, Lu A, Zhang J, Wu Y, Xie Z, Peng J. A Novel Prognostic Score Including the CD4/CD8 for AIDS-Related Lymphoma. Front Cell Infect Microbiol 2022; 12:919446. [PMID: 35873145 PMCID: PMC9299417 DOI: 10.3389/fcimb.2022.919446] [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: 04/13/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background A simple and clinically applicable prognostic scoring system for AIDS-related lymphoma (ARL) in the era of combination antiretroviral therapy (cART) is needed to better stratify patients' risks and to assist in the decision-making of therapeutic strategies. Methods We conducted a retrospective multicenter cohort study in 138 primary ARL patients over an 8-year period from 2013 to 2020. Survival curves were estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard models were performed to identify the association between patient-, lymphoma-, and HIV-specific variables with progression-free survival (PFS) and overall survival (OS). The incremental prognostic value of novel inflammatory biomarkers in the International Prognostic Index (IPI) was evaluated by comparing the receiver operating characteristic (ROC) curves, the concordance index (C-index), and the integrated Brier score (IBS). Results The median age was 49.14 ± 14.20 (range 18-79) years, 81.9% were men, and the median follow-up was 44.94 (95% CI = 37.05-52.84) months. The 3-year OS and PFS were 39.4% (95% CI = 16.3-21.2) and 38.7% (95% CI = 14.5-19.7), respectively. We found that age, extranodal sites, bulky mass, CD4 T-cell counts, CD4/CD8 ratio, and hypoalbuminemia were associated with OS (all P < 0.05) at both univariate and multivariate analyses. Of the new inflammatory markers, only the CD4/CD8 ratio was an independent prognostic parameter of OS and PFS. A lower CD4/CD8 ratio was strongly associated with adverse clinical factors, including older age, advanced Ann Arbor stage, more extranodal sites, elevated erythrocyte sedimentation rate, prior history of HIV, higher red cell distribution width ratio, hypoproteinemia, and emaciation. When the CD4/CD8 ratio was added to the IPI, the composite HIV-IPI score showed significantly better discrimination than IPI alone [AUC (95% CI): HIV-IPI, 0.83 (0.77-0.89) vs. IPI, 0.72 (0.70-0.85)]. The HIV-IPI model provided good predictive performance [C-index (95% CI): HIV-IPI, 0.82 (0.81-0.83) vs. IPI, 0.75 (0.73-0.77), P < 0.001] and a satisfactory calibration function. Conclusions The CD4/CD8 ratio, an inexpensive and readily available marker, is a powerful independent prognostic parameter in patients with ARL. Furthermore, when the CD4/CD8 ratio is used in combination with IPI, it increases prognostic ability. The useful prediction of expected outcomes in ARL can inform treatment decisions.
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Affiliation(s)
- Juanjuan Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuewu Liu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shanfang Qin
- Guangxi AIDS Diagnosis and Treatment Quality Control Center, Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Guangjing Ruan
- Guangxi AIDS Clinical Treatment Center, The Fourth People's Hospital of Nanning, Nanning, China
| | - Aili Lu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinxin Zhang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yihua Wu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiman Xie
- Guangxi AIDS Clinical Treatment Center, The Fourth People's Hospital of Nanning, Nanning, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
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8
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Ruffieux Y, Muchengeti M, Egger M, Efthimiou O, Bartels L, Olago V, Davidović M, Dhokotera T, Bohlius J, Singh E, Rohner E. Immunodeficiency and Cancer in 3.5 Million People Living With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study. Clin Infect Dis 2021; 73:e735-e744. [PMID: 33530095 DOI: 10.1093/cid/ciab087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/28/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We analyzed associations between immunodeficiency and cancer incidence in a nationwide cohort of people living with human immunodeficiency virus (HIV; PLWH) in South Africa. METHODS We used data from the South African HIV Cancer Match Study built on HIV-related laboratory measurements from the National Health Laboratory Services and cancer records from the National Cancer Registry. We evaluated associations between time-updated CD4 cell count and cancer incidence rates using Cox proportional hazards models. We reported adjusted hazard ratios (aHRs) over a grid of CD4 values and estimated the aHR per 100 CD4 cells/µL decrease. RESULTS Of 3 532 266 PLWH, 15 078 developed cancer. The most common cancers were cervical cancer (4150 cases), Kaposi sarcoma (2262 cases), and non-Hodgkin lymphoma (1060 cases). The association between lower CD4 cell count and higher cancer incidence rates was strongest for conjunctival cancer (aHR per 100 CD4 cells/µL decrease: 1.46; 95% confidence interval [CI], 1.38-1.54), Kaposi sarcoma (aHR, 1.23; 95% CI, 1.20-1.26), and non-Hodgkin lymphoma (aHR, 1.18; 95% CI, 1.14-1.22). Among infection-unrelated cancers, lower CD4 cell counts were associated with higher incidence rates of esophageal cancer (aHR, 1.06; 95% CI, 1.00-1.11) but not breast, lung, or prostate cancer. CONCLUSIONS Lower CD4 cell counts were associated with an increased risk of developing various infection-related cancers among PLWH. Reducing HIV-induced immunodeficiency may be a potent cancer-prevention strategy among PLWH in sub-Saharan Africa, a region heavily burdened by cancers attributable to infections.
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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
| | - 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
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Lina Bartels
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Victor Olago
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Maša Davidović
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Tafadzwa Dhokotera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.,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
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Eliane Rohner
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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9
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Carbone A, Gloghini A, Serraino D, Spina M, Tirelli U, Vaccher E. Immunodeficiency-associated Hodgkin lymphoma. Expert Rev Hematol 2021; 14:547-559. [PMID: 34044724 DOI: 10.1080/17474086.2021.1935851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Hodgkin lymphoma (HL) can occur in different host conditions, i.e. in the general population and immunocompromised individuals, either during HIV infection or solid organ/hematopoietic transplantation and immunosuppressive drug treatment.Areas covered: Areas covered include multidimensional characteristics of tumor cells and cellular composition of tumor microenvironment of HL. Current conventional treatments and new treatment strategies for HL in immunosuppressed patients, especially in persons living with HIV (PLWH), are also discussed.PubMed and MEDLINE were used for database searches to identify articles in English published from 1989 to 2020.Expert opinion: For people with post-transplant HL or for those with HIV/AIDS-associated HL, standard treatments mirror those in the general population. In the last decade, the combination of cART with anti-neoplastic treatments, alongside with current anti-rejection therapies, has increased long-term survival of people with HL and acquired immune deficiencies. High-dose chemotherapy and autologous stem cell transplantation have been favorably proven as salvage therapy in PLWH with relapsed and refractory HL. Immune checkpoint inhibitors emerged as an area of clinical investigation for relapsed and refractory HL in the general population. Pembrolizumab, an anti-programmed cell death protein 1 (PD-1) drug, resulted safe in PLWH indicating that PD-1 ligand assessment should be advisable in HIV-associated HL.
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Affiliation(s)
- Antonino Carbone
- Pathology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
| | - Annunziata Gloghini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Serraino
- Epidemiology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
| | - Michele Spina
- Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
| | - Umberto Tirelli
- Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
| | - Emanuela Vaccher
- Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
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10
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Immunophenotypic characterization of TCR γδ T cells and MAIT cells in HIV-infected individuals developing Hodgkin's lymphoma. Infect Agent Cancer 2021; 16:24. [PMID: 33865435 PMCID: PMC8052713 DOI: 10.1186/s13027-021-00365-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background Despite successful combined antiretroviral therapy (cART), the risk of non-AIDS defining cancers (NADCs) remains higher for HIV-infected individuals than the general population. The reason for this increase is highly disputed. Here, we hypothesized that T-cell receptor (TCR) γδ cells and/or mucosal-associated invariant T (MAIT) cells might be associated with the increased risk of NADCs. γδ T cells and MAIT cells both serve as a link between the adaptive and the innate immune system, and also to exert direct anti-viral and anti-tumor activity. Methods We performed a longitudinal phenotypic characterization of TCR γδ cells and MAIT cells in HIV-infected individuals developing Hodgkin’s lymphoma (HL), the most common type of NADCs. Cryopreserved PBMCs of HIV-infected individuals developing HL, matched HIV-infected controls without (w/o) HL and healthy controls were used for immunophenotyping by polychromatic flow cytometry, including markers for activation, exhaustion and chemokine receptors. Results We identified significant differences in the CD4+ T cell count between HIV-infected individuals developing HL and HIV-infected matched controls within 1 year before cancer diagnosis. We observed substantial differences in the cellular phenotype mainly between healthy controls and HIV infection irrespective of HL. A number of markers tended to be different in Vδ1 and MAIT cells in HIV+HL+ patients vs. HIV+ w/o HL patients; notably, we observed significant differences for the expression of CCR5, CCR6 and CD16 between these two groups of HIV+ patients. Conclusion TCR Vδ1 and MAIT cells in HIV-infected individuals developing HL show subtle phenotypical differences as compared to the ones in HIV-infected controls, which may go along with functional impairment and thereby may be less efficient in detecting and eliminating malignant cells. Further, our results support the potential of longitudinal CD4+ T cell count analysis for the identification of patients at higher risk to develop HL. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-021-00365-4.
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11
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Kimani SM, Painschab MS, Horner MJ, Muchengeti M, Fedoriw Y, Shiels MS, Gopal S. Epidemiology of haematological malignancies in people living with HIV. Lancet HIV 2020; 7:e641-e651. [PMID: 32791045 PMCID: PMC10199168 DOI: 10.1016/s2352-3018(20)30118-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022]
Abstract
People living with HIV or AIDS are at increased risk of Hodgkin and non-Hodgkin lymphoma compared with HIV-negative individuals. Data on the risk of multiple myeloma or leukaemia are inconsistent and of low quality but the risk does not seem to be increased. Specific haematological malignancies occur in different contexts of age, CD4 cell count, HIV control, viral co-infections, or chronic inflammation, and the expansion of combination antiretroviral therapy has led to varied demographic and epidemiological shifts among people with HIV. Increased use of combination antiretroviral therapy has substantially reduced the risks of diffuse large B-cell lymphoma, Burkitt lymphoma, and primary CNS lymphoma, and to a lesser extent, Hodgkin lymphoma. There is no effect of combination antiretroviral therapy use on multiple myeloma or leukaemia. Although many cases of HIV are in low-income and middle-income countries, high-quality epidemiological data for haematological malignancies from these regions are scarce. Closing this gap is an essential first step in decreasing mortality from HIV-associated haematological malignancies worldwide. Finally, although multicentric Castleman disease is not a neoplastic condition, it is an emerging precursor to neoplastic high-grade B-cell lymphoproliferation among people with HIV, especially for individuals on long-term combination antiretroviral therapy with well controlled HIV.
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Affiliation(s)
- Stephen M Kimani
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Matthew S Painschab
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Marie-Josèphe Horner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Yuri Fedoriw
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Satish Gopal
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi.
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12
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Shmakova A, Germini D, Vassetzky Y. HIV-1, HAART and cancer: A complex relationship. Int J Cancer 2020; 146:2666-2679. [PMID: 31603989 DOI: 10.1002/ijc.32730] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022]
Abstract
HIV infected people are at higher risk of developing cancer, although it is globally diminished in the era of highly active antiretroviral treatment (HAART). Recently, antioncogenic properties of some HAART drugs were discovered. We discuss the role of HAART in the prevention and improvement of treatment outcomes of cancers in HIV-infected people. We describe different trends in HAART-cancer relationships: cancer-predisposing as well as cancer-preventing. We cover the roles of particular drug regimens in cancer prevention. We also describe the causes of cancer treatment with HAART drugs in HIV-negative people, including ongoing clinical studies that may directly point to a possible independent anti-oncogenic activity of HAART drugs. We conclude that despite potent antioncogenic activities of every class of HAART drugs reported in preclinical models, the evidence to date indicates that their independent clinical impact in HIV-infected people is limited. Improved cancer prevention strategies besides HAART are needed to reduce HIV-cancer-related mortality.
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Affiliation(s)
- Anna Shmakova
- UMR 8126, CNRS, Univ. Paris-Sud, Institut Gustave Roussy, Université Paris Saclay, Édouard-Vaillant, Villejuif, France
- LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, Édouard-Vaillant, Villejuif, France
- Laboratory of Gene and Cell Technologies, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Diego Germini
- UMR 8126, CNRS, Univ. Paris-Sud, Institut Gustave Roussy, Université Paris Saclay, Édouard-Vaillant, Villejuif, France
- LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, Édouard-Vaillant, Villejuif, France
| | - Yegor Vassetzky
- UMR 8126, CNRS, Univ. Paris-Sud, Institut Gustave Roussy, Université Paris Saclay, Édouard-Vaillant, Villejuif, France
- LIA 1066 LFR2O French-Russian Joint Cancer Research Laboratory, Édouard-Vaillant, Villejuif, France
- Koltzov Institute of Developmental Biology, Moscow, Russia
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13
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Puronen CE, Ford ES, Uldrick TS. Immunotherapy in People With HIV and Cancer. Front Immunol 2019; 10:2060. [PMID: 31555284 PMCID: PMC6722204 DOI: 10.3389/fimmu.2019.02060] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 12/16/2022] Open
Abstract
HIV infection alters the natural history of several cancers, in large part due to its effect on the immune system. Immune function in people living with HIV may vary from normal to highly dysfunctional and is largely dependent on the timing of initiation (and continuation) of effective antiretroviral therapy (ART). An individual's level of immune function in turn affects their cancer risk, management, and outcomes. HIV-associated lymphocytopenia and immune dysregulation permit immune evasion of oncogenic viruses and premalignant lesions and are associated with inferior outcomes in people with established cancers. Various types of immunotherapy, including monoclonal antibodies, interferon, cytokines, immunomodulatory drugs, allogeneic hematopoietic stem cell transplant, and most importantly ART have shown efficacy in HIV-related cancer. Emerging data suggest that checkpoint inhibitors targeting the PD-1/PD-L1 pathway can be safe and effective in people with HIV and cancer. Furthermore, some cancer immunotherapies may also affect HIV persistence by influencing HIV latency and HIV-specific immunity. Studying immunotherapy in people with HIV and cancer will advance clinical care of all people living with HIV and presents a unique opportunity to gain insight into mechanisms for HIV eradication.
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Affiliation(s)
- Camille E Puronen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Emily S Ford
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Thomas S Uldrick
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Division of Global Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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14
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Shepherd L, Ryom L, Law M, Hatleberg CI, de Wit S, Monforte AD, Battegay M, Phillips A, Bonnet F, Reiss P, Pradier C, Grulich A, Sabin C, Lundgren J, Mocroft A. Differences in Virological and Immunological Risk Factors for Non-Hodgkin and Hodgkin Lymphoma. J Natl Cancer Inst 2019; 110:598-607. [PMID: 29267895 DOI: 10.1093/jnci/djx249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/27/2017] [Indexed: 12/18/2022] Open
Abstract
Background Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) are increased in populations with immune dysfunction, including people living with HIV; however, there is little evidence for to what degree immunological and virological factors differently affect NHL and HL risk. Methods Data from the Data Collection on Adverse events of Anti-HIV Drugs Study cohort were analyzed to identify independent risk factors for NHL and HL using hazard ratios (HRs), focusing on current and cumulative area under the curve (AUC) measures of immunological and virological status. Variables with different associations with NHL and HL were identified using marginal Cox models. All statistical tests were two-sided. Results Among 41 420 people followed for 337 020 person-years, 392 developed NHL (incidence rate = 1.17/1000 person-years of follow-up [PYFU], 95% confidence interval [CI] = 1.06 to 1.30) and 149 developed HL (incidence rate = 0.44/1000 PYFU, 95% CI = 0.38 to 0.52). Higher risk of both NHL and HL was associated with lower current CD4 cell count (adjusted HR [aHR] of NHL for CD4 <100 vs > 599 cells/mm3 = 8.08, 95% CI = 5.63 to 11.61; HL = 4.58, 95% CI = 2.22 to 9.45), whereas higher current HIV viral load (aHR of NHL for HIV-VL >1000 vs < 50 copies/mL = 1.97, 95% CI = 1.50 to 2.59) and higher AUC of HIV-VL (aHR of NHL for highest vs lowest quintile = 2.91, 95% CI = 1.92 to 4.41) were associated with NHL only. Both current and AUC of HIV-VL were factors that had different associations with NHL and HL, where the hazard ratio for NHL was progressively higher than for HL with increasing HIV-VL category. Lower current CD4 cell count had a strong but similar association with both NHL and HL. Conclusions CD4 depletion increased risk of both types of lymphomas while current and accumulated HIV-VL was associated with NHL only. This suggests that NHL development is related to both CD4 cell depletion and added immune dysfunction derived from ongoing HIV replication. This latter factor was not associated with HL risk.
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Affiliation(s)
- Leah Shepherd
- Research Department of Infection and Population Health, UCL, London, UK
| | - Lene Ryom
- CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthew Law
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Camilla Ingrid Hatleberg
- CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stephane de Wit
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antonella d'Arminio Monforte
- Dipartimento di Scienze della Salute, Clinica di Malattie Infectitive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrew Phillips
- Research Department of Infection and Population Health, UCL, London, UK
| | - Fabrice Bonnet
- CHU de Bordeaux and INSERM U1219, Université de Bordeaux, Bordeaux, France
| | - Peter Reiss
- Academic Medical Center, Division of Infectious Diseases, Department of Global Health, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, the Netherlands
| | | | | | - Caroline Sabin
- Research Department of Infection and Population Health, UCL, London, UK
| | - Jens Lundgren
- CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Research Department of Infection and Population Health, UCL, London, UK
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15
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Spagnuolo V, Uberti-Foppa C, Castagna A. Pharmacotherapeutic management of HIV in transplant patients. Expert Opin Pharmacother 2019; 20:1235-1250. [PMID: 31081726 DOI: 10.1080/14656566.2019.1612364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION In the last two decades, an increasing number of people living with HIV (PLWH) have undergone solid-organ and hematopoietic cell transplantation as a treatment of end-stage organ and hematological diseases, respectively. Although transplant outcomes are more than satisfactory, transplantation in PLWH is still challenging for clinicians because of concerns regarding potentially higher rates of infective complications, higher risks of allograft rejection, and drug-drug interactions between antiretroviral drugs and immunosuppressive agents. AREAS COVERED This review provides an overview of transplantation in PLWH, with focus on the management of combination antiretroviral therapy in this population. EXPERT OPINION Solid-organ and hematopoietic cell transplantations should be proposed without any reservation to all PLWH who may benefit from them. Particular attention should be paid to possible drug-drug interactions between antiretrovirals and immunosuppressive agents; moreover, when feasible, integrase strand transfer inhibitor-based antiretroviral regimens should be preferred to protease and non-nucleoside reverse transcriptase inhibitors. Considering the worse prognosis in HIV/hepatitis C virus (HCV) transplant recipients, treatment of HCV with new direct-acting antivirals (DAAs) represents a key issue in the management of this population. However, the timing of treatment (before or early after transplant) should be individualized by considering short-term prognosis, access to transplant, and comorbidities.
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Affiliation(s)
- Vincenzo Spagnuolo
- a Faculty of Medicine and Surgery , Vita-Salute San Raffaele University , Milan , Italy.,b Clinic of Infectious Diseases , Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute , Milan , Italy
| | - Caterina Uberti-Foppa
- a Faculty of Medicine and Surgery , Vita-Salute San Raffaele University , Milan , Italy.,b Clinic of Infectious Diseases , Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute , Milan , Italy
| | - Antonella Castagna
- a Faculty of Medicine and Surgery , Vita-Salute San Raffaele University , Milan , Italy.,b Clinic of Infectious Diseases , Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute , Milan , Italy
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16
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Conconi A, Zucca E, Margiotta-Casaluci G, Darling K, Hasse B, Battegay M, Staehelin C, Novak U, Schmid P, Scherrer A, Dirnhofer S, Kwee I, Nassi L, Cavalli F, Gaidano G, Bertoni F, Bernasconi E. Population-based outcome analysis of diffuse large B-cell lymphoma in people living with HIV infection and competent individuals. Hematol Oncol 2018; 36:757-764. [PMID: 30113708 DOI: 10.1002/hon.2536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/01/2018] [Accepted: 06/15/2018] [Indexed: 11/11/2022]
Abstract
The prognostic factors and outcome of 58 acquired immunodeficiency syndrome-related diffuse large B-cell lymphoma (AR-DLBCL) patients from the Swiss HIV Cohort Study, diagnosed from 2004 to 2011, were compared with those of 326 immunocompetent (IC)-DLBCL from the Hematology Division of the Amedeo Avogadro University (Italy) and the Oncology Institute of Southern Switzerland. Median follow-up was 6 years; 5-year overall survival (OS) was 68% (95% CI: 63%-73%) in IC-DLBCL and 63% (95% CI: 49%-75%) in AR-DLBCL (P = .220). The acquired immunodeficiency syndrome-related lymphoma international prognostic index predicted OS in AR-DLBCL. Among 148 patients younger than 61 years (40 AR-DLBCL and 108 IC-DLBCL) treated with RCHOP/RCHOP-like regimens, 20 IC-DLBCL and 9 AR-DLBCL patients died and OS was not significantly different. A higher proportion of early deaths occurred in the AR-DLBCL: indeed, 1-year OS was 94% (95% CI: 87%-97%) in IC-DLBCL and 82% (95% CI: 66%-91%) in AR-DLBCL patients. After rituximab and active antiretroviral therapy introduction, AR-DLBCL and IC-DLBCL patients treated with curative intent have similar long-term survival.
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Affiliation(s)
- Annarita Conconi
- Division of Hematology, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy
| | - Emanuele Zucca
- IOSI Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Foundation for the Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Gloria Margiotta-Casaluci
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Katharine Darling
- Infectious Disease Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases, University Hospital, Basel, Switzerland
| | - Cornelia Staehelin
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital, St Gallen, St Gallen, Switzerland
| | - Alexandra Scherrer
- Swiss HIV Cohort Study Data Center, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Ivo Kwee
- Università della Svizzera italiana, Institute of Oncology Research, Bellinzona, Switzerland.,Dalle Molle Institute for Artificial Intelligence (IDSIA), Manno, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Luca Nassi
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Franco Cavalli
- IOSI Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Foundation for the Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Francesco Bertoni
- Università della Svizzera italiana, Institute of Oncology Research, Bellinzona, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale Regionale di Lugano, Lugano, Switzerland
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17
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Epstein Barr Virus-Associated Hodgkin Lymphoma. Cancers (Basel) 2018; 10:cancers10060163. [PMID: 29799516 PMCID: PMC6025037 DOI: 10.3390/cancers10060163] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 01/27/2023] Open
Abstract
Classical Hodgkin lymphoma (cHL) is a distinct clinical and pathological entity with heterogeneous genetic and virological features, with regards to Epstein–Barr virus (EBV) infection. The variable association of cHL with EBV infection is probably related to the different levels of patient immunosuppression, both locally in the tumour tissue and at the systemic level. This review paper focuses on EBV-related cHL highlighting pathogenetic and pathological features that may impact pathobiology-driven treatment for the affected patients.
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18
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Gao L, Wang Y, Li Y, Dong Y, Yang A, Zhang J, Li F, Zhang R. Genome-wide expression profiling analysis to identify key genes in the anti-HIV mechanism of CD4 + and CD8 + T cells. J Med Virol 2018; 90:1199-1209. [PMID: 29508932 DOI: 10.1002/jmv.25071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/07/2018] [Indexed: 11/12/2022]
Abstract
Comprehensive bioinformatics analyses were performed to explore the key biomarkers in response to HIV infection of CD4+ and CD8+ T cells. The numbers of CD4+ and CD8+ T cells of HIV infected individuals were analyzed and the GEO database (GSE6740) was screened for differentially expressed genes (DEGs) in HIV infected CD4+ and CD8+ T cells. Gene Ontology enrichment, KEGG pathway analyses, and protein-protein interaction (PPI) network were performed to identify the key pathway and core proteins in anti-HIV virus process of CD4+ and CD8+ T cells. Finally, we analyzed the expressions of key proteins in HIV-infected T cells (GSE6740 dataset) and peripheral blood mononuclear cells(PBMCs) (GSE511 dataset). 1) CD4+ T cells counts and ratio of CD4+ /CD8+ T cells decreased while CD8+ T cells counts increased in HIV positive individuals; 2) 517 DEGs were found in HIV infected CD4+ and CD8+ T cells at acute and chronic stage with the criterial of P-value <0.05 and fold change (FC) ≥2; 3) In acute HIV infection, type 1 interferon (IFN-1) pathway might played a critical role in response to HIV infection of T cells. The main biological processes of the DEGs were response to virus and defense response to virus. At chronic stage, ISG15 protein, in conjunction with IFN-1 pathway might play key roles in anti-HIV responses of CD4+ T cells; and 4) The expression of ISG15 increased in both T cells and PBMCs after HIV infection. Gene expression profile of CD4+ and CD8+ T cells changed significantly in HIV infection, in which ISG15 gene may play a central role in activating the natural antiviral process of immune cells.
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Affiliation(s)
- Lijie Gao
- Medicine College of Yan'an University, Yan'an, Shaanxi, P. R. China
| | - Yunqi Wang
- Department of Urology, Yangling Demonstration Zone Hospital, Yangling, Shaanxi, P. R. China
| | - Yi Li
- Medicine College of Yan'an University, Yan'an, Shaanxi, P. R. China
| | - Ya Dong
- Medicine College of Yan'an University, Yan'an, Shaanxi, P. R. China
| | - Aimin Yang
- School of Public Health, Brown University, Providence, Rhode Island.,School of Public Health, Lanzhou University, Lanzhou, Gansu, P. R. China
| | - Jie Zhang
- School of Public Health, Brown University, Providence, Rhode Island
| | - Fengying Li
- Immunization Department of Center for Disease Control and Prevention of Xianyang, Xianyang, Shaanxi, P. R. China
| | - Rongqiang Zhang
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, P. R. China
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19
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Blanco JR, Alejos B, Moreno S. Impact of dolutegravir and efavirenz on immune recovery markers: results from a randomized clinical trial. Clin Microbiol Infect 2017; 24:900-907. [PMID: 29183782 DOI: 10.1016/j.cmi.2017.11.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/19/2017] [Accepted: 11/20/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES CD4/CD8 ratio and CD4+ T-cell percentage (CD4%) predicts the risk of AIDS and non-AIDS events. Multiple T-cell marker recovery (MTMR) has been proposed as the most complete level of immune reconstitution. We quantified differences in the CD4/CD8 ratio, CD4% recovery and MTMR after starting HIV-1 treatment with dolutegravir/abacavir/lamivudine vs. efavirenz (EFV)/tenofovir (TDF)/emtricitabine (FTC). METHODS Exploratory post hoc analysis of the SINGLE study, a randomized double-blind, clinical trial. Percentage differences and corresponding precision based on 95% confidence intervals, and p values were calculated for CD4/CD8 ratio normalization, CD4% normalization and the achievement of MTMR. Cox models taking into account competing risks were used to estimate sub-hazard ratios when comparing the times to normalization of the CD4/CD8 ratio and the CD4% by treatment arm. RESULTS Data from 833 participants were analysed (414 in the dolutegravir/abacavir/lamivudine arm). There were no statistically significant differences in the proportion of patients who reached a CD4/CD8 ratio ≥0.5 at weeks 48 and 96. However, at week 96, the proportion of patients with a CD4/CD8 ratio ≥1 was higher in the EFV-TDF-FTC group (difference, 11.70; 95% confidence interval, 4.49-18.91; p 0.002). The decrease from baseline in CD8+ cell count was consistently greater in the EFV-TDF-FTC arm. Analysis of CD4+ percentages showed no significant differences during the study. The proportion of patients attaining a MTMR was higher in the EFV-TDF-FTC group, although the difference was only statistically significant at week 96 (p 0.001). CONCLUSIONS EFV-TDF-FTC showed significantly greater increases in CD4/CD8 ratio ≥1.0 or MTMR beyond treatment week 96. Additional studies are necessary to better understand the impact of these findings.
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Affiliation(s)
- J R Blanco
- Department of Infectious Diseases, Hospital San Pedro-CIBIR, Logroño, La Rioja, Spain.
| | - B Alejos
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - S Moreno
- Department of Infectious Diseases, Hospital Ramón y Cajal, Alcalá de Henares University, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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Shepherd L, Borges ÁH, Harvey R, Bower M, Grulich A, Silverberg M, Weber J, Ristola M, Viard JP, Bogner JR, Gargalianos-Kakolyris P, Mussini C, Mansinho K, Yust I, Paduta D, Jilich D, Smiatacz T, Radoi R, Tomazic J, Plomgaard P, Frikke-Schmidt R, Lundgren J, Mocroft A. The extent of B-cell activation and dysfunction preceding lymphoma development in HIV-positive people. HIV Med 2017; 19:90-101. [PMID: 28857427 DOI: 10.1111/hiv.12546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES B-cell dysfunction and activation are thought to contribute to lymphoma development in HIV-positive people; however, the mechanisms are not well understood. We investigated levels of several markers of B-cell dysfunction [free light chain (FLC)-κ, FLC-λ, immunoglobulin G (IgG), IgA, IgM and IgD] prior to lymphoma diagnosis in HIV-positive people. METHODS A nested matched case-control study was carried out within the EuroSIDA cohort, including 73 HIV-positive people with lymphoma and 143 HIV-positive lymphoma-free controls. Markers of B-cell dysfunction were measured in prospectively stored serial plasma samples collected before the diagnosis of lymphoma (or selection date in controls). Marker levels ≤ 2 and > 2 years prior to diagnosis were investigated. RESULTS Two-fold higher levels of FLC-κ [odds ratio (OR) 1.84; 95% confidence interval (CI) 1.19, 2.84], FLC-λ (OR 2.15; 95% CI 1.34, 3.46), IgG (OR 3.05; 95% CI 1.41, 6.59) and IgM (OR 1.46; 95% CI 1.01, 2.11) were associated with increased risk of lymphoma > 2 years prior to diagnosis, but not ≤ 2 years prior. Despite significant associations > 2 years prior to diagnosis, the predictive accuracy of each marker was poor, with FLC-λ emerging as the strongest candidate with a c-statistic of 0.67 (95% CI 0.58, 0.76). CONCLUSIONS FLC-κ, FLC-λ and IgG levels were higher > 2 years before lymphoma diagnosis, suggesting that B-cell dysfunction occurs many years prior to lymphoma development. However, the predictive value of each marker was low and they are unlikely candidates for risk assessment for targeted intervention.
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Affiliation(s)
- L Shepherd
- Research Department of Infection and Population Health, University College London, London, UK
| | - Á H Borges
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - R Harvey
- Charing Cross Oncology Laboratory and Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College Healthcare National Health Service Trust, London, UK
| | - M Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Grulich
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - M Silverberg
- Kaiser Permanente Northern California, Oakland, CA, USA
| | - J Weber
- Imperial College London, London, UK
| | - M Ristola
- Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J-P Viard
- AP-HP, Diagnostic & Therapeutic Center, Hotel Dieu Hospital, Paris, France
| | - J R Bogner
- Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - P Gargalianos-Kakolyris
- First Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - C Mussini
- Clinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Azienda Policlinico, Modena, Italy
| | - K Mansinho
- Department of Infectious Diseases, Hospital Egas Moniz-CHLO, E.P.E., Lisboa, Portugal
| | - I Yust
- Ichilov Hospital, Tel Aviv, Israel
| | - D Paduta
- Gomel Regional Centre for Hygiene, Gomel, Belarus
| | - D Jilich
- Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Smiatacz
- Infectious Diseases Department, Medical University of Gdańsk, Gdańsk, Poland
| | - R Radoi
- Clinical Hospital of Infectious and Tropical Diseases 'Dr. Victor Babeş', Bucharest, Romania
| | - J Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - P Plomgaard
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - R Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - J Lundgren
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Mocroft
- Research Department of Infection and Population Health, University College London, London, UK
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Abstract
INTRODUCTION The emergence of combined antiretroviral therapy (cART) and improvements in the management of opportunistic infections have altered the HIV epidemic over the last 30 years. We aimed to assess changes to the biology and outcomes of HIV-associated lymphomas over this period at the national center for HIV oncology in the United Kingdom. METHODS Clinical characteristics at lymphoma diagnosis have been prospectively collected since 1986, along with details of lymphoma treatment and outcomes. The clinical features and outcomes were compared between 3 decades: pre-cART decade (1986-1995), early-cART decade (1996-2005), and late-cART decade (2006-2015). RESULTS A total of 615 patients with HIV-associated lymphoma were included in the study: 158 patients in the pre-cART era, 200 patients in the early-cART era, and 257 patients in the late-cART era. In more recent decades, patients were older (P < 0.0001) and had higher CD4 cell counts (P < 0.0001) at lymphoma diagnosis. Over time, there has also been a shift in lymphoma histological subtypes, with an increase in lymphoma subtypes associated with moderate immunosuppression. The overall survival for patients with HIV-associated lymphoma has dramatically improved over the 3 decades (P < 0.0001). CONCLUSION Over the last 30 years, the clinical demographic of HIV-associated lymphomas has evolved, and the outcomes have improved.
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22
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Westmoreland KD, Stanley CC, Montgomery ND, Kaimila B, Kasonkanji E, El-Mallawany NK, Wasswa P, Mtete I, Butia M, Itimu S, Chasela M, Mtunda M, Chikasema M, Makwakwa V, Kampani C, Dhungel BM, Sanders MK, Krysiak R, Tomoka T, Liomba NG, Dittmer DP, Fedoriw Y, Gopal S. Hodgkin lymphoma, HIV, and Epstein-Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26302. [PMID: 27781380 PMCID: PMC5529120 DOI: 10.1002/pbc.26302] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/07/2016] [Accepted: 09/19/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Contemporary descriptions of classical Hodgkin lymphoma (cHL) are lacking from sub-Saharan Africa where human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) are prevalent. METHODS We describe a prospective cHL cohort in Malawi enrolled from 2013 to 2015. Patients received standardized treatment and evaluation, including HIV status and EBV testing of tumors and plasma. RESULTS Among 31 patients with confirmed cHL, the median age was 19 years (range, 2-51 years) and 22 (71%) were male. Sixteen patients (52%) had stage III/IV, 25 (81%) B symptoms, and 16 (52%) performance status impairment. Twenty-three patients (74%) had symptoms >6 months, and 11 of 29 (38%) had received empiric antituberculosis treatment. Anemia was common with median hemoglobin 8.2 g/dL (range, 3.1-17.1 g/dL), which improved during treatment. No children and 5 of 15 adults (33%) were HIV+. All HIV+ patients were on antiretroviral therapy for a median 15 months (range, 2-137 months), with median CD4 count 138 cells/μL (range, 23-329 cells/μL) and four (80%) having undetectable HIV. EBV was present in 18 of 24 (75%) tumor specimens, including 14 of 20 (70%) HIV- and 4 of 4 (100%) HIV+. Baseline plasma EBV DNA was detected in 25 of 28 (89%) patients, with median viral load 4.7 (range, 2.0-6.7) log10 copies/mL, and subsequently declined in most patients. At 12 months, overall survival was 75% (95% confidence interval [CI], 55%-88%) and progression-free survival 65% (95% CI, 42%-81%). Baseline plasma EBV DNA and persistent viremia during treatment were associated with poorer outcomes. CONCLUSION cHL in Malawi is characterized by delayed diagnosis and advanced disease. Most cases were EBV associated and one-third of adults were HIV+. Despite resource limitations, 12-month outcomes were good.
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Affiliation(s)
- Katherine D. Westmoreland
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | | | - Nathan D. Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Peter Wasswa
- Section of Hematology/Oncology, Texas Children’s Hospital, Houston, Texas
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Idah Mtete
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Mercy Butia
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | | | - Mary Chasela
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Mary Mtunda
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | | | | | | | | | - Marcia K. Sanders
- Department of Microbiology & Immunology, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Dirk P. Dittmer
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Microbiology & Immunology, University of North Carolina, Chapel Hill, North Carolina
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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23
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Vassallo M, Fabre R, Durant J, Lebrun-Frenay C, Joly H, Ticchioni M, DeSalvador F, Harvey-Langton A, Dunais B, Laffon M, Cottalorda J, Dellamonica P, Pradier C. A decreasing CD4/CD8 ratio over time and lower CSF-penetrating antiretroviral regimens are associated with a higher risk of neurocognitive deterioration, independently of viral replication. J Neurovirol 2016; 23:216-225. [PMID: 27815816 DOI: 10.1007/s13365-016-0490-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 09/13/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
Persistent immune activation is one of the suspected causes of HIV-associated neurocognitive disorders (HAND) in cART era. The CD4/CD8 ratio has been recently showed as a marker of immune activation and HAND. Our aim was to analyze if a decrease in the CD4/CD8 ratio over time could have an impact on neurocognitive deterioration. Randomly selected HIV-infected patients were followed for neuropsychological (NP) testing during a period of almost 2 years. Tests were adjusted for age, gender, and education. Patients were divided into 5 groups: normal tests (NT), neuropsychological deficit (ND, one impaired cognitive domain), asymptomatic neurocognitive disorders (ANI), mild neurocognitive disorders (MND), and HIV-associated dementia (HAD). Risk factors for neurocognitive deterioration were analyzed. Two hundred fifty-six patients underwent NP tests and 94 participated in the follow-up. The groups were comparable. Upon neuropsychological re-testing, six patients showed clinical improvement, 30 had worsened, and 58 were stable, resulting in 42 patients presenting with HAND (45 %). The majority of HAND cases consisted of ANI (26 %) and MND (16 %). In patients whose NP performance worsened, CPE 2010 score was lower at inclusion (7.13 vs 8.00, p = 0.003) and CD4/CD8 decrease more frequent (60 vs 31 %, p = 0.008) than in those who were stable or improved. Multivariate analysis confirmed these results. A decreasing CD4/CD8 ratio during a longitudinal follow-up of randomly selected HIV-infected patients and lower CSF-penetrating regimens were independently associated with cognitive decline. Monitoring trends in CD4/CD8 ratio could contribute to identifying patients at higher risk of neurocognitive deterioration.
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Affiliation(s)
- Matteo Vassallo
- Department of Infectious Diseases, L'Archet Hospital, University of Nice, Nice, France. .,Department of Internal Medicine, Cannes General Hospital, Cannes, France.
| | - R Fabre
- Department of Public Health, L'Archet Hospital, University of Nice, Nice, France
| | - J Durant
- Department of Infectious Diseases, L'Archet Hospital, University of Nice, Nice, France
| | - C Lebrun-Frenay
- Department of Neurology, Pasteur Hospital, University of Nice, Nice, France
| | - H Joly
- Department of Neurology, Pasteur Hospital, University of Nice, Nice, France
| | - M Ticchioni
- Immunology Laboratory Unit, L'Archet Hospital, University of Nice, Nice, France
| | - F DeSalvador
- Department of Infectious Diseases, L'Archet Hospital, University of Nice, Nice, France
| | - A Harvey-Langton
- Department of Infectious Diseases, L'Archet Hospital, University of Nice, Nice, France
| | - B Dunais
- Department of Infectious Diseases, L'Archet Hospital, University of Nice, Nice, France.,Department of Public Health, L'Archet Hospital, University of Nice, Nice, France
| | - M Laffon
- Department of Neurology, Pasteur Hospital, University of Nice, Nice, France
| | - J Cottalorda
- Virology Laboratory Unit, L'Archet Hospital, University of Nice, Nice, France
| | - P Dellamonica
- Department of Infectious Diseases, L'Archet Hospital, University of Nice, Nice, France
| | - C Pradier
- Department of Public Health, L'Archet Hospital, University of Nice, Nice, France
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Risk of Cancer among Commercially Insured HIV-Infected Adults on Antiretroviral Therapy. J Cancer Epidemiol 2016; 2016:2138259. [PMID: 27882054 PMCID: PMC5110893 DOI: 10.1155/2016/2138259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to explore the cancer incidence rates among HIV-infected persons with commercial insurance who were on antiretroviral therapy and compare them with those rates in the general population. Paid health insurance claims for 63,221 individuals 18 years or older, with at least one claim with a diagnostic code for HIV and at least one filled prescription for an antiretroviral medication between January 1, 2006, and September 30, 2012, were obtained from the LifeLink® Health Plan Claims Database. The expected number of cancer cases in the general population for each gender-age group (<30, 30–39, 40–49, 50–59, and >60 years) was estimated using incidence rates from the Surveillance Epidemiology and End Results (SEER) program. Standardized incidence ratios (SIRs) were estimated using their 95% confidence intervals (CIs). Compared to the general population, incidence rates for HIV-infected adults were elevated (SIR, 95% CI) for Kaposi sarcoma (46.08; 38.74–48.94), non-Hodgkin lymphoma (4.22; 3.63–4.45), Hodgkin lymphoma (9.83; 7.45–10.84), and anal cancer (30.54; 25.62–32.46) and lower for colorectal cancer (0.69; 0.52–0.76), lung cancer (0.70; 0.54, 0.77), and prostate cancer (0.54; 0.45–0.58). Commercially insured, treated HIV-infected adults had elevated rates for infection-related cancers, but not for common non-AIDS defining cancers.
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25
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Carbone A, Gloghini A, Caruso A, De Paoli P, Dolcetti R. The impact of EBV and HIV infection on the microenvironmental niche underlying Hodgkin lymphoma pathogenesis. Int J Cancer 2016; 140:1233-1245. [DOI: 10.1002/ijc.30473] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/11/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Antonino Carbone
- Department of Pathology; Centro di Riferimento Oncologico - IRCCS, National Cancer Institute; Aviano PN Italy
| | - Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine; Fondazione IRCCS Istituto Nazionale dei Tumori; Milano Italy
| | - Arnaldo Caruso
- Department of Molecular and Translational Medicine; University of Brescia Medical School; Brescia Italy
| | - Paolo De Paoli
- Molecular Virology Unit and Scientific Directorate; Centro di Riferimento Oncologico - IRCCS, National Cancer Institute; Aviano PN Italy
| | - Riccardo Dolcetti
- Cancer Bio-Immunotherapy Unit, Centro di Riferimento Oncologico - IRCCS; National Cancer Institute; Aviano PN Italy
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland; Brisbane QLD Australia
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Low CD4/CD8 Ratio Is Associated with Non AIDS-Defining Cancers in Patients on Antiretroviral Therapy: ANRS CO8 (Aproco/Copilote) Prospective Cohort Study. PLoS One 2016; 11:e0161594. [PMID: 27548257 PMCID: PMC4993515 DOI: 10.1371/journal.pone.0161594] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/08/2016] [Indexed: 01/09/2023] Open
Abstract
Objectives To study the association between CD4/CD8 ratio and morbidity in HIV-infected patients on antiretroviral therapy (ART). Methods The APROCO/COPILOTE cohort enrolled patients initiating a protease inhibitor-containing ART in 1997–1999. The association between occurrence of first non AIDS-defining severe events (NADE) and time-dependent measures of immune restoration was assessed by 4 Cox models with different definitions of restoration, CD4+ cell counts (CD4), CD4/CD8 ratio, both CD4 and CD4/CD8 ratio, or a composite variable (CD4< 500/mm3, CD4 > 500/mm3 and CD4/CD8 ratio < 1, CD4 > 500/mm3 and CD4/CD8 ratio > 1). Models adjusted on baseline characteristics and time-dependent viral load were compared using Akaike Information Criterion. Results We included 1227 patients. Median duration of follow-up was 9.2 years (IQR: 4.2–11.4). Median CD4 was 530/mm3 at 9 years. Median CD4/CD8 ratio was 0.3 (IQR: 0.2–0.5) at baseline and 0.6 (IQR: 0.4–0.9) after 9 years. Incidence of first NADE was 7.4/100 person-years, the most common being bacterial infections (21%), cardiovascular events (14%) and cancers (10%). For both bacterial infections and cardiovascular events, the CD4/CD8 ratio did not add predictive information to the CD4 cell count. However, low CD4/CD8 ratio was the best predictor of non-AIDS cancers (adjusted HR = 2.13 for CD4/CD8 < 0.5; 95% CI = 1.32–3.44). Conclusions CD4/CD8 ratio remains < 1 in most HIV-infected patients despite long-term CD4+ cell counts restoration on ART. A CD4/CD8 ratio < 0.5 could identify patients who require a more intensive strategy of cancer prevention or screening.
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Aherfi S, Colson P, Audoly G, Nappez C, Xerri L, Valensi A, Million M, Lepidi H, Costello R, Raoult D. Marseillevirus in lymphoma: a giant in the lymph node. THE LANCET. INFECTIOUS DISEASES 2016; 16:e225-e234. [PMID: 27502174 DOI: 10.1016/s1473-3099(16)30051-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/18/2016] [Accepted: 04/07/2016] [Indexed: 12/12/2022]
Abstract
The family Marseilleviridae is a new clade of giant viruses whose original member, marseillevirus, was described in 2009. These viruses were isolated using Acanthamoeba spp primarily from the environment. Subsequently, a close relative of marseillevirus was isolated from the faeces of a healthy young man, and others were detected in blood samples of blood donors and recipients and in a child with lymph node adenitis. In this Grand Round we describe the detection of marseillevirus by PCR, fluorescence in-situ hybridisation, direct immunofluorescence, and immunohistochemistry in the lymph node of a 30-year-old woman diagnosed with Hodgkin's lymphoma, together with IgG antibodies to marseillevirus. A link with viruses and bacteria has been reported for many lymphomas. We review the literature describing these associations, the criteria used to consider a causal association, and the underlying mechanisms of lymphomagenesis. Our observations suggest that consideration should be given to marseillevirus infections as an additional viral cause or consequence of Hodgkin's lymphoma, and that this hypothesis should be tested further.
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Affiliation(s)
- Sarah Aherfi
- Research Unit on Emerging Infectious and Tropical Diseases (URMITE), CNRS UMR 7278, IRD 198, Inserm U1095, Aix-Marseille Université, Marseille, France; Méditerranée Infection Foundation (IHU), Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Philippe Colson
- Research Unit on Emerging Infectious and Tropical Diseases (URMITE), CNRS UMR 7278, IRD 198, Inserm U1095, Aix-Marseille Université, Marseille, France; Méditerranée Infection Foundation (IHU), Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Gilles Audoly
- Research Unit on Emerging Infectious and Tropical Diseases (URMITE), CNRS UMR 7278, IRD 198, Inserm U1095, Aix-Marseille Université, Marseille, France
| | - Claude Nappez
- Research Unit on Emerging Infectious and Tropical Diseases (URMITE), CNRS UMR 7278, IRD 198, Inserm U1095, Aix-Marseille Université, Marseille, France
| | - Luc Xerri
- Département de Bio-Pathologie, Oncologie moléculaire, Hématologie et Immunologie des tumeurs, Aix-Marseille Université, Marseille, France; Institut Paoli-Calmettes, Marseille, France
| | - Audrey Valensi
- Research Unit on Emerging Infectious and Tropical Diseases (URMITE), CNRS UMR 7278, IRD 198, Inserm U1095, Aix-Marseille Université, Marseille, France
| | - Matthieu Million
- Research Unit on Emerging Infectious and Tropical Diseases (URMITE), CNRS UMR 7278, IRD 198, Inserm U1095, Aix-Marseille Université, Marseille, France; Méditerranée Infection Foundation (IHU), Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Hubert Lepidi
- Research Unit on Emerging Infectious and Tropical Diseases (URMITE), CNRS UMR 7278, IRD 198, Inserm U1095, Aix-Marseille Université, Marseille, France; Méditerranée Infection Foundation (IHU), Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Regis Costello
- Technological Advances for Genomics and Clinics (TAGC), Inserm UMR 1090, Aix-Marseille Université, Marseille, France
| | - Didier Raoult
- Research Unit on Emerging Infectious and Tropical Diseases (URMITE), CNRS UMR 7278, IRD 198, Inserm U1095, Aix-Marseille Université, Marseille, France; Méditerranée Infection Foundation (IHU), Assistance Publique-Hôpitaux de Marseille, Marseille, France.
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Riedel DJ, Tang LS, Rositch AF. The role of viral co-infection in HIV-associated non-AIDS-related cancers. Curr HIV/AIDS Rep 2016; 12:362-72. [PMID: 26152660 DOI: 10.1007/s11904-015-0276-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
HIV-infected individuals are at increased risk for most types of cancer, including those typically classified as non-AIDS-defining cancers (NADCs). This increased risk is likely multifactorial, but a prominent risk factor for the increased rate of some cancers is co-infection with oncogenic viruses. Anal cancer, hepatocellular carcinoma, and Hodgkin lymphoma are three of the most common NADCs, and they are associated with co-infection with human papillomavirus, hepatitis B and C, and Epstein Barr virus, respectively. This review will examine the epidemiology, pathogenesis, and future trends around these virally associated NADCs frequently found in HIV-infected individuals.
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Affiliation(s)
- David J Riedel
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA,
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29
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Serrano-Villar S, Gutiérrez F, Miralles C, Berenguer J, Rivero A, Martínez E, Moreno S. Human Immunodeficiency Virus as a Chronic Disease: Evaluation and Management of Nonacquired Immune Deficiency Syndrome-Defining Conditions. Open Forum Infect Dis 2016; 3:ofw097. [PMID: 27419169 PMCID: PMC4943534 DOI: 10.1093/ofid/ofw097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/29/2016] [Indexed: 12/17/2022] Open
Abstract
In the modern antiretroviral therapy (ART) era, motivated people living with human immunodeficiency virus (HIV) who have access to therapy are expected to maintain viral suppression indefinitely and to receive treatment for decades. Hence, the current clinical scenario has dramatically shifted since the early 1980s, from treatment and prevention of opportunistic infections and palliative care to a new scenario in which most HIV specialists focus on HIV primary care, ie, the follow up of stable patients, surveillance of long-term toxicities, and screening and prevention of age-related conditions. The median age of HIV-infected adults on ART is progressively increasing. By 2030, 3 of every 4 patients are expected to be aged 50 years or older in many countries, more than 80% will have at least 1 age-related disease, and approximately one third will have at least 3 age-related diseases. Contemporary care of HIV-infected patients is evolving, and questions about how we might monitor and perhaps even treat HIV-infected adults have emerged. Through key published works, this review briefly describes the most prevalent comorbidities and age-associated conditions and highlights the differential features in the HIV-infected population. We also discuss the most critical aspects to be considered in the care of patients with HIV for the management and prevention of age-associated disease.
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Affiliation(s)
- Sergio Serrano-Villar
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
| | - Félix Gutiérrez
- Hospital Universitario de Elche and Universidad Miguel Hernández , Alicante
| | | | - Juan Berenguer
- Juan Berenguer , Hospital Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón , Madrid
| | - Antonio Rivero
- Unidad de Gestión Clínica Enfermedades Infecciosas , Hospital Universitario Reina Sofía and Instituto Maimónides de Investigación Biomédica de Córdoba
| | - Esteban Martínez
- Hospital Clínic and Instituto de Investigaciones Biomédicas August Pi i Sunyer, University of Barcelona , Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
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CD4+ and CD8+ T-cell kinetics in aviremic HIV-infected patients developing Hodgkin or non-Hodgkin lymphoma. AIDS 2016; 30:753-60. [PMID: 26605513 DOI: 10.1097/qad.0000000000000980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The risk of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) is increased in HIV-infected individuals. We studied the kinetics of lymphocyte subsets in patients who subsequently developed HL or NHL while on virologically suppressive antiretroviral therapy (ART). DESIGN Using a nested case-control design, cases of HIV+ HL or NHL were selected from two prospective clinical studies. Aviremia was defined as less than 200 HIV-RNA copies/ml for at least 6 months prior to lymphoma diagnosis. Each case was matched to three aviremic HIV+ controls without lymphoma. RESULTS In the 81 cases (50 HL and 31 NHL), prediagnostic CD4 T cells and CD8 T cells displayed discordant kinetics compared with controls. Within the last and within the next-to-last year preceding HL diagnosis, mean CD4 T cells decreased by -168 and by -2 cells/μl, compared with an increase of +44 and +73 cells/μl in the controls, respectively. Mean CD8 T cells decreased by -352 and -115 cells/μl, compared with nonsignificant changes of -29 and ±0 cells/μl in the controls, respectively. T-cell kinetics demonstrated a marked inter-individual variability. Kinetics of CD4 and CD8 T cells were also discordant between NHL cases and controls. CONCLUSION This study on a large number of aviremic patients developing HL and NHL who were carefully matched with controls, gives insights to prediagnostic kinetics of immune parameters. The discordant kinetics of both CD4 and CD8 T cells are already seen 1-2 years prior to lymphoma diagnosis, are more pronounced during the last year and in patients developing HL but are also seen in NHL.
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Shepherd L, Borges Á, Ledergerber B, Domingo P, Castagna A, Rockstroh J, Knysz B, Tomazic J, Karpov I, Kirk O, Lundgren J, Mocroft A. Infection-related and -unrelated malignancies, HIV and the aging population. HIV Med 2016; 17:590-600. [PMID: 26890156 DOI: 10.1111/hiv.12359] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-unrelated malignancies (IURMs). The aim of the study was to determine the impact of aging on future IRM and IURM incidence. METHODS People enrolled in EuroSIDA and followed from the latest of the first visit or 1 January 2001 until the last visit or death were included in the study. Poisson regression was used to investigate the impact of aging on the incidence of IRMs and IURMs, adjusting for demographic, clinical and laboratory confounders. Linear exponential smoothing models forecasted future incidence. RESULTS A total of 15 648 people contributed 95 033 person-years of follow-up, of whom 610 developed 643 malignancies [IRMs: 388 (60%); IURMs: 255 (40%)]. After adjustment, a higher IRM incidence was associated with a lower CD4 count [adjusted incidence rate ratio (aIRR) CD4 count < 200 cells/μL: 3.77; 95% confidence interval (CI) 2.59, 5.51; compared with ≥ 500 cells/μL], independent of age, while a CD4 count < 200 cells/μL was associated with IURMs in people aged < 50 years only (aIRR: 2.51; 95% CI 1.40-4.54). Smoking was associated with IURMs (aIRR: 1.75; 95% CI 1.23, 2.49) compared with never smokers in people aged ≥ 50 years only, and not with IRMs. The incidences of both IURMs and IRMs increased with older age. It was projected that the incidence of IRMs would decrease by 29% over a 5-year period from 3.1 (95% CI 1.5-5.9) per 1000 person-years in 2011, whereas the IURM incidence would increase by 44% from 4.1 (95% CI 2.2-7.2) per 1000 person-years over the same period. CONCLUSIONS Demographic and HIV-related risk factors for IURMs (aging and smoking) and IRMs (immunodeficiency and ongoing viral replication) differ markedly and the contribution from IURMs relative to IRMs will continue to increase as a result of aging of the HIV-infected population, high smoking and lung cancer prevalence and a low prevalence of untreated HIV infection. These findings suggest the need for targeted preventive measures and evaluation of the cost-benefit of screening for IURMs in HIV-infected populations.
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Affiliation(s)
- L Shepherd
- Department of Infection and Population Health, University College London Medical School, London, UK
| | - Áh Borges
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases and Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland
| | | | - A Castagna
- San Raffaele Scientific Institute, Milan, Italy
| | - J Rockstroh
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - B Knysz
- Department of Infectious Diseases, Wroclaw University, Wroclaw, Poland
| | - J Tomazic
- Department of Infectious Diseases, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - I Karpov
- Belarus State Medical University, Minsk, Belarus
| | - O Kirk
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases and Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Lundgren
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases and Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Mocroft
- Department of Infection and Population Health, University College London Medical School, London, UK
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DE MARTEL C, SHIELS MS, FRANCESCHI S, SIMARD EP, VIGNAT J, HALL HI, ENGELS EA, PLUMMER M. Cancers attributable to infections among adults with HIV in the United States. AIDS 2015; 29:2173-81. [PMID: 26182198 PMCID: PMC4636914 DOI: 10.1097/qad.0000000000000808] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE HIV-infected people are at increased risk of cancers of infectious origin. We estimated the burden of cancer attributable to infections among HIV-infected people in the United States in 2008. DESIGN Incidence rates for cancer sites associated with infections were estimated from record linkage between HIV/AIDS registries and cancer registries. METHODS Rates were applied to estimates of the population living with diagnosed HIV in the United States in 2008 to obtain the number of incident cancer cases. Site-specific attributable fractions and corresponding 95% confidence intervals (CIs) were estimated from infection prevalence among cancer cases. Infection prevalence data were derived from literature review of case series. RESULTS Of an estimated 6200 incident cancer cases (95% CI 6000-6500), 2500 (95% CI 2400-2700) were attributable to infection (attributable fraction = 40%, 95% CI 39-42). The most important infections were Kaposi sarcoma herpes virus, Epstein-Barr virus, and human papillomavirus, which together were responsible for 2200 new cancer cases (95% CI 2100-2400), mainly Kaposi sarcoma, lymphomas, and ano-genital cancers. The attributable fraction in HIV-infected people was highest in the age group 20-29 years (69%, 95% CI 65-72). MSM were the HIV transmission group with the highest attributable fraction (48%, 95% CI 46-50), due to the high incidence of both Kaposi sarcoma and anal cancer. CONCLUSION The very high fraction of cancer attributable to infection in HIV-infected people points to special opportunities to prevent these cancers, that is, avoidance, detection, and early treatment of cancer-associated infections, and universal early detection and uninterrupted treatment of HIV infection to avoid immunosuppression.
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Affiliation(s)
| | | | | | | | - Jérôme VIGNAT
- International Agency for Research on Cancer, Lyon, France
| | - H. Irene HALL
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Martyn PLUMMER
- International Agency for Research on Cancer, Lyon, France
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Microenvironment and HIV-related lymphomagenesis. Semin Cancer Biol 2015; 34:52-7. [DOI: 10.1016/j.semcancer.2015.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/16/2015] [Indexed: 12/18/2022]
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CD4:CD8 ratio as a frontier marker for clinical outcome, immune dysfunction and viral reservoir size in virologically suppressed HIV-positive patients. J Int AIDS Soc 2015; 18:20052. [PMID: 26130226 PMCID: PMC4486418 DOI: 10.7448/ias.18.1.20052] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/14/2015] [Accepted: 06/01/2015] [Indexed: 01/21/2023] Open
Abstract
Introduction Absolute CD4 T cell count and plasma viral load have been established as predictors of HIV disease progression, and CD4 T cell count is used as an indicator for initiation of antiretroviral therapy. Following long-term therapy, patients generally present with significant CD4 T cell recovery contrasting with persistently elevated CD8 T cell counts, which leads to a partial restoration of CD4:CD8 ratio. This review focuses on the relevance of the CD4:CD8 ratio on clinical outcomes, immune dysfunction and HIV reservoir size in long-term treated patients. Method We conducted a comprehensive literature review of publications in English language using major electronic databases. Our search was focused on factors contributing to CD4:CD8 T cell ratio and clinical outcome in adult HIV-positive patients in the context of treated infection. Discussion Low CD4:CD8 ratio has been linked to ageing and acts as a predictor of mortality in the general population. This ratio may represent the combined effects of inflammation and immunological changes called “inflammaging.” Although the mechanisms underlying partial correction of the CD4:CD8 ratio and persistently elevated CD8 T cell count in long-term treated patients remain poorly understood, it has been recently indicated that patients with optimal CD4 T cell recovery and low CD4:CD8 ratio still harbour increased immune activation, an immune senescent phenotype and have a higher risk of non-AIDS morbidity and mortality. This review reconsiders CD4:CD8 ratio in the light of advances in the understanding of immune dysfunction and examines its pathophysiological features and implications on clinical outcome and HIV reservoir size in long-term treated HIV-positive adults. Conclusion The CD4:CD8 ratio can contribute to the immunological evaluation of treated patients in a long-term follow-up and may be applied for monitoring both immune dysfunction and viral reservoir size in immune-based clinical trials.
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Birendra KC, Afzal MZ, Wentland KA, Hashmi H, Singh S, Ivan E, Lakhani N. Spontaneous Regression of Refractory Diffuse Large B-Cell Lymphoma with Improvement in Immune Status with ART in a Patient with HIV: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:347-52. [PMID: 26046822 PMCID: PMC4467606 DOI: 10.12659/ajcr.892883] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patient: Male, 55 Final Diagnosis: Diffuse large B-cell lymphoma • HIV Symptoms: Fatigue • weight loss Medication: — Clinical Procedure: Renal biopsy Specialty: Oncology
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Affiliation(s)
| | - Muhammad Zubair Afzal
- Department of Internal Medicine, Grand Rapids Medical Education Partners, Grand Rapdis, MI, USA
| | - Katherine A Wentland
- Department of Internal Medicine, Grand Rapids Medical Education Partners, Grand Rapdis, MI, USA
| | - Hamza Hashmi
- Department of Internal Medicine, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA
| | - Sudhir Singh
- Department of Cancer Immunodiagnostics, Van Andel Research Institute, Grand Rapids, MI, USA
| | | | - Nehal Lakhani
- Department of Hematology/Oncology, Cancer and Hematology Centers of Western Michigan, Grand Rapids, MI, USA
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Abstract
Abstract
Treatment of Hodgkin lymphoma is associated with 2 major types of risk: that the treatment may fail to cure the disease or that the treatment will prove unacceptably toxic. Careful assessment of the amount of the lymphoma (tumor burden), its behavior (extent of invasion or specific organ compromise), and host related factors (age; coincident systemic infection; and organ dysfunction, especially hematopoietic, cardiac, or pulmonary) is essential to optimize outcome. Elaborately assembled prognostic scoring systems, such as the International Prognostic Factors Project score, have lost their accuracy and value as increasingly effective chemotherapy and supportive care have been developed. Identification of specific biomarkers derived from sophisticated exploration of Hodgkin lymphoma biology is bringing promise of further improvement in targeted therapy in which effectiveness is increased at the same time off-target toxicity is diminished. Parallel developments in functional imaging are providing additional potential to evaluate the efficacy of treatment while it is being delivered, allowing dynamic assessment of risk during chemotherapy and adaptation of the therapy in real time. Risk assessment in Hodgkin lymphoma is continuously evolving, promising ever greater precision and clinical relevance. This article explores the past usefulness and the emerging potential of risk assessment for this imminently curable malignancy.
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Cobucci RNO, Lima PH, de Souza PC, Costa VV, Cornetta MDCDM, Fernandes JV, Gonçalves AK. Assessing the impact of HAART on the incidence of defining and non-defining AIDS cancers among patients with HIV/AIDS: a systematic review. J Infect Public Health 2014; 8:1-10. [PMID: 25294086 DOI: 10.1016/j.jiph.2014.08.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/27/2014] [Accepted: 08/24/2014] [Indexed: 02/06/2023] Open
Abstract
After highly active antiretroviral therapy (HAART) became widespread, several studies demonstrated changes in the incidence of defining and non-defining AIDS cancers among HIV/AIDS patients. We conducted a systematic review of observational studies evaluating the incidence of malignancies before and after the introduction of HAART in people with HIV/AIDS. Eligible studies were searched up to December 2012 in the following databases: Pubmed, Embase, Scielo, Cancerlit and Google Scholar. In this study, we determined the cancer risk ratio by comparing the pre- and post-HAART eras. Twenty-one relevant articles were found, involving more than 600,000 people with HIV/AIDS and 10,891 new cases of cancers. The risk for the development of an AIDS-defining cancer decreased after the introduction of HAART: Kaposi's sarcoma (RR=0.30, 95% CI: 0.28-0.33) and non-Hodgkin's lymphoma (RR=0.52, 95% CI: 0.48-0.56), in contrast to invasive cervical cancer (RR=1.46, 95% CI: 1.09-1.94). Among the non-AIDS-defining cancers, the overall risk increased after the introduction of HAART (RR=2.00, 95% CI: 1.79-2.23). The incidence of AIDS-defining cancers decreased and the incidence of non-AIDS-defining cancers increased after the early use of HAART, probably due to better control of viral replication, increased immunity and increased survival provided by new drugs.
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Affiliation(s)
- Ricardo Ney Oliveira Cobucci
- Center for Health Sciences of the Federal University of Rio Grande do Norte, Natal, Brazil; Department of Gynecology and Obstetrics of the Potiguar University, Natal, Brazil.
| | - Paulo Henrique Lima
- Center for Health Sciences of the Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Vanessa Viana Costa
- Department of Gynecology and Obstetrics of the Potiguar University, Natal, Brazil
| | | | | | - Ana Katherine Gonçalves
- Department of Gynecology and Obstetrics of the Federal University of Rio Grande do Norte, Natal, Brazil
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Abstract
In human immunodeficiency virus (HIV)-infected persons, the incidence of hematologic malignancies, including leukemia and lymphoma, is increased despite the use of successful antiretroviral therapy. Hematopoietic stem cell transplantation (SCT) is emerging as a safe and effective therapy for HIV-infected persons with hematologic malignancies. Management of these patients is complicated by drug-drug interactions involving antiretroviral therapy (ART) that may impact conditioning agent efficacy and metabolism of immunosuppressive medications and potentiate drug toxicities. As such, optimal strategies for ART remain controversial. We discuss recent advances, controversies, and future directions related to SCT in HIV-infected persons, including the investigation of allogeneic SCT as a strategy for HIV cure.
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Affiliation(s)
- Ignacio A Echenique
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 900, Chicago, IL, 60611, USA,
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Vaccher E, Serraino D, Carbone A, De Paoli P. The evolving scenario of non-AIDS-defining cancers: challenges and opportunities of care. Oncologist 2014; 19:860-7. [PMID: 24969164 PMCID: PMC4122480 DOI: 10.1634/theoncologist.2014-0024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/13/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The impact of highly active antiretroviral therapies (HAART) on the risk of non-AIDS-defining cancers (NADCs) and the role of biological and clinical factors in their pathogenesis are debated issues. The purpose of this review is to examine the epidemiology, etiology, and not-yet-defined pathogenic characteristics of NADCs and discuss topics such as treatment strategies, comorbidity, and multidrug interactions. Four types of NADCs that deserve special attention are examined: anal cancer, Hodgkin lymphoma (HL), hepatocellular carcinoma, and lung cancer. METHODS The PubMed database and the Cochrane Library were searched by focusing on NADCs and on the association among NADCs, HAART, aging, and/or chronic inflammation. All articles were reviewed to identify those reporting variables of interest. RESULTS NADC incidence is twofold higher in patients with HIV/AIDS than in the corresponding general population, and this elevated risk persists despite the use of HAART. The mechanisms that HIV may use to promote the development of NADCs are presently unclear; immunological mechanisms, either immunodeficiency and/or immunoactivation, may play a role. CONCLUSION Recent clinical studies have suggested that equivalent antineoplastic treatment is feasible and outcome can be similar in HIV-infected patients on HAART compared with uninfected patients for the treatment of HL and anal and lung cancers. However, patients with advanced HIV disease and/or aging-related comorbidities are likely to experience worse outcomes and have poorer tolerance of therapy compared with those with less advanced HIV disease.
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Affiliation(s)
- Emanuela Vaccher
- Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Diego Serraino
- Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Antonino Carbone
- Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Paolo De Paoli
- Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
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Yanik EL, Napravnik S, Cole SR, Achenbach CJ, Gopal S, Dittmer DP, Olshan AF, Kitahata MM, Mugavero MJ, Saag M, Moore RD, Mathews WC, Hunt P, Eron JJ. Relationship of immunologic response to antiretroviral therapy with non-AIDS defining cancer incidence. AIDS 2014; 28:979-87. [PMID: 24681415 PMCID: PMC4040952 DOI: 10.1097/qad.0000000000000167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the association between immunologic response to antiretroviral therapy (ART) and non-AIDS defining cancer (NADC) incidence in HIV-infected patients. DESIGN A prospective cohort including patients with at least 1 cell/μl CD4 cell count and HIV-1 RNA measure after ART initiation between 1996 and 2011 in the Centers for AIDS Research Network of Integrated Clinical Systems, a collaboration of eight HIV clinics at major academic medical centres in the United States. METHODS Measures of immunologic response were 6-month CD4 post-ART, latest CD4 and CD4 count-years, a cumulative measure of CD4 lymphopenia. Cox regression with inverse probability-of-exposure weights was used to calculate adjusted hazard ratios of virus-related and virus-unrelated NADC incidence. RESULTS Among 9389 patients at ART initiation, median CD4 cell count was 200 cells/μl [interquartile range (IQR) 60-332)], and median HIV-1 RNA was 4.8 log10 copies/ml (IQR 4.3-5.4). Median follow-up was 3.3 years (IQR 1.5-6.5). After 6 months of ART, median CD4 cell count was 304 cells/μl (IQR 163-469). One hundred and sixty-four NADCs were diagnosed during study follow-up, 65 (40%) considered virus-related. Virus-related NADCs were inversely associated with 6-month CD4 cell count (hazard ratio per 100 cells/μl increase=0.71), latest CD4 cell count (hazard ratio per 100 cells/μl increase=0.70) and CD4 cell count-years (hazard ratio per 200 cell-years/μl increase=0.91) independent of CD4 cell count at ART initiation, age and HIV-1 RNA response. No associations were found with virus-unrelated NADCs. CONCLUSION Poor CD4 cell count response was strongly associated with virus-related NADC incidence, suggesting an important role for T-cell mediated immunity in pathogenesis. Lower CD4 cell count proximal to cancer diagnosis may be a result of subclinical cancer. Intensified cancer screening should be considered for patients on ART with low CD4 cell counts.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Peter Hunt
- University of California, San Francisco, CA
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Gupta RK, Marks M, Edwards SG, Smith K, Fletcher K, Lee SM, Ramsay A, Copas AJ, Miller RF. A declining CD4 count and diagnosis of HIV-associated Hodgkin lymphoma: do prior clinical symptoms and laboratory abnormalities aid diagnosis? PLoS One 2014; 9:e87442. [PMID: 24504076 PMCID: PMC3913599 DOI: 10.1371/journal.pone.0087442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 12/24/2013] [Indexed: 12/22/2022] Open
Abstract
Background The incidence of Hodgkin lymphoma (HL) among HIV-infected individuals remains unchanged since the introduction of combination antiretroviral therapy (cART). Recent epidemiological data suggest that CD4 count decline over a year is associated with subsequent diagnosis of HL. In an era of economic austerity monitoring the efficacy of cART by CD4 counts may no longer be required where CD4 count>350 cells/µl and viral load is suppressed (<50 copies/ml). Methods We sought to establish among our HIV outpatient cohort whether a CD4 count decline prior to diagnosis of HL, whether any decline was greater than in patients without the diagnosis, and also whether other clinical or biochemical indices were reliably associated with the diagnosis. Results Twenty-nine patients with a diagnosis of HL were identified. Among 15 individuals on cART with viral load <50 copies/ml the change in CD4 over 12 months preceding diagnosis of HL was −82 cells/µl (95% CI −163 to −3; p = 0.04). Among 18 matched controls the mean change was +5 cells/µl, 95% CI −70 to 80, p = 0.89). The decline in CD4 over the previous 6–12 months was somewhat greater in cases than controls (mean difference in change −55 cells/µl, 95% CI −151 to 39; p = 0.25). In 26 (90%) patients B symptoms had been present for a median of three months (range one–12) before diagnosis of HL. Conclusions The CD4 count decline in the 12 months prior to diagnosis of Hodgkin lymphoma among HIV-infected individuals with VL<50 copies/ml on cART was not significantly different from that seen in other fully virologically suppressed individuals in receipt of cART and who did not develop HL. All those who developed HL had B symptoms and/or new palpable lymphadenopathy, suggesting that CD4 count monitoring if performed less frequently, or not at all, among those virologically suppressed individuals with CD4 counts >350 may not have delayed diagnosis.
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Affiliation(s)
- Ravindra K. Gupta
- Division of Infection and Immunity, University College London, London, United Kingdom
- University College London Hospitals’ NHS Foundation Trust, London, United Kingdom
- * E-mail:
| | - Michael Marks
- University College London Hospitals’ NHS Foundation Trust, London, United Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon G. Edwards
- University College London Hospitals’ NHS Foundation Trust, London, United Kingdom
- Mortimer Market Centre, Camden Provider Services, Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Katie Smith
- University College London Hospitals’ NHS Foundation Trust, London, United Kingdom
| | - Katie Fletcher
- University College London Hospitals’ NHS Foundation Trust, London, United Kingdom
| | - Siow-Ming Lee
- University College London Hospitals’ NHS Foundation Trust, London, United Kingdom
| | - Alan Ramsay
- University College London Hospitals’ NHS Foundation Trust, London, United Kingdom
| | - Andrew J. Copas
- Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | - Robert F. Miller
- University College London Hospitals’ NHS Foundation Trust, London, United Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mortimer Market Centre, Camden Provider Services, Central and North West London NHS Foundation Trust, London, United Kingdom
- Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
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Shiels MS, Koritzinsky E, Clarke CA, Suneja G, Morton LM, Engels EA. Prevalence of HIV Infection among U.S. Hodgkin lymphoma cases. Cancer Epidemiol Biomarkers Prev 2014; 23:274-81. [PMID: 24326629 PMCID: PMC3946161 DOI: 10.1158/1055-9965.epi-13-0865] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma is uncommon in the U.S. general population; however, Hodgkin lymphoma risk is elevated in people with human immunodeficiency virus (HIV) infection. Thus, despite the low HIV prevalence in the United States, the HIV epidemic may have contributed substantially to the general population burden of Hodgkin lymphoma. METHODS We used data from 14 U.S. cancer registries in the Surveillance, Epidemiology, and End Results Program that recorded HIV status of Hodgkin lymphoma cases at diagnosis during 2000 to 2010. We computed the HIV prevalence in Hodgkin lymphoma cases by demographic and tumor characteristics, the proportion of deaths among Hodgkin lymphoma cases because of HIV, and 5-year mortality by HIV status. RESULTS Of 22,355 Hodgkin lymphoma cases, 848 (3.79%) were HIV infected at diagnosis. HIV prevalence in Hodgkin lymphoma cases was greater among males than females (6.0% vs. 1.2%). Among males, HIV prevalence was greatest among 40- to 59-year-olds (14.2%), non-Hispanic blacks (16.9%), Hispanics (9.9%), and among cases of lymphocyte-depleted (15.1%), and mixed cellularity Hodgkin lymphoma (10.5%). Eight percent of male and 1.5% of female Hodgkin lymphoma cases died from HIV. Five-year mortality was two-fold higher in HIV-infected Hodgkin lymphoma cases (36.9% vs. 17.5%). CONCLUSION In the United States, a substantial proportion of lymphocyte-depleted and mixed cellularity Hodgkin lymphoma cases and Hodgkin lymphoma cases among non-Hispanic black, Hispanic, and middle-aged men are HIV infected. In addition, HIV is an important cause of death among Hodgkin lymphoma cases. IMPACT Clinicians should be aware of the high prevalence of HIV in certain subgroups of patients with Hodgkin lymphoma and routine HIV testing should be recommended for all patients presenting with Hodgkin lymphoma.
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Affiliation(s)
- Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Erik Koritzinsky
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Gita Suneja
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Lindsay M. Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Serrano-Villar S, Pérez-Elías MJ, Dronda F, Casado JL, Moreno A, Royuela A, Pérez-Molina JA, Sainz T, Navas E, Hermida JM, Quereda C, Moreno S. Increased risk of serious non-AIDS-related events in HIV-infected subjects on antiretroviral therapy associated with a low CD4/CD8 ratio. PLoS One 2014; 9:e85798. [PMID: 24497929 PMCID: PMC3907380 DOI: 10.1371/journal.pone.0085798] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 12/02/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A low CD4/CD8 ratio has been identified in the general population as a hallmark of inmmunosenescence and a surrogate of all-cause mortality. We aimed to investigate in treated HIV-infected individuals the relationship between the CD4/CD8 ratio and serious non-AIDS events. METHODS Case-control study within a prospective hospital-based cohort of HIV-infected subjects during at least one year of ART-mediated viral suppression. Cases were patients with serious non-AIDS events (non-AIDS malignancies, cardiovascular disease, and end-stage kidney disease), and controls individuals who did not developed non-AIDS events during follow-up. Data were analyzed using ROC analysis and multivariate logistic regression. Conditional logistic regression was performed in 200 cases/controls matched by age, sex, nadir CD4 and proximal CD4 counts. RESULTS We analyzed 407 subjects (109 cases, 298 controls). The CD4/CD8 ratio was lower in cases (0.44 vs. 0.70, P<0.0001), with higher discriminatory ability for the detection of non-AIDS events than the CD4 count, CD8 count and nadir CD4. Multivariate analyses (adjusted for age, sex, nadir CD4, proximal CD4 count, year of ART initiation and ART duration) confirmed the independent association of a low CD4/CD8 ratio with the risk of non-AIDS morbidity (per CD4/CD8 ratio quartile decrease, OR, 2.9; 95% CI, 1.3-6.2) and non-AIDS mortality (OR, 2.8; 95% CI, 1.5-5.3). CONCLUSIONS The CD4/CD8 ratio provides additional information to the CD4 counts and nadir CD4 in treated HIV-infected individuals, since it is independently associated with the risk of non-AIDS-related morbidity and mortality. This association is robust and maintained within different subgroups of patients.
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Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
| | - María Jesús Pérez-Elías
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
| | - Fernando Dronda
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
| | - José Luis Casado
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
| | - Ana Moreno
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
| | - Ana Royuela
- CIBER, Epidemiología y Salud Pública, Clinical Biostatistics Unit, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - José Antonio Pérez-Molina
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
| | - Talia Sainz
- Laboratory of Molecular Immune Biology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Enrique Navas
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
| | - José Manuel Hermida
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
| | - Carmen Quereda
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain
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Leung V, Gillis J, Raboud J, Cooper C, Hogg RS, Loutfy MR, Machouf N, Montaner JSG, Rourke SB, Tsoukas C, Klein MB. Predictors of CD4:CD8 ratio normalization and its effect on health outcomes in the era of combination antiretroviral therapy. PLoS One 2013; 8:e77665. [PMID: 24204912 PMCID: PMC3813720 DOI: 10.1371/journal.pone.0077665] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/04/2013] [Indexed: 12/22/2022] Open
Abstract
Background HIV leads to CD4:CD8 ratio inversion as immune dysregulation progresses. We examined the predictors of CD4:CD8 normalization after combination antiretroviral therapy (cART) and determined whether normalization is associated with reduced progression to AIDS-defining illnesses (ADI) and death. Methods A Canadian cohort of HIV-positive adults with CD4:CD8<1.2 prior to starting cART from 2000–2010 were analyzed. Predictors of (1) reaching a CD4:CD8 ≥1.2 on two separate follow-up visits >30 days apart, and (2) ADI and death from all causes were assessed using adjusted proportional hazards models. Results 4206 patients were studied for a median of 2.77 years and 306 (7.2%) normalized their CD4:CD8 ratio. Factors associated with achieving a normal CD4:CD8 ratio were: baseline CD4+ T-cells >350 cells/mm3, baseline CD8+ T-cells <500 cells/mm3, time-updated HIV RNA suppression, and not reporting sex with other men as a risk factor. There were 213 ADIs and 214 deaths in 13476 person-years of follow-up. Achieving a normal CD4:CD8 ratio was not associated with time to ADI/death. Conclusions In our study, few individuals normalized their CD4:CD8 ratios within the first few years of initiating modern cART. This large study showed no additional short-term predictive value of the CD4:CD8 ratio for clinical outcomes after accounting for other risk factors including age and HIV RNA.
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Affiliation(s)
- Victor Leung
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jennifer Gillis
- Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Janet Raboud
- Toronto General Research Institute, University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Curtis Cooper
- University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert S. Hogg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- * E-mail:
| | - Mona R. Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Maple Leaf Medical Clinic, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Chris Tsoukas
- Department of Medicine, McGill University, Montreal, Canada
- McGill University Health Centre, Montreal, Canada
| | - Marina B. Klein
- Department of Medicine, McGill University, Montreal, Canada
- McGill University Health Centre, Montreal, Canada
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Effect of immune reconstitution on the incidence of HIV-related Hodgkin lymphoma. PLoS One 2013; 8:e77409. [PMID: 24098586 PMCID: PMC3788758 DOI: 10.1371/journal.pone.0077409] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/03/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The incidence of Hodgkin lymphoma (HL) has increased since introduction of combined antiretroviral therapy (cART). While HIV-related HL is highly associated with EBV, the causes underlying the rising incidence remain unclear. The aim of this study was to evaluate the effect of immune reconstitution on HL incidence among a cohort of HIV-infected male veterans ever receiving cART. METHODS We performed a retrospective cohort study utilizing data from the Veterans Affairs HIV Clinical Case Registry from 1985-2010. HL cases were identified using ICD-9 codes (201.4-9). Poisson regression was conducted to evaluate relationships between cART-related immunologic measures (e.g., nadir CD4 before cART, time-updated CD4, % time undetectable HIV RNA) and HL incidence. Additionally, we examined CD4 change after cART initiation. RESULTS 31,056 cART users contributed 287,256 person-years and 196 HL cases (IR=6.8/10,000 person-years). Rate of CD4 increase after cART was worse among HL cases than non-cases (p<0.05). In multivariate regression, HL risk was elevated among veterans with recent CD4 200-350 cells/µL (IRR=1.67, 95%CI=1.16-2.40) and <200 cells/µL (IRR=1.61, 95%CI=1.09-2.39), compared to >350 cells/µL. HL risk was lower among veterans with >80% time undetectable HIV RNA (IRR=0.57, 95%CI=0.35-0.92) and 40-80% undetectable (IRR=0.68, 95%CI=0.47-0.99), compared to <40% undetectable. HL risk was higher in the first 12 months (IRR=2.02, 95%CI=1.32-3.10) and 12-24 months (IRR=1.75, 95%CI=1.16-2.64) after cART initiation, compared to >36 months. CONCLUSION These data highlight immunosuppression and poor viral control may increase HL risk, specifically during immune reconstitution in the interval post cART initiation. Findings suggest an immune reconstitution type mechanism in HIV-related HL development.
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Gotti D, Danesi M, Calabresi A, Ferraresi A, Albini L, Donato F, Castelli F, Scalzini A, Quiros-Roldan, and Brescia HIV Canc E. Clinical characteristics, incidence, and risk factors of HIV-related Hodgkin lymphoma in the era of combination antiretroviral therapy. AIDS Patient Care STDS 2013; 27:259-65. [PMID: 23600703 DOI: 10.1089/apc.2012.0424] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
HIV-infected patients are at increased risk for developing HIV-related Hodgkin lymphoma (HIV-HL) despite the success of combination antiretroviral therapy (cART). To study the incidence of HIV-HL in HIV-patients with respect to the general population of Brescia, Italy, we conducted a single-center cohort study of HIV-patients followed from 1999 to 2009. The incidence of HIV-HL was compared to the incidence in the general population of Brescia using standardized incidence ratios (SIRs). Poisson analysis was used to study the association between covariates and HL. A total of 5085 HIV-patients were observed among 30,946 person-years; 30 patients developed HIV-HL. The incidence rate was 9.9 (95% confidence interval [CI], 6.7-14.1) per 10,000 person-years of follow-up. HL was substantially more frequent in HIV-patients than in the general population living in the same district area [standardized incidence rate, SIR=21.8 (95% CI, 15.33-31)]. The risk of HIV-HL tended to increase with lowering CD4+ cell counts at time of HL diagnosis [adjusted incidence relative risk (IRR) for CD4 cell count<50 cells/μL: 41.70, p<0.001]. HL risk had been elevated during the 6 months after combination antiretroviral therapy (cART) initiation (IRR: 26.65, p<0.001). Twenty-two HIV-HL cases were matched to 3280 controls. In the year preceding HIV-HL diagnosis the mean change in CD4+ cell counts between cases and controls was significantly different (-99 cells/μL for cases vs. +37 cells/μL for controls, p<0.0001). Compared with the general population, HIV-infected patients showed an increased risk for developing HL. The risk of HIV-HL increased significantly in the first months after cART initiation.
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Affiliation(s)
- Daria Gotti
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Marta Danesi
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Alessandra Calabresi
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Alice Ferraresi
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Laura Albini
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Francesco Donato
- Department of Experimental and Applied Medicine, Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Alfredo Scalzini
- Department of Infectious and Tropical Diseases, Spedali Civili of Brescia, Brescia, Italy
| | - Eugenia Quiros-Roldan, and Brescia HIV Canc
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
- Brescia HIV Study Cancer Group: S. Casari,3 F. Castelnuovo,3 C. Cattaneo,6 Andrea Festa,2 M. Magoni,5 C. Paraninfo,3 A. Re,6 C. Scarcella,5 and C. Torti1
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Spindle-shaped CD163+ rosetting macrophages replace CD4+ T-cells in HIV-related classical Hodgkin lymphoma. Mod Pathol 2013; 26:648-57. [PMID: 23307058 DOI: 10.1038/modpathol.2012.217] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Combination antiretroviral therapy is highly effective in HIV infection, leading to decreased incidences of AIDS-defining neoplasms. However, HIV patients still have a 10-fold increased risk of developing classical Hodgkin lymphoma compared with the general population. As Hodgkin- and Reed-Sternberg cells represent only a minority in the tumor infiltrate, the aim of the present study was to characterize the microenvironment of HIV-related classical Hodgkin lymphoma and compare it with classical Hodgkin lymphoma cases of immunocompetent individuals. The major morphologic differences were the presence of necrotic foci and the absence of epithelioid cell formation in HIV-related Hodgkin lymphoma. We observed a significantly decreased number of CD4+ T-cells and a significantly increased number of CD163+ macrophages in HIV-related Hodgkin lymphoma. Cases exhibiting a 'sarcomatoid' pattern of the reactive infiltrate exhibited significantly greater numbers of macrophages, associating the 'sarcomatoid' pattern to the presence of spindle-shaped macrophages. Whereas, rosetting of CD4+ T-cells around Hodgkin- and Reed-Sternberg cells was frequently observed in classical Hodgkin lymphoma in immunocompetent persons; rosetting in a subset of HIV-related Hodgkin lymphoma cases appeared to involve cytoplasmic protrusions of spindle-shaped macrophages. HIV-related Hodgkin lymphoma, therefore, is characterized by unique morphologic features, which should be recognized by pathologists.
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Chadburn A, Abdul-Nabi AM, Teruya BS, Lo AA. Lymphoid Proliferations Associated With Human Immunodeficiency Virus Infection. Arch Pathol Lab Med 2013; 137:360-70. [DOI: 10.5858/arpa.2012-0095-ra] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Individuals who are immune deficient are at an increased risk for developing lymphoproliferative lesions and lymphomas. Human immunodeficiency virus (HIV) infection is 1 of 4 clinical settings associated with immunodeficiency recognized by the World Health Organization (WHO) in which there is an increased incidence of lymphoma and other lymphoproliferative disorders.
Objectives.—To describe the major categories of benign lymphoid proliferations, including progressive HIV-related lymphadenopathy, benign lymphoepithelial cystic lesions, and multicentric Castleman disease, as well as the different types of HIV-related lymphomas as defined by the WHO. The characteristic morphologic, immunophenotypic, and genetic features of the different entities will be discussed in addition to some of the pathogenetic mechanisms.
Data Sources.—The WHO classification of tumors of hematopoietic and lymphoid tissues (2001 and 2008), published literature from PubMed (National Library of Medicine), published textbooks, and primary material from the authors' current and previous institutions.
Conclusions.—HIV infection represents one of the clinical settings recognized by the WHO in which immunodeficiency-related lymphoproliferative disorders may arise. Although most lymphomas that arise in patients with HIV infection are diffuse, aggressive B-cell lesions, other lesions, which are “benign” lymphoid proliferations, may also be associated with significant clinical consequences. These lymphoproliferations, like many other immunodeficiency-associated lymphoproliferative disorders, are often difficult to classify. Studies of HIV-associated lymphoid proliferations will continue to increase our understanding of both the immune system and lymphomagenesis.
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Affiliation(s)
- Amy Chadburn
- From the Department of Pathology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois (Drs Chadburn, Abdul-Nabi, Teruya, and Lo)
| | - Anmaar M. Abdul-Nabi
- From the Department of Pathology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois (Drs Chadburn, Abdul-Nabi, Teruya, and Lo)
| | - Bryan Scott Teruya
- From the Department of Pathology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois (Drs Chadburn, Abdul-Nabi, Teruya, and Lo)
| | - Amy A. Lo
- From the Department of Pathology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois (Drs Chadburn, Abdul-Nabi, Teruya, and Lo)
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