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Rizzo A, Salari F, Eplite A, Giacomelli A, Moschese D, Dalu D, Cossu MV, Lorusso R, Pozza G, Morelli L, Fasola C, Tonielli C, Fusetti C, De Cristofaro V, Gori A, Lombardi A, Rizzardini G, Gismondo MR, Antinori S. Detection and typization of HPV genotypes in subjects with oral and upper respiratory tract lesions, Milan, Italy. Infect Dis (Lond) 2024; 56:293-298. [PMID: 38217420 DOI: 10.1080/23744235.2024.2303020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Oral human papillomavirus (HPV) is common among healthy individuals but causes and implications of persistent infections are under evaluation in the pathogenesis of head and neck neoplasms. METHODS This was a retrospective study evaluating the prevalence of high-risk (HR), probable HR and low-risk (LR) HPV types in patients reporting signs/symptoms of oral and upper respiratory tract lesions. Individuals attending between 2019 and 2022 a University Hospital in Milan, Italy, with risk factors for HPV (unprotected oral sex and/or previous documentation of HPV infection in oral and upper respiratory tract and/or another anatomical site) were included. RESULTS Fourteen out of 110 (12.7%) individuals tested positive for HPV DNA. The prevalence of HR-HPV and LR-HPV was 3.6% (4/110) and 9.1% (10/110), respectively. No probable/possible HR-HPV was detected. Specifically, 10/110 (9.1%) were diagnosed with 1 LR-HPV genotype, 3/110 (2.7%) were infected with 1 HR-HPV and 1/110 had 3 concomitant HR-HPV types. HPV 16 (2.7%, 3/110) and 6 (4.5%, 5/110) were the most common HR and LR types, respectively. One patient positive for HPV 16, 33 and 35 was diagnosed with cancer at the base of the tongue. Two individuals among those who tested positive for HPV DNA reported previous HPV vaccination. CONCLUSIONS Our data, in line with observations from previous prevalence studies, support the potential role of HPV in head and neck neoplasms. HPV DNA testing should be performed in patients presenting lesions in oral/respiratory tracts and risk factors for HPV. Improvement in HPV vaccination coverage is warranted.
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Affiliation(s)
- Alberto Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Federica Salari
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Angelo Eplite
- Otolaryngology Unit - ASST Fatebenefratelli Sacco, "Luigi Sacco" University Hospital, Milano, Italy
| | - Andrea Giacomelli
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Davide Moschese
- I Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Davide Dalu
- Department of Oncology - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Maria Vittoria Cossu
- I Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Rosaria Lorusso
- Otolaryngology Unit - ASST Fatebenefratelli Sacco, "Luigi Sacco" University Hospital, Milano, Italy
| | - Giacomo Pozza
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Loriana Morelli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Cinzia Fasola
- Department of Oncology - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Claudia Tonielli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Chiara Fusetti
- II Infectious Disease Unit - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Valeria De Cristofaro
- Otolaryngology Unit - ASST Fatebenefratelli Sacco, "Luigi Sacco" University Hospital, Milano, Italy
| | - Andrea Gori
- II Infectious Disease Unit - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milano, Italy
- Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Milano, Italy
| | - Alessandra Lombardi
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Giuliano Rizzardini
- I Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
- Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Milano, Italy
| | - Spinello Antinori
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
- Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Milano, Italy
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2
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Rudolph JE, Calkins K, Xu X, Wentz E, Pirsl F, Visvanathan K, Lau B, Joshu C. Comparing Cancer Incidence in an Observational Cohort of Medicaid Beneficiaries With and Without HIV, 2001-2015. J Acquir Immune Defic Syndr 2024; 95:26-34. [PMID: 37831615 PMCID: PMC10843061 DOI: 10.1097/qai.0000000000003318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Life expectancy among people with HIV (PWH) is increasing, making chronic conditions-including cancer-increasingly relevant. Among PWH, cancer burden has shifted from AIDS-defining cancers (ADCs) toward non-AIDS-defining cancers (NADCs). SETTING We described incidence of cancer in a claims-based cohort of Medicaid beneficiaries. We included 43,426,043 Medicaid beneficiaries (180,058 with HIV) from 14 US states, aged 18-64, with >6 months of enrollment (with no dual enrollment in another insurance) and no evidence of a prveious cancer. METHODS We estimated cumulative incidence of site-specific cancers, NADCs, and ADCs, by baseline HIV status, using age as the time scale and accounting for death as a competing risk. We compared cumulative incidence across HIV status to estimate risk differences. We examined cancer incidence overall and by sex, race/ethnicity, and calendar period. RESULTS PWH had a higher incidence of ADCs, infection-related NADCs, and death. For NADCs such as breast, prostate, and colon cancer, incidence was similar or higher among PWH below age 50, but higher among those without HIV by age 65. Incidence of lung and head and neck cancer was always higher for female beneficiaries with HIV, whereas the curves crossed for male beneficiaries. We saw only small differences in incidence trends by race/ethnicity. CONCLUSION Our findings suggest an increased risk of certain NADCs at younger ages among PWH, even when compared against other Medicaid beneficiaries, and highlight the importance of monitoring PWH for ADCs and NADCs. Future work should explore possible mechanisms explaining the differences in incidence for specific cancer types.
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Affiliation(s)
- Jacqueline E. Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Keri Calkins
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Mathematica, Ann Arbor, MI
| | - Xiaoqiang Xu
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Eryka Wentz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Filip Pirsl
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Kala Visvanathan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Corinne Joshu
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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3
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Zhao X, Gopalappa C. Joint modeling HIV and HPV using a new hybrid agent-based network and compartmental simulation technique. PLoS One 2023; 18:e0288141. [PMID: 37922306 PMCID: PMC10624270 DOI: 10.1371/journal.pone.0288141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/20/2023] [Indexed: 11/05/2023] Open
Abstract
Persons living with human immunodeficiency virus (HIV) have a disproportionately higher burden of human papillomavirus infection (HPV)-related cancers. Causal factors include both behavioral and biological. While pharmaceutical and care support interventions help address biological risk of coinfection, as social conditions are common drivers of behaviors, structural interventions are key part of behavioral interventions. Our objective is to develop a joint HIV-HPV model to evaluate the contribution of each factor, to subsequently inform intervention analyses. While compartmental modeling is sufficient for faster spreading HPV, network modeling is suitable for slower spreading HIV. However, using network modeling for jointly modeling HIV and HPV can generate computational complexities given their vastly varying disease epidemiology and disease burden across sub-population groups. We applied a recently developed mixed agent-based compartmental (MAC) simulation technique, which simulates persons with at least one slower spreading disease and their immediate contacts as agents in a network, and all other persons including those with faster spreading diseases in a compartmental model, with an evolving contact network algorithm maintaining the dynamics between the two models. We simulated HIV and HPV in the U.S. among heterosexual female, heterosexual male, and men who have sex with men (men only and men and women) (MSM), sub-populations that mix but have varying HIV burden, and cervical cancer among women. We conducted numerical analyses to evaluate the contribution of behavioral and biological factors to risk of cervical cancer among women with HIV. The model outputs for HIV, HPV, and cervical cancer compared well with surveillance estimates. Model estimates for relative prevalence of HPV (1.67 times) and relative incidence of cervical cancer (3.6 times), among women with HIV compared to women without, were also similar to that reported in observational studies in the literature. The fraction attributed to biological factors ranged from 22-38% for increased HPV prevalence and 80% for increased cervical cancer incidence, the remaining attributed to behavioral. The attribution of both behavioral and biological factors to increased HPV prevalence and cervical cancer incidence suggest the need for behavioral, structural, and pharmaceutical interventions. Validity of model results related to both individual and joint disease metrics serves as proof-of-concept of the MAC simulation technique. Understanding the contribution of behavioral and biological factors of risk helps inform interventions. Future work can expand the model to simulate sexual and care behaviors as functions of social conditions to jointly evaluate behavioral, structural, and pharmaceutical interventions for HIV and cervical cancer prevention.
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Affiliation(s)
- Xinmeng Zhao
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Chaitra Gopalappa
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, United States of America
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4
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Greenberg L, Ryom L, Bakowska E, Wit F, Bucher HC, Braun DL, Phillips A, Sabin C, d'Arminio Monforte A, Zangerle R, Smith C, De Wit S, Bonnet F, Pradier C, Mussini C, Muccini C, Vehreschild JJ, Hoy J, Svedhem V, Miró JM, Wasmuth JC, Reiss P, Llibre JM, Chkhartishvili N, Stephan C, Hatleberg CI, Neesgaard B, Peters L, Jaschinski N, Dedes N, Kuzovatova E, Van Der Valk M, Menozzi M, Lehmann C, Petoumenos K, Garges H, Rooney J, Young L, Lundgren JD, Bansi-Matharu L, Mocroft A, On Behalf Of The Respond And D A D Study Groups. Trends in Cancer Incidence in Different Antiretroviral Treatment-Eras amongst People with HIV. Cancers (Basel) 2023; 15:3640. [PMID: 37509301 PMCID: PMC10377704 DOI: 10.3390/cancers15143640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Despite cancer being a leading comorbidity amongst individuals with HIV, there are limited data assessing cancer trends across different antiretroviral therapy (ART)-eras. We calculated age-standardised cancer incidence rates (IRs) from 2006-2021 in two international cohort collaborations (D:A:D and RESPOND). Poisson regression was used to assess temporal trends, adjusted for potential confounders. Amongst 64,937 individuals (31% ART-naïve at baseline) and 490,376 total person-years of follow-up (PYFU), there were 3763 incident cancers (IR 7.7/1000 PYFU [95% CI 7.4, 7.9]): 950 AIDS-defining cancers (ADCs), 2813 non-ADCs, 1677 infection-related cancers, 1372 smoking-related cancers, and 719 BMI-related cancers (groups were not mutually exclusive). Age-standardised IRs for overall cancer remained fairly constant over time (8.22/1000 PYFU [7.52, 8.97] in 2006-2007, 7.54 [6.59, 8.59] in 2020-2021). The incidence of ADCs (3.23 [2.79, 3.72], 0.99 [0.67, 1.42]) and infection-related cancers (4.83 [4.2, 5.41], 2.43 [1.90, 3.05]) decreased over time, whilst the incidence of non-ADCs (4.99 [4.44, 5.58], 6.55 [5.67, 7.53]), smoking-related cancers (2.38 [2.01, 2.79], 3.25 [2.63-3.96]), and BMI-related cancers (1.07 [0.83, 1.37], 1.88 [1.42, 2.44]) increased. Trends were similar after adjusting for demographics, comorbidities, HIV-related factors, and ART use. These results highlight the need for better prevention strategies to reduce the incidence of NADCs, smoking-, and BMI-related cancers.
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Affiliation(s)
- Lauren Greenberg
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Lene Ryom
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Department of Infectious Diseases 144, Hvidovre University Hospital, DK-2650 Copenhagen, Denmark
| | | | - Ferdinand Wit
- Stichting HIV Monitoring, 1105 BD Amsterdam, The Netherlands
| | - Heiner C Bucher
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8001 Zurich, Switzerland
| | - Dominique L Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8001 Zurich, Switzerland
| | - Andrew Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK
| | - Caroline Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK
| | | | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, 6020 Innsbruch, Austria
| | - Colette Smith
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London NW3 2PF, UK
| | - Stéphane De Wit
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., 1000 Brussels, Belgium
| | - Fabrice Bonnet
- CHU de Bordeaux and Bordeaux University, BPH, INSERM U1219, 33076 Bordeaux, France
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d'Azur et Centre Hospitalier Universitaire, 06000 Nice, France
| | - Cristina Mussini
- Modena HIV Cohort, Università Degli Studi Di Modena and Reggio Emilia, 41125 Modena, Italy
| | - Camilla Muccini
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, 20132 Milano, Italy
| | | | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne 3004, Australia
- The Australian HIV Observational Database (AHOD), Kirby Institute, UNSW, Sydney 2052, Australia
| | - Veronica Svedhem
- Swedish InfCareHIV Cohort, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - Peter Reiss
- Amsterdam UMC Location, Department of Global Health, University of Amsterdam, Global Health, Meibergdreef 9, 1105 Amsterdam, The Netherlands
| | - Josep M Llibre
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Nikoloz Chkhartishvili
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Christoph Stephan
- HIV Center, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt, Germany
| | - Camilla I Hatleberg
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Bastian Neesgaard
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Lars Peters
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Nadine Jaschinski
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Nikos Dedes
- European AIDS Treatment Group, 1000 Brussels, Belgium
| | - Elena Kuzovatova
- Nizhny Novgorod Scientific and Research Institute, 603155 Nizhny Novgorod, Russia
| | - Marc Van Der Valk
- Stichting HIV Monitoring, 1105 BD Amsterdam, The Netherlands
- Amsterdam University Medical Centers, University of Amsterdam, 1117 Amsterdam, The Netherlands
| | - Marianna Menozzi
- Modena HIV Cohort, Università Degli Studi Di Modena and Reggio Emilia, 41125 Modena, Italy
| | | | - Kathy Petoumenos
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne 3004, Australia
- The Australian HIV Observational Database (AHOD), Kirby Institute, UNSW, Sydney 2052, Australia
| | - Harmony Garges
- ViiV Healthcare, Research Triangle Park, Durham, NC 27709, USA
| | - Jim Rooney
- Gilead Science, Foster City, CA 94404, USA
| | | | - Jens D Lundgren
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK
| | - Amanda Mocroft
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK
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5
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Sanchez-Covarrubias AP, Crane J, Montgomerie EK, Potter JE, Duthely LM, Bahadue F, Jeudin PP. Examining 5-Year Cervical Cytology Progression Among Minority Women Living With HIV and Baseline Negative Cytology. J Low Genit Tract Dis 2022; 26:304-309. [PMID: 36126202 PMCID: PMC9508966 DOI: 10.1097/lgt.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Women living with HIV (WLWH) have increased risk of human papillomavirus (HPV) infection, precancers, and invasive cervical cancers. This study aims to determine the rate of cervical cytologic progression and related factors in minority WLWH across 5 years. MATERIALS AND METHODS We used our HIV clinic database, complemented with a retrospective chart review to identify WLWH with a baseline negative cervical cytology between 2009 and 2012 and 5-year follow-up. Data included race/ethnicity, age, years living with HIV, AIDS status, viral load, history of smoking, drug use, and HPV status. Multivariate logistic regression tested progression of negative cytology to low-grade/high-grade squamous intraepithelial lesions (LGSIL/HGSIL). RESULTS Among 162 WLWH, 42% were African American, 30% non-Hispanic African Caribbean, and 26% Hispanic. At baseline, 21% had detectable viral load (>200 cp/mL), mean age was 44.8 (±11 years), and mean years living with HIV was 9.6 (±6.9). After 5 years, 19% of the cohort progressed to LGSIL/HGSIL. Human papillomavirus was detected consistently among women with cytologic changes (30% vs 7%, p < .01). Significant factors that predicted higher likelihood of progression to LGSIL/HGSIL were detection of HPV (adjusted odds ratios = 5.11 [1.31-19.93]; p = .02), and Centers for Disease Control and Prevention-defined AIDS status (adjusted odds ratios = 4.28 [1.04-17.63]; p = .04). Of the women who maintained negative cytology at 1 to 2 years (n = 102), 5 women (5%) progressed during the following 3 years before the recommended follow-up. CONCLUSIONS Human papillomavirus detection and AIDS status were significant factors predicting progression to LGSIL/HGSIL among minority WLWH. Providers screening WLWH for cervical intraepithelial neoplasia should carefully decide screening intervals for minority populations.
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Affiliation(s)
- Alex P. Sanchez-Covarrubias
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Joshua Crane
- Georgetown University School of Medicine, Washington DC
| | | | - JoNell E. Potter
- Sylvester Comprehensive Cancer Center, Miami, FL
- Division of Research and Special Projects, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami, Miami, FL
| | - Lunthita M. Duthely
- Sylvester Comprehensive Cancer Center, Miami, FL
- Division of Research and Special Projects, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami, Miami, FL
| | - Felicia Bahadue
- Division of Research and Special Projects, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami, Miami, FL
| | - Patricia P. Jeudin
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, Miami, FL
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6
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Koroukian SM, Zhou G, Navale SM, Schiltz NK, Kim U, Rose J, Cooper GS, Moore SE, Mintz LJ, Avery AK, Mukherjee S, Markt SC. Excess cancer prevalence in men with HIV: A nationwide analysis of Medicaid data. Cancer 2022; 128:1987-1995. [PMID: 35285515 DOI: 10.1002/cncr.34166] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cancer is one of the most common comorbidities in men living with HIV (MLWH). However, little is known about the MLWH subgroups with the highest cancer burden to which cancer prevention efforts should be targeted. Because Medicaid is the most important source of insurance for MLWH, we evaluated the excess cancer prevalence in MLWH on Medicaid relative to their non-HIV counterparts. METHODS In this cross-sectional study using 2012 Medicaid Analytic eXtract data nationwide, we flagged the presence of HIV, 13 types of cancer, symptomatic HIV, and viral coinfections using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. The study population included individuals administratively noted to be of male sex (men), aged 18 to 64 years, with (n = 82,495) or without (n = 7,302,523) HIV. We developed log-binomial models with cancer as the outcome stratified by symptomatic status, age, and race/ethnicity. RESULTS Cancer prevalence was higher in MLWH than in men without HIV (adjusted prevalence ratio [APR], 1.84; 95% confidence interval [CI], 1.78-1.90) and was higher among those with symptomatic HIV (APR, 2.74; 95% CI, 2.52-2.97) than among those with asymptomatic HIV (APR, 1.73; 95% CI, 1.67-1.79). The highest APRs were observed for anal cancer in younger men, both in the symptomatic and asymptomatic groups: APR, 312.97; 95% CI, 210.27-465.84, and APR, 482.26; 95% CI, 390.67-595.32, respectively. In race/ethnicity strata, the highest APRs were among Hispanic men for anal cancer (APR, 198.53; 95% CI, 144.54-272.68) and for lymphoma (APR, 9.10; 95% CI, 7.80-10.63). CONCLUSIONS Given the Medicaid program's role in insuring MLWH, the current findings highlight the importance of the program's efforts to promote healthy behaviors and vaccination against human papillomavirus in all children and adolescents and to provide individualized cancer screening for MLWH.
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Affiliation(s)
- Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Guangjin Zhou
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Nicholas K Schiltz
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Uriel Kim
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Cleveland, Ohio.,Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Johnie Rose
- Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Cleveland, Ohio.,Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Clinical Translational Science Doctoral Program, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Gregory S Cooper
- Department of Internal Medicine, University Hospital Cleveland Medical Center, Cleveland, Ohio.,Cancer Prevention and Control Program, Case Comprehensive Cancer Center, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Laura J Mintz
- School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Department of Internal Medicine Pediatrics, MetroHealth Medical Center, Cleveland, Ohio
| | - Ann K Avery
- School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Division of Infectious Diseases, MetroHealth Medical Center, Cleveland, Ohio
| | - Sudipto Mukherjee
- Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio.,Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Sarah C Markt
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Cancer Analytics Shared Resource, Case Comprehensive Cancer Center, Cleveland, Ohio
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7
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De Vincentis S, Tartaro G, Rochira V, Santi D. HIV and Sexual Dysfunction in Men. J Clin Med 2021; 10:jcm10051088. [PMID: 33807833 PMCID: PMC7961513 DOI: 10.3390/jcm10051088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress and stigma), alongside classical factors non-related to HIV, should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients.
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Affiliation(s)
- Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Giulia Tartaro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
- Correspondence: ; Tel.: +39-059-396-2453; Fax: +39-059-396-1335
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
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Ye Y, Burkholder GA, Mukherjee A, Chu D, Bansal A, Sudenga SL, Junkins A, Al Diffalha S, Saag MS, Shrestha S. A 12-year retrospective evaluation of anal pre-cancerous lesions and cancer in people living with HIV-1 infection in the Southeastern U.S. Infect Agent Cancer 2021; 16:14. [PMID: 33596943 PMCID: PMC7891006 DOI: 10.1186/s13027-021-00354-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/04/2021] [Indexed: 01/15/2023] Open
Abstract
Background Anal cancer is rare in the general population in both genders in the US, but an increased incidence of anal cáncer (AC) has been reported among people living with HIV-1 infection (PLWH) and little is known among the population in South US. Methods In a retrospective study design, electronic health records from 2006 to 2018 were reviewed in a HIV clinical cohort at the University of Alabama at Birmingham. Associations of demographic, sociodemographic, and HIV-clinical indicators were examined in univariate analyses between high-grade squamous intraepithelial lesions (HSIL) and AC cases and condition-free individuals. Factors for anal/rectal cytology screening tests among PLWH were also assessed over time. Ages at onset of anal cancer were compared with the general US population reported by the National Surveillance, Epidemiology, and End Results Program. Results A total of 79 anal HSIL (96% men) and 43 cancer (100% men) patients were observed along with 4367 HSIL/cancer-free patients (75.9% men). HSIL (P < 0.0001) and AC (0.0001 < P < 0.01) were associated with being men who have sex with men (MSM). An incidence of 258 per 100,000 person-year was observed among this clinical cohort of PLWH. PLWH who were 45–54 years appeared to be at highest risk of AC (58.1%), as compared to those 55–64 years in the general population. Overall, 79% of PLWH anal cancers were diagnosed among those under 55 years (vs 39.5% in general population) indicating early onset of AC. In total 29.1% of HSIL and 44.2% of AC patients had not received an anal/rectal cytology examination 1 year prior to diagnosis. Conclusion AC incidence among HIV-infected men was 161 times higher than general population with an earlier age of onset/diagnosis. Many patients with AC had missed screening opportunities that could potentially have captured neoplasia in pre-cancerous stages. AC-related screening guidelines need to be integrated into routine clinical care, especially among PLWH at highest risk such as MSM and those with lower CD4 counts.
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Affiliation(s)
- Yuanfan Ye
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Greer A Burkholder
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Amrita Mukherjee
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Daniel Chu
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Anju Bansal
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Staci L Sudenga
- Department of Medicine, Vanderbilt University, Nashville, TN, 37203, USA
| | - Anna Junkins
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Sameer Al Diffalha
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Michael S Saag
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
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Ye Y, Burkholder GA, Wiener H, Aslibekyan S, Khan AE, Shrestha S. HSV-infection-related herpetic anogenital ulcer disease among PLWH in southeastern US: electronic medical record based analysis. Sex Transm Infect 2021; 98:44-49. [PMID: 33436506 PMCID: PMC8784998 DOI: 10.1136/sextrans-2020-054503] [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: 03/11/2020] [Revised: 11/24/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
The southeastern US is a domestic epicentre for incident HIV with high prevalence of herpes simplex virus (HSV) coinfection. We estimated the incidence rates (IR) of symptomatic herpetic anogenital ulcer disease (HAUD) and assessed its associations with demographic and clinical characteristics, specifically with immunological markers using median, nadir and trajectory CD4 counts.
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Affiliation(s)
- Yuanfan Ye
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Greer A Burkholder
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Howard Wiener
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stella Aslibekyan
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashraf E Khan
- Disease Control, Jefferson County Department of Health, Birmingham, Alabama, USA
| | - Sadeep Shrestha
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ye Y, Shrestha S, Burkholder G, Bansal A, Erdmann N, Wiener H, Tang J. Rates and Correlates of Incident Type 2 Diabetes Mellitus Among Persons Living With HIV-1 Infection. Front Endocrinol (Lausanne) 2020; 11:555401. [PMID: 33329379 PMCID: PMC7719801 DOI: 10.3389/fendo.2020.555401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022] Open
Abstract
The prevalence of various comorbidities continue to rise in aging persons living with HIV-1 infection (PLWH), and our study here aimed to assess the rates and correlates of incident type 2 diabetes mellitus (T2DM) in PLWH from a retrospective, southeastern U.S. cohort. Based on electronic health records, we examined patient demographics, body mass index (BMI), HIV-1-related outcomes, hepatitis C virus co-infection, common comorbidities (e.g. shingles and asthma), usage of protease inhibitors, and usage of statins as potential correlates for T2DM occurrence. Among 3,975 PLWH with ≥12 months of follow-up between January 1999 and March 2018, the overall rate of incident T2DM was 135 per 10,000 person-years, almost 2-fold higher than the rate reported for the general U.S. population. In multivariable models (354 T2DM patients and 3,617 control subjects), sex, BMI, nadir CD4+ T-cell count, HIV-1 viral load (VL) and duration of statin use were independent correlates of incident T2DM (adjusted P <0.05 for all), with clear consistency in several sensitivity analyses. The strongest associations (adjusted odds ratio/OR >2.0 and P <0.0001) were noted for: i) statin use for ≥6 months (OR = 10.2), ii) BMI ≥30 kg/m2 (OR = 3.4), and iii) plasma VL ≥200 copies/ml (OR = 2.2). Their collective predictive value was substantial: the C-statistic for area under the receiver operating characteristics curve was 0.87 (95% CI = 0.84-0.91), showing close similarity between two major racial groups (C-statistic = 0.87 for African Americans and 0.91 for European Americans). Overall, these findings not only establish a promising algorithm for predicting incident T2DM in PLWH but also suggest that patients who are obese and use statins should require special consideration for T2DM diagnosis and prevention.
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Affiliation(s)
- Yuanfan Ye
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nathaniel Erdmann
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Howard Wiener
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jianming Tang
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Jianming Tang,
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