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Dusingize JC, Murenzi G, Muhoza B, Businge L, Remera E, Uwinkindi F, Hagenimana M, Rwibasira G, Nsanzimana S, Castle PE, Anastos K, Clifford GM. Cancer risk among people living with Human Immuodeficiency Virus (HIV) in Rwanda from 2007 to 2018. Int J Cancer 2024. [PMID: 39128948 DOI: 10.1002/ijc.35091] [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: 01/21/2024] [Revised: 05/06/2024] [Accepted: 06/04/2024] [Indexed: 08/13/2024]
Abstract
Assessing the risk of cancer among people living with HIV (PLHIV) in the current era of antiretroviral therapy (ART) is crucial, given their increased susceptibility to many types of cancer and prolonged survival due to ART exposure. Our study aims to compare the association between HIV infection and specific cancer sites in Rwanda. Population-based cancer registry data were used to identify cancer cases in both PLHIV and HIV-negative persons. A probabilistic record linkage approach between the HIV and cancer registries was used to supplement HIV status ascertainment in the cancer registry. Associations between HIV infection and different cancer types were evaluated using unconditional logistic regression models. We performed several sensitivity analyses to assess the robustness of our findings and to evaluate the potential impact of different assumptions on our results. From 2007 to 2018, the cancer registry recorded 17,679 cases, of which 7% were diagnosed among PLHIV. We found significant associations between HIV infection and Kaposi's Sarcoma (KS) (adjusted odds ratio [OR]: 29.1, 95% CI: 23.2-36.6), non-Hodgkin lymphoma (NHL) (1.6, 1.3-2.0), Hodgkin lymphoma (HL) (1.6, 1.1-2.4), cervical (2.3, 2.0-2.7), vulvar (4.0, 2.5-6.5), penile (3.0, 2.0-4.5), and eye cancers (2.2, 1.6-3.0). Men living with HIV had a higher risk of anal cancer (3.1, 1.0-9.5) than men without HIV, but women living with HIV did not have higher risk than women without HIV (1.0, 0.2-4.3). Our study found that in an era of expanded ART coverage in Rwanda, HIV is associated with a broad range of cancers, particularly those linked to viral infections.
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Affiliation(s)
- Jean Claude Dusingize
- Cancer Epidemiology, Prevention & Control Program, Montefiore Einstein Cancer Center, Bronx, New York, USA
| | - Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Benjamin Muhoza
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | | | | | | | | | | | | | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Kathryn Anastos
- Department of Medicine and of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gary M Clifford
- Early Detection Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
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2
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Singini MG, Muchengeti M, Sitas F, Chen WC, Combes JD, Waterboer T, Clifford GM. Antibodies against high-risk human papillomavirus proteins as markers for noncervical HPV-related cancers in a Black South African population, according to HIV status. Int J Cancer 2024; 155:251-260. [PMID: 38577820 DOI: 10.1002/ijc.34919] [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: 11/07/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 04/06/2024]
Abstract
Human papillomavirus (HPV) proteins may elicit antibody responses in the process toward HPV-related malignancy. However, HPV seroepidemiology in noncervical HPV-related cancers remains poorly understood, particularly in populations with a high prevalence of human immunodeficiency virus (HIV). Using a glutathione S-transferase-based multiplex serology assay, antibodies against E6, E7 and L1 proteins of HPV16 and HPV18 were measured in sera of 535 cases of noncervical HPV-related cancers (anal (n = 104), vulval (n = 211), vaginal (n = 49), penile (n = 37) and oropharyngeal (n = 134)) and 6651 non-infection-related cancer controls, from the Johannesburg Cancer Study that recruited Black South African with newly diagnosed cancer between 1995 and 2016. Logistic and Poisson regression models were used to calculate adjusted odds ratios (aOR) and prevalence ratios (aPR) and 95% confidence intervals (CI) in cases versus controls. HPV16 E6 was more strongly associated with noncervical HPV-related cancers than HPV16 L1 or E7, or HPV18 proteins: anal (females (HPV16 E6 aOR = 11.50;95%CI:6.0-22.2), males (aOR = 10.12;95%CI:4.9-20.8), vulval (aOR = 11.69;95%CI:7.9-17.2), vaginal (aOR = 10.26;95%CI:5.0-21), penile (aOR = 18.95;95%CI:8.9-40), and oropharyngeal (females (aOR = 8.95;95%CI:2.9-27.5), males (aOR = 3.49;95%CI:1.8-7.0)) cancers. HPV16-E6 seropositivity ranged from 24.0% to 35.1% in anal, vulval, vaginal and penile cancer but was significantly lower (11.2%) in oropharyngeal cancer. After adjustment for HIV, prevalence of which increased from 22.2% in 1995-2005 to 54.1% in 2010-2016, HPV16 E6 seropositivity increased by period of diagnosis (aPR for 2010-2016 vs. 1995-2006 = 1.84;95%CI:1.1-3.0). Assuming HPV16 E6 seroprevalence reflects HPV attributable fraction, the proportion of certain noncervical-HPV-related cancers caused by HPV is increasing over time in South Africa. This is expected to be driven by the increasing influence of HIV.
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Affiliation(s)
- Mwiza Gideon Singini
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mazvita Muchengeti
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Freddy Sitas
- Center for Primary Health Care and Equity, School of Population Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Menzies Center of Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wenlong Carl Chen
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean-Damien Combes
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Tim Waterboer
- Infections and Cancer Epidemiology Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gary M Clifford
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
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3
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Davidović M, Dhokotera T, dos-Santos-Silva I, Bohlius J, Sengayi-Muchengeti M. Breast cancer in women by HIV status: A report from the South African National Cancer Registry. PLoS One 2024; 19:e0305274. [PMID: 38885245 PMCID: PMC11182510 DOI: 10.1371/journal.pone.0305274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 05/27/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Breast cancer (BC) is the leading cause of cancer-related morbidity and mortality in women living in South Africa, a country with a high HIV burden. However, characteristics of the double burden of HIV and BC in South Africa have not been properly investigated. We described characteristics of BC cases by HIV status in South Africa. METHODS In this nationwide South African study, we obtained BC records for women aged ≥15 years diagnosed in the public health sector between January 2004 and December 2014. We included records from the National Cancer Registry that had been linked to HIV-related laboratory records from the National Health Laboratory Service. We assessed the odds of being HIV positive versus HIV negative in relation to patient-, cancer-, and municipality-related characteristics. RESULTS From 2004-2014, 40 520 BC cases were diagnosed in women aged ≥15 years. Of these, 73.5% had unknown HIV status, 18.7% were HIV negative, and 7.7% were HIV positive. The median age at BC diagnosis was 43 years (interquartile range [IQR]: 37-52) in HIV positive and 57 years (IQR: 46-68) in HIV negative women, respectively. The odds of being HIV positive was higher for women who were aged 30-34 years compared to women aged 35-39 years at cancer diagnosis (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.10-1.71), Black versus non-Black (OR 6.41, 95% CI 5.68-7.23), diagnosed with cancer in rural versus urban areas (OR 1.59, 95% CI 1.40-1.82) and diagnosed in municipalities with low and middle (OR 3.46, 95% CI 2.48-4.82) versus high socioeconomic position (OR 2.69, 95% CI 2.11-3.42). CONCLUSION HIV status was unknown for the majority of BC patients. Among those with known HIV status, being HIV positive was associated with a younger age at cancer diagnosis, being Black and receiving care in municipalities of poor socioeconomic position. Future studies should examine opportunities to integrate HIV and BC control programs.
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Affiliation(s)
- Maša Davidović
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Tafadzwa Dhokotera
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julia Bohlius
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Mazvita Sengayi-Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Suk-Ouichai C, Coghill AE, Schabath MB, Sanchez JA, Chahoud J, Necchi A, Giuliano AR, Spiess PE. A clinical overview of people living with HIV and genitourinary cancer care. Nat Rev Urol 2024; 21:373-383. [PMID: 38238527 DOI: 10.1038/s41585-023-00846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 06/10/2024]
Abstract
The number of people living with HIV infection has been increasing globally. Administration of antiretroviral therapy is effective in controlling the infection for most patients and, as a consequence, people living with HIV (PLWH) now often have a long life expectancy. However, their risk of developing cancer - most notably virus-related cancers - has been increasing. To date, few studies have assessed the risk of genitourinary cancers in PLWH, and robust scientific data on their treatment-related outcomes are lacking. Previous studies have noted that PLWH are at a reduced risk of prostate cancer; however, low adoption and/or availability of prostate cancer screening among these patients might be confounding the validity of this finding. In genitourinary cancers, advanced stage at diagnosis and reduced cancer-specific mortality have been reported in PLWH. These data likely reflect, at least in part, the inequity of health care access for PLWH. Notably, systemic chemotherapy and/or radiotherapy could decrease total CD4+ cell counts, which could, therefore, increase the risk of morbidity and mortality from cancer treatments in PLWH. Immune checkpoint inhibitors have become the therapeutic backbone for many advanced malignancies in the general population; however, most studies validating their efficacy have excluded PLWH owing to concerns of severe adverse effects from immune checkpoint inhibitors themselves and/or related to their immunosuppressed status. To our knowledge, no genitourinary cancer survivorship programme exists that specifically caters to the needs of PLWH. By including PLWH in ongoing cancer trials, we can gain invaluable insights that will help to improve cancer care specifically for PLWH.
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Affiliation(s)
- Chalairat Suk-Ouichai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anna E Coghill
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Julian A Sanchez
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Andrea Necchi
- Department of Medical Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
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Dube Mandishora RS, Galati L, Reich RR, Combes JD, McKay-Chopin S, Makunike-Mutasa R, Masanganise R, Gwambiwa B, Magombei T, Zito FA, Lagiou P, Clifford GM, Giuliano AR, Coghill AE, Tommasino M, Gheit T. Epstein-Barr Virus DNA Is Associated With Conjunctival Squamous Cell Carcinomas: A Case-Control Study From Zimbabwe. Open Forum Infect Dis 2024; 11:ofae165. [PMID: 38623569 PMCID: PMC11017324 DOI: 10.1093/ofid/ofae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
Incidence of conjunctival squamous cell carcinoma (cSCC) in Zimbabwe is >30-fold higher than the global average. cSCC risk is notably higher among people with human immunodeficiency virus, implicating impaired immune response and a yet unknown infectious etiology. Formalin-fixed, paraffin-embedded blocks from Zimbabwe, comprising conjunctival precancer (n = 78), invasive cSCC cases (n = 148) and nonmalignant eye lesions (n = 119), were tested for multiple DNA viruses using Luminex bead-based technology. Epstein-Barr virus (EBV) type 1 positivity was strongly associated with cSCC diagnosis (adjusted odds ratio [aOR], 5.6 [95% confidence interval {CI}, 3.0-10.4) and marginally associated with precancer (aOR, 2.1 [95% CI, 1.0-4.5]). On analyzing EBV transcriptional activity with any of LMP1, EBNA1, and BZLF1, RNA transcripts were detected in 5 of 112 controls, 3 of 67 precancers, and 10 of 139 cases and none were associated with conjunctival case status. Our EBV DNA data suggest that EBV may play a role in cSCC. However, the low detection rate of EBV RNA supports further investigation to infer causality.
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Affiliation(s)
- Racheal S Dube Mandishora
- Center for Immunization and Infection Research in Cancer and the Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Medical Microbiology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Luisa Galati
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
| | - Richard R Reich
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jean-Damien Combes
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Sandrine McKay-Chopin
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
| | - Rudo Makunike-Mutasa
- Histopathology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Rangarirai Masanganise
- Ophthalmology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Bevele Gwambiwa
- Histopathology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Tricia Magombei
- Medical Microbiology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Francesco Alfredo Zito
- Pathology Department, Istituto di Ricovero e Cura a Carattere Scientifico – Istituto Tumori ‘Giovanni Paolo II’, Bari, Italy
| | - Pagona Lagiou
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gary M Clifford
- Histopathology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer and the Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Anna E Coghill
- Center for Immunization and Infection Research in Cancer and the Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Massimo Tommasino
- Pathology Department, Istituto di Ricovero e Cura a Carattere Scientifico – Istituto Tumori ‘Giovanni Paolo II’, Bari, Italy
| | - Tarik Gheit
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, Lyon, France
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6
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Ashindoitiang JA, Nwagbara VIC, Ozinko MO, Ugbem TI, Asuquo ME. Multiple carcinomas in a woman with HIV infection: a case report and literature review. J Int Med Res 2024; 52:3000605241245011. [PMID: 38606735 PMCID: PMC11015788 DOI: 10.1177/03000605241245011] [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: 10/24/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Non-acquired immunodeficiency syndrome-defining cancers (NADCs) are malignancies in persons living with human immunodeficiency virus (PLWHIV) and are not primarily due to the host's immunodeficiency. There is renewed clinical interest in long-term morbidities in PLWHIV as well as malignancies that occur in this population. We herein describe a 36-year-old woman with a 2-year history of an anal wound and right breast mass. She had been diagnosed with HIV infection prior to the development of these lesions. Clinical and laboratory evaluations led to diagnoses of breast and anal cancers. Chemotherapy and antiretroviral therapy were begun, but the patient discontinued these treatments early and was lost to follow-up. NADCs will continue to be a major clinical issue as the global population ages. This presentation of two NADCs (breast and anal cancers) in a PLWHIV further highlights the burden of multiple malignancies on the depleted health of HIV-infected patients. Early identification and treatment of HIV upon patients' presentation to cancer care sites and screening for NADCs at HIV/AIDS care sites are recommended for improved outcomes.
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Affiliation(s)
- John Adi Ashindoitiang
- Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Mba Okpan Ozinko
- Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Theophilus Ipeh Ugbem
- Department of Pathology, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Maurice Efana Asuquo
- Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
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7
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Nwakasi C, Esiaka D, Staab T, Philip AA, Nweke C. HIV knowledge and information access among women cancer survivors in Nigeria. J Cancer Policy 2024; 39:100456. [PMID: 37989454 DOI: 10.1016/j.jcpo.2023.100456] [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: 07/12/2023] [Revised: 10/09/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Abstract
Women in Nigeria have a high burden of diseases, such as cancer and HIV. Nigerian women also have inadequate access to health information, especially for disease prevention and health promotion. Researchers have indicated that living with HIV can be particularly harmful to the health and survival of cancer survivors. However, there is a dearth of research on Nigerian women cancer survivors' knowledge of cancer and HIV linkage and their access to HIV health information. This knowledge gap may have negative health consequences. Therefore, there is a need to ensure HIV prevention among Nigerian women cancer survivors by improving access to health information. This study used a qualitative descriptive method to examine HIV knowledge and access to health information among women cancer survivors in Nigeria. Semi-structured interviews were conducted with a purposive sample of 30 women cancer survivors from Abuja, Nigeria. We identified three themes from the data, illuminating women's knowledge of the connection between HIV and cancer. The themes include: (a) perception of HIV versus cancer which described views of HIV and cancer as distinct health conditions, (b) perceived effect of HIV on cancer given that HIV can worsen cancer outcomes, and (c) sourcing for HIV health information which highlighted issues of inadequate or inaccessible HIV-cancer information. Our findings showed that targeted health education interventions are required to address the lack of HIV information among cancer survivors.
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Affiliation(s)
- Candidus Nwakasi
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA.
| | - Darlingtina Esiaka
- Department of Behavioral Science, Center for Health Equity Transformation (CHET), The University of Kentucky College of Medicine, Lexington, KY, USA
| | - Theresa Staab
- Department of Health Sciences, Providence College, Providence, RI, USA
| | - Aaron Akpu Philip
- Faculty of Health, School of Public Health, and Social Work, Queensland University of Technology (QUT) Brisbane, Australia
| | - Chizobam Nweke
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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8
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Engels EA, Shiels MS, Barnabas RV, Bohlius J, Brennan P, Castilho J, Chanock SJ, Clarke MA, Coghill AE, Combes JD, Dryden-Peterson S, D'Souza G, Gopal S, Jaquet A, Lurain K, Makinson A, Martin J, Muchengeti M, Newton R, Okuku F, Orem J, Palefsky JM, Ramaswami R, Robbins HA, Sigel K, Silver S, Suneja G, Yarchoan R, Clifford GM. State of the science and future directions for research on HIV and cancer: Summary of a joint workshop sponsored by IARC and NCI. Int J Cancer 2024; 154:596-606. [PMID: 37715370 PMCID: PMC11133517 DOI: 10.1002/ijc.34727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 09/17/2023]
Abstract
An estimated 38 million people live with human immunodeficiency virus (HIV) worldwide and are at excess risk for multiple cancer types. Elevated cancer risks in people living with HIV (PLWH) are driven primarily by increased exposure to carcinogens, most notably oncogenic viruses acquired through shared transmission routes, plus acceleration of viral carcinogenesis by HIV-related immunosuppression. In the era of widespread antiretroviral therapy (ART), life expectancy of PLWH has increased, with cancer now a leading cause of co-morbidity and death. Furthermore, the types of cancers occurring among PLWH are shifting over time and vary in their relative burden in different parts of the world. In this context, the International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI) convened a meeting in September 2022 of multinational and multidisciplinary experts to focus on cancer in PLWH. This report summarizes the proceedings, including a review of the state of the science of cancer descriptive epidemiology, etiology, molecular tumor characterization, primary and secondary prevention, treatment disparities and survival in PLWH around the world. A consensus of key research priorities and recommendations in these domains is also presented.
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Affiliation(s)
- Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Ruanne V Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia Bohlius
- University of Basel, Basel, Switzerland
- Department for Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Jessica Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Anna E Coghill
- Department of Cancer Epidemiology and Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jean-Damien Combes
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Scott Dryden-Peterson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Antoine Jaquet
- National Institute for Health and Medical Research (INSERM), UMR, 1219, Research Institute for Sustainable Development (IRD), EMR 271, Bordeaux Population, Health Centre, University of Bordeaux, Bordeaux, France
| | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alain Makinson
- Infectious Disease Department, CHU La Colombière, Montpellier & Inserm U1175, University of Montpellier, Montpellier, France
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York, UK
| | - Fred Okuku
- Uganda Cancer Institute, Kampala, Uganda
| | | | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California, USA
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Keith Sigel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Gary M Clifford
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
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9
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Ferreira MP, Thuler LCS, Bergmann A, Soares EA, Soares MA. Differential survival of Brazilian patients with diffuse large B-cell lymphoma with and without HIV infection. AIDS 2023; 37:2331-2338. [PMID: 37650761 DOI: 10.1097/qad.0000000000003700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Combinatorial antiretroviral therapy provided improvement of HIV patients' immune function and a decrease in the incidence of non-Hodgkin lymphoma (NHL). Diffuse large B-cell lymphoma (DLBCL) is one of the most common NHL forms affecting HIV+ patients. The present study aimed to evaluate the impact of HIV infection on the prognosis of patients treated for DLBCL in a reference cancer treatment center in Brazil. METHODS A retrospective case-control study was developed with patients followed-up at the Brazilian National Cancer Institute, in which 243 DLBCL patients (91 HIV+ and 152 HIV-) were enrolled. HIV- controls were matched to HIV+ according to date of cancer diagnosis, clinical staging, primary cancer treatment and date of birth. Sociodemographic and cancer treatment data were extracted from medical charts. Kaplan-Meier analyses were carried out to estimate survival, while univariate and multiple Cox regression analyses were used to determine factors associated with mortality. RESULTS A total of 98 deaths were observed in a 5-year period after cancer diagnosis. A negative association of HIV infection with both overall and disease-specific survival 1 year after cancer diagnosis was observed [hazard ratio (HR) = 1.98 and 1.96, respectively]. The negative association with HIV infection with disease-specific survival remained significant for a 5-year period after cancer diagnosis (HR = 1.53). HIV viral load above 1000 copies/ml at study entry was also associated with shorter overall and cancer-specific survival. CONCLUSIONS HIV infection negatively impacted prognosis and mortality of DLBCL patients irrespective of cancer-related clinical factors.
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Affiliation(s)
| | | | | | | | - Marcelo A Soares
- Programa de Oncovirologia, Instituto Nacional do Câncer
- Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Olago V, Nimako G, Bartels L, Bohlius J, Dhokotera T, Egger M, Singh E, Sengayi-Muchengeti M. Cancer diagnostic service use in people with HIV in South Africa: a cross-sectional study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.10.23295338. [PMID: 37745395 PMCID: PMC10516037 DOI: 10.1101/2023.09.10.23295338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective The objective of this study was to map place of cancer diagnosis in relation to Human Immunodeficiency Virus (HIV) care centre among people with HIV (PWH) within South Africa (SA) using national laboratory database. Design We linked HIV and cancer laboratory data from 2004-2014 using supervised machine-learning algorithms. We performed a cross-sectional analysis comparing province where individuals accessed their HIV care versus where they had their cancer diagnosis. Setting We used laboratory test records related to HIV diagnostics and care, such as CD4 cell counts and percentages, rapid tests, qualitative Polymerase Chain Reaction (PCR), antibody and antigen tests for HIV data that was documented as HIV positive and laboratory diagnosed cancer records from SA. Study population Our study population consisted of HIV records from the National Health Laboratory Service (NHLS) that linked to cancer record at the National Cancer Registry (NCR) between 2004- 2014. Primary and secondary outcomes We linked HIV records from NHLS to cancer records at NCR in order to study the inherent characteristics of the population with both HIV and cancer. Results The study population was 68,284 individuals with cancer and documented HIV related laboratory test. The median age at cancer diagnosis was 40 [IQR, 33-48] years for the study population with most cancers in PWH diagnosed in females 70.9% [n=46,313]. Of all the PWH and cancer, 25% (n=16,364 p < 0.001) sought treatment outside their province of residence with 60.7% (n=10,235) travelling to Gauteng. KZN had 46.6% (n=4,107) of its PWH getting cancer diagnosis in Gauteng. Western Cape had 95% (n=6,200) of PWH getting cancer diagnosis within the province. Conclusions Our results showed health systems inequalities across provinces in South Africa with respect to cancer diagnosis. KZN for example had nearly half of the PWH getting cancer diagnosis outside the province while Western Cape is able to offer cancer diagnostic services to most of the PWH in the province. Gauteng is getting over burdened with referral for cancer diagnosis from other provinces. More effort is required to ensure equitable access to cancer diagnostic services within the country.
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Affiliation(s)
- Victor Olago
- National Cancer Registry (NCR), National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gideon Nimako
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Industrialization, Science, Technology and Innovation Hub, The NEPAD Planning and Coordinating Agency, Johannesburg, South Africa
| | - Lina Bartels
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Julia Bohlius
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Tafadzwa Dhokotera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Elvira Singh
- National Cancer Registry (NCR), National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mazvita Sengayi-Muchengeti
- National Cancer Registry (NCR), National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, South Africa
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Keddy KH, Rachmawati T. Herd immunity or health equity? - extending HPV vaccination. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100793. [PMID: 37547051 PMCID: PMC10398578 DOI: 10.1016/j.lanwpc.2023.100793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 08/08/2023]
Affiliation(s)
| | - Tety Rachmawati
- Center for Public Health and Nutrition Research, National Research and Innovation Agency, Jakarta, Indonesia
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Shumba K, Bor J, Nattey C, Gareta D, Lauren E, Macleod W, Fox MP, Puren A, Mlisana K, Onoya D. Record linkage without patient identifiers: proof of concept using data from South Africa's national HIV program. RESEARCH SQUARE 2023:rs.3.rs-2893943. [PMID: 37292689 PMCID: PMC10246237 DOI: 10.21203/rs.3.rs-2893943/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Linkage between health databases typically requires identifiers such as patient names and personal identification numbers. We developed and validated a record linkage strategy to combine administrative health databases without the use of patient identifiers, with application to South Africa's public sector HIV treatment program. Methods We linked CD4 counts and HIV viral loads from South Africa's HIV clinical monitoring database (TIER.Net) and the National Health Laboratory Service (NHLS) for patients receiving care between 2015-2019 in Ekurhuleni District (Gauteng Province). We used a combination of variables related to lab results contained in both databases (result value; specimen collection date; facility of collection; patient year and month of birth; and sex). Exact matching linked on exact linking variable values while caliper matching applied exact matching with linkage on approximate test dates (± 5 days). We then developed a sequential linkage approach utilising specimen barcode matching, then exact matching, and lastly caliper matching. Performance measures were sensitivity and positive predictive value (PPV); share of patients linked across databases; and percent increase in data points for each linkage approach. Results We attempted to link 2,017,290 lab results from TIER.Net (representing 523,558 unique patients) and 2,414,059 lab results from the NHLS database. Linkage performance was evaluated using specimen barcodes (available for a minority of records in TIER.net) as a "gold standard". Exact matching achieved a sensitivity of 69.0% and PPV of 95.1%. Caliper-matching achieved a sensitivity of 75.7% and PPV of 94.5%. In sequential linkage, we matched 41.9% of TIER.Net labs by specimen barcodes, 51.3% by exact matching, and 6.8% by caliper matching, for a total of 71.9% of labs matched, with PPV=96.8% and Sensitivity = 85.9%. The sequential approach linked 86.0% of TIER.Net patients with at least one lab result to the NHLS database (N=1,450,087). Linkage to the NHLS Cohort increased the number of laboratory results associated with TIER.Net patients by 62.6%. Conclusions Linkage of TIER.Net and NHLS without patient identifiers attained high accuracy and yield without compromising patient privacy. The integrated cohort provides a more complete view of patients' lab history and could yield more accurate estimates of HIV program indicators.
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Martins CDS, Maasdorp SD. Outcomes of patients with haematological malignancies and febrile neutropenia at the Universitas Academic Hospital multidisciplinary intensive care unit, Free State Province, South Africa. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i1.263. [PMID: 37476654 PMCID: PMC10354873 DOI: 10.7196/ajtccm.2023.v29i1.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/17/2023] [Indexed: 07/22/2023] Open
Abstract
Background Mortality rates in patients with haematological malignancies who required intensive care unit (ICU) admission have in the past been high. More recently, however, improved outcomes for critically ill haematological patients have been reported. Objectives To determine outcomes, average length of ICU stay, and factors associated with mortality in patients with haematological malignancies and neutropenic fever in the multidisciplinary ICU (MICU) at Universitas Academic Hospital (UAH), Bloemfontein, Free State Province, South Africa. Methods We conducted a retrospective review of medical and laboratory records of all patients admitted to the UAH MICU with haematological malignancies and febrile neutropenia between 2010 and 2019. Results A total of 182 patients with haematological malignancies were admitted to the MICU between 1 January 2010 and 31 December 2019, of whom 51 (28.0%) fulfilled the inclusion criteria for the study. The median age was 33 years, and 29 patients (56.9%) were female. Most patients had either acute myeloid leukaemia (n=22; 43.1%) or acute lymphocytic leukaemia (n=16; 31.4%), while B-cell lymphoma (n=12; 23.5%) and multiple myeloma (n=1; 2%) were less frequent. The median length of stay in the ICU was 3 days. ICU mortality was 76.5% and hospital mortality 82.4%. Factors associated with mortality included septic shock, vasoactive agent use and mechanical ventilation. Conclusion Patients with haematological malignancies and febrile neutropenia in the UAH MICU have high ICU and hospital mortality rates. More needs to be done with regard to timeous management of patients with haematological malignancies and septic shock in our setting to improve survival. Study synopsis This is the first study to report on ICU mortality of adult patients with haematological malignancies and neutropenic sepsis in a tertiary hospital ICU in the Free State. These patients had a high mortality rate. What the study adds. Our study shows that septic shock, vasoactive agent use and mechanical ventilation were associated with increased ICU mortality.Implications of the findings. Strict adherence to infection prevention and control measures in haematology wards is required. Early recognition and treatment of sepsis before it progresses to septic shock is important. ICUs must be designed so that isolation cubicles are readily available to prevent cross-infection of patients.
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Affiliation(s)
- C D S Martins
- Division of Critical Care, Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - S D Maasdorp
- Division of Critical Care, Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Wright CY, Norval M. Solar Ultraviolet Radiation, Skin Cancer and Photoprotective Strategies in South Africa †. Photochem Photobiol 2023; 99:509-518. [PMID: 35841370 DOI: 10.1111/php.13676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
The most recent data relating to the incidence of, and mortality from, the three commonest forms of skin cancer, namely basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and cutaneous melanoma (CM), in the Black African, Colored, Asian/Indian and White population groups in South Africa are reviewed. While exposure to solar ultraviolet radiation is the major environmental risk factor for BCC in all four groups, for SSC in the White and Asian/Indian groups and for CM in the White group, this is unlikely to be the case for most SCCs in the Black African group and for most CMs in the Black African and Asian/Indian groups. Strategies for practical personal photoprotection in South Africa are discussed with particular emphasis on people at heightened risk of skin cancer including the White population group, those with HIV or oculocutaneous albinism and outdoor workers.
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Affiliation(s)
- Caradee Yael Wright
- Environment and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
| | - Mary Norval
- Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, UK
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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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Ramberg IMS. Human papillomavirus-related neoplasia of the ocular adnexa. Acta Ophthalmol 2022; 100 Suppl 272:3-33. [PMID: 36203222 PMCID: PMC9827891 DOI: 10.1111/aos.15244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 01/12/2023]
Abstract
Human papillomaviruses (HPV) are involved in approximately 5% of solid cancers worldwide. The mucosotropic genotypes infect the stratified epithelium of various locations, where persistent infection may lead to invasive carcinomas. While the causative role of HPV in certain anogenital and head and neck carcinomas is well established, the role of HPV in carcinomas arising in the mucosal membranes of the ocular adnexal tissue (the lacrimal drainage system and the conjunctiva) has been a topic of great uncertainty. Therefore, we conducted a series of studies to assess the correlation between HPV and carcinomas arising in the mucosa of the ocular adnexal tissue and characterize the clinical, histopathological, and genomic features of the tumors in the context of HPV status in a Danish nationwide cohort. We collected clinical and histopathological data and tumor specimens from patients with carcinomas of the conjunctiva and the lacrimal drainage system, and their potential precursors, identified in Danish nationwide registries. The HPV status of the tumors was determined by the combined use of HPV DNA polymerase chain reaction (PCR), HPV E6/E7 mRNA in-situ hybridization, and p16 immunohistochemistry. The genomic profile was investigated by high-throughput DNA sequencing targeting 523 cancer-relevant genes. The literature to date on carcinomas of the lacrimal drainage system and the conjunctiva was summarized. In the Danish cohort, 67% of all carcinomas of the lacrimal drainage system and 21% of all conjunctival carcinomas were HPV-positive. HPV16 was the most frequently implicated genotype. A full-thickness expression of the viral oncogenes E6 and E7 was evident in almost all HPV DNA-positive cases. The HPV-positive carcinomas of the conjunctiva and the lacrimal drainage system shared histopathological and genomic features distinct from their HPV-negative counterparts. The HPV-positive carcinomas were characterized by a non-keratinizing morphology, p16 overexpression, high transcriptional activity of HPV E6/E7, and frequent pathogenic variants in the PI3K-AKT signaling cascade. In contrast, the HPV-negative carcinomas were characterized by a keratinizing morphology, lack of p16 and E6/E7 expression, and frequent somatic pathogenic variants in TP53, CDKN2A, and RB1. Among the patients with conjunctival tumors, HPV positivity was associated with a younger age at diagnosis and a higher risk of recurrence. In conclusion, the results support an etiological role of HPV in a subset of conjunctival and LDS carcinomas and their precursor lesions. Our investigations have shown that the HPV-positive carcinomas of the ocular adnexa share genomic and phenotypic characteristics with HPV-positive carcinomas of other anatomical locations. Therefore, these patients may be eligible for inclusion in future basket trials and future treatment regimens tailored to the more frequently occurring HPV-positive carcinomas of other locations. Future research will further elucidate the diagnostic, prognostic, and predictive role of HPV in these carcinomas.
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Penzhorn IH, Schneider JW, Sher-Locketz C. The Prevalence of Epstein-Barr Virus in Plasma Cell Neoplasms is Higher in HIV-Positive Individuals. Int J Surg Pathol 2022:10668969221113490. [PMID: 35912479 DOI: 10.1177/10668969221113490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Epstein-Barr virus (EBV) is causally associated with many hematolymphoid malignancies. This laboratory-based study aimed to establish the prevalence of EBV in plasma cell neoplasms in a large South African cohort and to determine whether there is any correlation between EBV-positivity and human immunodeficiency virus (HIV) status in patients with plasma cell neoplasms, including plasma cell myeloma and plasmacytoma (solitary plasmacytoma of bone and extraosseous plasmacytoma). METHODS This single-institution retrospective study included all patients with a histopathologic diagnosis of plasma cell neoplasm between 2003 and 2020. EBV-expression in the plasma cell neoplasms was assessed by EBV-encoded RNA (EBER) in situ hybridization (ISH) and correlated with HIV status. HIV status was determined by retrieving prior serologic results. Formalin-fixed paraffin-embedded tissue from HIV-unknown patients underwent HIV-1 p24 antibody testing. RESULTS Sixteen of 89 plasma cell neoplasms (18%) were EBV-positive. There was a significant correlation between EBV and HIV infection in plasma cell neoplasms, with 6/10 tumors from HIV positive patients showing EBV-positivity in tumor cells. The EBV-positive cohort was significantly younger than the EBV-negative group. CONCLUSION EBV-positivity in plasma cell neoplasms in this study is higher than previously reported. The significant occurrence of EBV in plasma cell neoplasms from HIV-positive patients suggests a co-carcinogenic relationship between the two viruses.
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Affiliation(s)
- Ingrid H Penzhorn
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service, 98826University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Johann W Schneider
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service, 98826University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Candice Sher-Locketz
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service, 98826University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa.,Anatomical Pathology, 484973PathCare, Cape Town, South Africa
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Phase I of the DiaVACCS screening trial: Study design, methods, population demographics and baseline results. S Afr Med J 2022. [DOI: 10.7196/samj.2022.v112i7.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Human papillomavirus (HPV)-based primary screening guidelines are based on screening test performance and prevalence data generated in high-resource areas with low HIV infection rates. There is an urgent need for local data on infection and disease prevalence, as well as screening test performance, among both HIV-positive and HIV-negative South African (SA) women, in order to inform updated screening guidelines.
Objectives. This study describes the baseline characteristics of participants in the cross-sectional phase of the multicentric DIAgnosis in Vaccine And Cervical Cancer Screen (DiaVACCS) screening trial. The objective was to determine the prevalence of positive screening and pre-invasive disease using different tests and strategies in the SA HIV-positive and HIV-negative population.Methods. A total of 1 104 women aged 25 - 65 years and eligible for screening were included, 465 HIV positive and 639 HIV negative. Visual inspection and molecular and cytological screening tests were done on self-sampled and healthcare worker-collected specimens. All participants who screened positive and 49.1% of those who screened negative were invited for colposcopy and biopsy, and those qualifying for treatment were recalled for large loop excision of the transformation zone as part of the trial. The worst histology result for each participant was used, and for untested women, multiple imputation was used to estimate verification bias- adjusted histology values.
Results. Visual inspection was positive in 50.4% of HIV-positive v. 20.9% of HIV-negative women, cytology (atypical squamous cells of undetermined significance) in 39.9% v. 17.0%, and high-risk HPV DNA in 41.2% v. 19.6%. Overall, high-grade squamous intraepithelial lesion-positive cytology peaked in the age group 30 - 39 years at 16.7%. After adjustment for verification bias, histological diagnosis of cervical intraepithelial neoplasia (CIN)2+ was suspected in 44.7% v. 23.5% and CIN3+ in 23.3% v. 10.2% of HIV-positive and negative women, respectively. Invasive cancer was diagnosed in 15 women (1.95% of histological studies performed), and verification bias adjustment suggested 20 cases (1.8% of the study population).
Conclusion. The baseline findings from the DiaVACCS trial confirm a high prevalence of HPV-related cervical pathology in the SA HIV-negative screening population, showing a clear need to reach these women with a screening programme. Among HIV-positive women, prevalence values were almost doubled. The prevalence of existing invasive cervical cancer was 1 - 2% of all women. Further analysis of the performance of single and multiple screening tests between the two subgroups will contribute to the choice of the most effective strategies to identify women at risk of developing invasive cancer.
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Makgoo L, Mosebi S, Mbita Z. Long noncoding RNAs (lncRNAs) in HIV-mediated carcinogenesis: Role in cell homeostasis, cell survival processes and drug resistance. Noncoding RNA Res 2022; 7:184-196. [PMID: 35991514 PMCID: PMC9361211 DOI: 10.1016/j.ncrna.2022.07.003] [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: 05/09/2022] [Revised: 07/04/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022] Open
Abstract
There is accruing data implicating long non-coding RNAs (lncRNAs) in the development and progression of non-communicable diseases such as cancer. These lncRNAs have been implicated in many diverse HIV-host interactions, some of which are beneficial to HIV propagation. The virus-host interactions induce the expression of HIV-regulated long non-coding RNAs, which are implicated in the carcinogenesis process, therefore, it is critical to understand the molecular mechanisms that underpin these HIV-regulated lncRNAs, especially in cancer formation. Herein, we summarize the role of HIV-regulated lncRNAs targeting cancer development-related processes including apoptosis, cell cycle, cell survival signalling, angiogenesis and drug resistance. It is unclear how lncRNAs regulate cancer development, this review also discuss recent discoveries regarding the functions of lncRNAs in cancer biology. Innovative research in this field will be beneficial for the future development of therapeutic strategies targeting long non-coding RNAs that are regulated by HIV, especially in HIV associated cancers.
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Radebe L, Haeri Mazanderani A, Sherman GG. Evaluating patient data quality in South Africa's National Health Laboratory Service Data Warehouse, 2017-2020: implications for monitoring child health programmes. BMC Public Health 2022; 22:1266. [PMID: 35768861 PMCID: PMC9241268 DOI: 10.1186/s12889-022-13508-y] [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: 11/10/2021] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
Background South Africa’s National Health Laboratory Service (NHLS), the only clinical laboratory service in the country’s public health sector, is an important resource for monitoring public health programmes. Objectives We describe NHLS data quality, particularly patient demographics among infants, and the effect this has on linking multiple test results to a single patient. Methods Retrospective descriptive analysis of NHLS data from 1st January 2017—1st September 2020 was performed. A validated probabilistic record-linking algorithm linked multiple results to individual patients in lieu of a unique patient identifier. Paediatric HIV PCR data was used to illustrate the effect on monitoring and evaluating a public health programme. Descriptive statistics including medians, proportions and inter quartile ranges are reported, with Chi-square univariate tests for independence used to determine association between variables. Results During the period analysed, 485 300 007 tests, 98 217 642 encounters and 35 771 846 patients met criteria for analysis. Overall, 15.80% (n = 15 515 380) of all encounters had a registered national identity (ID) number, 2.11% (n = 2 069 785) were registered without a given name, 63.15% (n = 62 020 107) were registered to women and 32.89% (n = 32 304 329) of all folder numbers were listed as either the patient’s date of birth or unknown. For infants tested at < 7 days of age (n = 2 565 329), 0.099% (n = 2 534) had an associated ID number and 48.87% (n = 1 253 620) were registered without a given name. Encounters with a given name were linked to a subsequent encounter 40.78% (n = 14 180 409 of 34 775 617) of the time, significantly more often than the 21.85% (n = 217 660 of 996 229) of encounters registered with a baby-derivative name (p-value < 0.001). Conclusion Unavailability and poor capturing of patient demographics, especially among infants and children, affects the ability to accurately monitor routine health programmes. A unique national patient identifier, other than the national ID number, is urgently required and must be available at birth if South Africa is to accurately monitor programmes such as the Prevention of Mother-to-Child Transmission of HIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13508-y.
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Affiliation(s)
- Lebohang Radebe
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.,Paediatric HIV Diagnostics Division, Wits Health Consortium, Johannesburg, South Africa
| | - Ahmad Haeri Mazanderani
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa. .,Paediatric HIV Diagnostics Division, Wits Health Consortium, Johannesburg, South Africa. .,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Gayle G Sherman
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.,Paediatric HIV Diagnostics Division, Wits Health Consortium, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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21
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Musekiwa A, Moyo M, Mohammed M, Matsena-Zingoni Z, Twabi HS, Batidzirai JM, Singini GC, Kgarosi K, Mchunu N, Nevhungoni P, Silinda P, Ekwomadu T, Maposa I. Mapping Evidence on the Burden of Breast, Cervical, and Prostate Cancers in Sub-Saharan Africa: A Scoping Review. Front Public Health 2022; 10:908302. [PMID: 35784211 PMCID: PMC9246362 DOI: 10.3389/fpubh.2022.908302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCancer remains a major public health problem, especially in Sub-Saharan Africa (SSA) where the provision of health care is poor. This scoping review mapped evidence in the literature regarding the burden of cervical, breast and prostate cancers in SSA.MethodsWe conducted this scoping review using the Arksey and O'Malley framework, with five steps: identifying the research question; searching for relevant studies; selecting studies; charting the data; and collating, summarizing, and reporting the data. We performed all the steps independently and resolved disagreements through discussion. We used Endnote software to manage references and the Rayyan software to screen studies.ResultsWe found 138 studies that met our inclusion criteria from 2,751 studies identified through the electronic databases. The majority were retrospective studies of mostly registries and patient files (n = 77, 55.8%), followed by cross-sectional studies (n = 51, 36.9%). We included studies published from 1990 to 2021, with a sharp increase from 2010 to 2021. The quality of studies was overall satisfactory. Most studies were done in South Africa (n = 20) and Nigeria (n = 17). The majority were on cervical cancer (n = 93, 67.4%), followed by breast cancer (67, 48.6%) and the least were on prostate cancer (48, 34.8%). Concerning the burden of cancer, most reported prevalence and incidence. We also found a few studies investigating mortality, disability-adjusted life years (DALYs), and years of life lost (YLL).ConclusionsWe found many retrospective record review cross-sectional studies, mainly in South Africa and Nigeria, reporting the prevalence and incidence of cervical, breast and prostate cancer in SSA. There were a few systematic and scoping reviews. There is a scarcity of cervical, breast and prostate cancer burden studies in several SSA countries. The findings in this study can inform policy on improving the public health systems and therefore reduce cancer incidence and mortality in SSA.
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Affiliation(s)
- Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- *Correspondence: Alfred Musekiwa
| | - Maureen Moyo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mohanad Mohammed
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Zvifadzo Matsena-Zingoni
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jesca Mercy Batidzirai
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Kabelo Kgarosi
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nobuhle Mchunu
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Portia Nevhungoni
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Patricia Silinda
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Theodora Ekwomadu
- Department of Biological Sciences, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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22
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Baluku JB, Bogere N, Namiiro S, Walusansa V, Andia-Biraro I, Worodria W, Kirenga B. HIV-related lung cancer in Uganda: a cohort study. Infect Agent Cancer 2022; 17:24. [PMID: 35668439 PMCID: PMC9169266 DOI: 10.1186/s13027-022-00439-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background There are few reports on lung cancer among people with HIV (PWH) in Sub-Saharan Africa. In this report, we describe a cohort of PWH and lung cancer at the Uganda Cancer Institute.
Methods This retrospective cohort of PWH and lung cancer was managed at the Uganda Cancer Institute between 2008 and 2018. Sociodemographic and clinical data were abstracted from the patient charts. The median survival from diagnosis to death, loss-to-follow up or 31st December 2018, was estimated.
Results There were 18 people with HIV and lung cancer. The median (interquartile range, IQR) age was 49.5 (38.8–56.0) years, 11 (61.1%) were women and 5 (27.8%) were smokers. Of the 18 PWH, 13 (72.2%) were on antiretroviral therapy and the median (IQR) CD4 count (n = 13) was 380 (243.5–595) cells per mm3. Difficulty in breathing (88.9%), chest pain (78.6%, n = 11), cough (76.5%, n = 17) and weight loss (72.2%) were the commonest symptoms while pleural effusions were observed in 12 (66.7%). In this cohort, 8 (44.4%) were presumptively treated for tuberculosis before the diagnosis of lung cancer. Seven (38.9%) had an Eastern Cooperative Oncology Group performance status of 3. Non-small cell lung cancer was the predominant histological type observed in 17 (94.4%) of whom 14 (82.4%) had adenocarcinoma. Majority of PWH had stage IV disease (88.9%). The median (IQR) survival was 3.3 (1.1–13.2) months and all were either dead (72.2%) or lost-to-follow up (27.8%) at five years from diagnosis. Conclusion People with HIV and lung cancer in Uganda report low rates of smoking, present with advanced disease and post very poor survival rates. There is need for biomarkers for early detection of lung cancer in HIV.
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Affiliation(s)
- Joseph Baruch Baluku
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda. .,Kiruddu National Referral Hospital, Kampala, Uganda.
| | | | - Sharon Namiiro
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda
| | | | | | - William Worodria
- Makerere University College of Health Sciences, Kampala, Uganda.,Mulago National Referral Hospital, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda.,Makerere University College of Health Sciences, Kampala, Uganda
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23
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Epidemiology of Kaposi’s sarcoma in sub-Saharan Africa. Cancer Epidemiol 2022; 78:102167. [DOI: 10.1016/j.canep.2022.102167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 12/24/2022]
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24
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Muchengeti M, Bartels L, Olago V, Dhokotera T, Chen WC, Spoerri A, Rohner E, Bütikofer L, Ruffieux Y, Singh E, Egger M, Bohlius J. Cohort profile: the South African HIV Cancer Match (SAM) Study, a national population-based cohort. BMJ Open 2022; 12:e053460. [PMID: 35410922 PMCID: PMC9003610 DOI: 10.1136/bmjopen-2021-053460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 03/16/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The South African HIV Cancer Match (SAM) Study is a national cohort of people living with HIV (PLWH). It was created using probabilistic record linkages of routine laboratory records of PLWH retrieved by National Health Laboratory Services (NHLS) and cancer data from the National Cancer Registry. The SAM Study aims to assess the spectrum and risk of cancer in PLWH in the context of the evolving South African HIV epidemic. The SAM Study's overarching goal is to inform cancer prevention and control programmes in PLWH in the era of antiretroviral treatment in South Africa. PARTICIPANTS PLWH (both adults and children) who accessed HIV care in public sector facilities and had HIV diagnostic or monitoring laboratory tests from NHLS. FINDINGS TO DATE The SAM cohort currently includes 5 248 648 PLWH for the period 2004 to 2014; 69% of these are women. The median age at cohort entry was 33.0 years (IQR: 26.2-40.9). The overall cancer incidence in males and females was 235.9 (95% CI: 231.5 to 240.5) and 183.7 (181.2-186.2) per 100 000 person-years, respectively.Using data from the SAM Study, we examined national cancer incidence in PLWH and the association of different cancers with immunodeficiency. Cancers with the highest incidence rates were Kaposi sarcoma, cervix, breast, non-Hodgkin's lymphoma and eye cancer. FUTURE PLANS The SAM Study is a unique, evolving resource for research and surveillance of malignancies in PLWH. The SAM Study will be regularly updated. We plan to enrich the SAM Study through record linkages with other laboratory data within the NHLS (eg, tuberculosis, diabetes and lipid profile data), mortality data and socioeconomic data to facilitate comprehensive epidemiological research of comorbidities among PLWH.
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Affiliation(s)
- Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Lina Bartels
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Victor Olago
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Tafadzwa Dhokotera
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Yann Ruffieux
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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25
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Motlhale M, Sitas F, Bradshaw D, Chen WC, Singini MG, de Villiers CB, Lewis CM, Muchengeti M, Waterboer T, Mathew CG, Newton R, Singh E. Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study. Cancer Epidemiol 2022; 78:102158. [PMID: 35421713 DOI: 10.1016/j.canep.2022.102158] [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: 09/16/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/15/2022]
Abstract
Kaposi Sarcoma (KS) is endemic in several countries in Southern and Eastern Africa, relatively rare worldwide but a leading cancer among people living with HIV. KS has always been more common in adult males than females. We assessed the prevalence of known cancer modifying factors (parity, hormonal contraceptive use in females, sex-partners, smoking and alcohol consumption in both sexes), and their relationship to KS, and whether any of these could account for the unequal KS sex ratios. We calculated logistic regression case-control adjusted odds ratios (ORadj), and 95% confidence intervals (95%CI), between KS and each of the modifying factors, using appropriate comparison controls. Controls were cancer types that had no known relationship to exposures of interest (infection or alcohol or smoking or contraceptive use). The majority of the 1275 KS cases were HIV positive (97%), vs. 15.7% in 10,309 controls. The risk of KS among those with HIV was high in males (ORadj=116.70;95%CI=71.35-190.88) and females (ORadj=93.91;95%CI=54.22-162.40). Among controls, the prevalence of smoking and alcohol consumption was five and three times higher in males vs. females. We found a positive association between KS and heavy vs. non-drinking (ORadj=1.31;95%CI=1.03-1.67), and in current heavy vs. never smokers (ORadj=1.82;95%CI=1.07-3.10). These associations remained positive for alcohol consumption (but with wider CIs) after stratification by sex, and restriction to HIV positive participants. We found no evidence of interactions of smoking and alcohol by sex. Smoking and alcohol consumption may provide a possible explanation for the KS sex differences, given both exposures are more common in men, but confounding and bias cannot be fully ruled out. The role smoking and alcohol play in relation to viral loads of HIV/KSHV, differences in immunological responses or other genetic differences between males and females warrant further studies.
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Affiliation(s)
- Melitah Motlhale
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Freddy Sitas
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Centre for Primary Health Care and Equity, School of Population Health, University of New South Wales Sydney, Australia; Menzies Centre of Health Policy, School of Public Health, University of Sydney, Australia
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mwiza Gideon Singini
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8AF, United Kingdom; Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christopher G Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; University of York, York, United Kingdom
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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26
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Dhokotera T, Asangbeh S, Bohlius J, Singh E, Egger M, Rohner E, Ncayiyana J, Clifford GM, Olago V, Sengayi-Muchengeti M. Cervical cancer in women living in South Africa: a record linkage study of the National Health Laboratory Service and the National Cancer Registry. Ecancermedicalscience 2022; 16:1348. [PMID: 35242229 PMCID: PMC8831110 DOI: 10.3332/ecancer.2022.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION In countries with high HIV prevalence, it is important to understand the cervical cancer (CC) patterns by HIV status to ensure targeted prevention measures. We aimed to determine the factors associated with CC compared to non-infection related cancer in women living in South Africa. METHODS This was a cross-sectional study of women aged 15 years and older diagnosed with CC and non-infection related cancer in the South African public health sector from 2004 to 2014. The National Cancer Registry provided data on cancer, whilst HIV status was determined from routinely collected HIV related data from the National Health Laboratory Service. We explored the association of HIV infection, age, ethnicity and calendar period with CC compared to non-infection related cancer. RESULTS From 2004 to 2014, 49,599 women were diagnosed with CC, whilst 78,687 women had non-infection related cancer. About 40% (n = 20,063) of those with CC and 28% (n = 5,667) of those with non-infection related cancer had a known HIV status. The median age at CC diagnosis was 44 years (interquartile range (IQR): 37-52) and 54 years (IQR: 46-64) for HIV positive and negative women, respectively, and for non-infection related cancer, 45 years (IQR: 47-55) and 56 years (IQR: 47-66) for HIV negative and positive women, respectively. Diagnosis of CC was associated with HIV positivity, Black ethnicity, earlier calendar period (2004-2006) and the ages 30-49 years. In comparison with Black women, the odds of CC were 44% less in Coloured women, 50% less in Asian women and 51% less in White women. CONCLUSIONS HIV positive women presented a decade earlier with CC compared to HIV negative women. A large proportion of women with CC were unaware of their HIV status with a disproportionate burden of CC in Black women. We recommend women attending CC screening facilities to be offered HIV testing so that recommendations for their follow-up visits are given according to their HIV status.
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Affiliation(s)
- Tafadzwa Dhokotera
- National Cancer Registry, National Health Laboratory Science, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Uni Mittelstrasse, Mittelstrasse 43, CH-3012 Bern, Switzerland
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel Land, Switzerland
| | - Serra Asangbeh
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Uni Mittelstrasse, Mittelstrasse 43, CH-3012 Bern, Switzerland
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel Land, Switzerland
| | - Julia Bohlius
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel Land, Switzerland
- University of Basel, Peterspl. 1, 4001 Basel, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Science, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Beacon House, Queens Road, Bristol BS8 1QU, UK
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Falmouth Rd, Observatory, Cape Town 7925, South Africa
| | - Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Jabulani Ncayiyana
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, George Campbell Building, 2nd Floor, Rm 226, 238 Mazisi Kunene Rd, Glenwood, Durban 4041, South Africa
| | - Gary M Clifford
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, (IARC/WHO), 150 cours Albert Thomas, 69372 Lyon, Cedex 08, France
| | - Victor Olago
- National Cancer Registry, National Health Laboratory Science, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
| | - Mazvita Sengayi-Muchengeti
- National Cancer Registry, National Health Laboratory Science, 1 Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
- School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg 2193, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, 19 Jonkershoek Road, Stellenbosch 7600, South Africa
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27
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Mbuya W, Held K, Mcharo RD, Haule A, Mhizde J, Mnkai J, Mahenge A, Mwakatima M, Sembo M, Mwalongo W, Agrea P, Hoelscher M, Maboko L, Saathoff E, Geisenberger O, Rwegoshora F, Torres L, Koup RA, Kroidl A, Chachage M, Geldmacher C. Depletion of Human Papilloma Virus E6- and E7-Oncoprotein-Specific T-Cell Responses in Women Living With HIV. Front Immunol 2021; 12:742861. [PMID: 34759925 PMCID: PMC8573218 DOI: 10.3389/fimmu.2021.742861] [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: 07/16/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cervical cancer - caused by persistent High Risk Human Papilloma Virus (HR HPV) infections - is the second most common cancer affecting women globally. HIV infection increases the risk for HPV persistence, associated disease progression and malignant cell transformation. We therefore hypothesized that this risk increase is directly linked to HIV infection associated dysfunction or depletion of HPV-oncoprotein-specific T-cell responses. Methods The 2H study specifically included HIV+ and HIV- women with and without cervical lesions and cancer to analyze HPV oncogene-specific T cell responses in relation to HPV infection, cervical lesion status and HIV status. Oncoprotein E6 and E7 specific T-cell responses were quantified for the most relevant types HPV16, 18 and 45 and control antigens (CMV-pp65) and M.tb-PPD in 373 women, using fresh peripheral blood mononuclear cells in an IFN-γ release ELISpot assay. Results Overall, systemic E6- and E7-oncoprotein-specific T-cell responses were infrequent and of low magnitude, when compared to CMV-pp65 and M.tb-PPD (p < 0.001 for all HR HPV types). Within HIV negative women infected with either HPV16, 18 or 45, HPV16 infected women had lowest frequency of autologous-type-E6/E7-specific T-cell responses (33%, 16/49), as compared to HPV18 (46% (6/13), p = 0.516) and HPV45 (69% (9/13), p = 0.026) infected women. Prevalent HPV18 and 45, but not HPV16 infections were linked to detectable oncoprotein-specific T-cell responses, and for these infections, HIV infection significantly diminished T-cell responses targeting the autologous infecting genotype. Within women living with HIV, low CD4 T-cell counts, detectable HIV viremia as well as cancerous and precancerous lesions were significantly associated with depletion of HPV oncoprotein-specific T-cell responses. Discussion Depletion of HPV-oncoprotein-specific T-cell responses likely contributes to the increased risk for HR HPV persistence and associated cancerogenesis in women living with HIV. The low inherent immunogenicity of HPV16 oncoproteins may contribute to the exceptional potential for cancerogenesis associated with HPV16 infections.
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Affiliation(s)
- Wilbert Mbuya
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.,Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Kathrin Held
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Ruby D Mcharo
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Antelmo Haule
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Jacklina Mhizde
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Jonathan Mnkai
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Anifrid Mahenge
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Maria Mwakatima
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Margareth Sembo
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Wolfram Mwalongo
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Peter Agrea
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Leonard Maboko
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.,Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Otto Geisenberger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - France Rwegoshora
- Pathology Department, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Liset Torres
- Pathology Department, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Richard A Koup
- Vaccine Research Centre, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Mkunde Chachage
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.,Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,Microbiology and Immunology Department, University of Dar es Salaam -Mbeya College of Health and Allied Sciences (UDSM-MCHAS), Mbeya, Tanzania
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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Castle PE, Einstein MH, Sahasrabuddhe VV. Cervical cancer prevention and control in women living with human immunodeficiency virus. CA Cancer J Clin 2021; 71:505-526. [PMID: 34499351 PMCID: PMC10054840 DOI: 10.3322/caac.21696] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Despite being highly preventable, cervical cancer is the fourth most common cancer and cause of cancer death in women globally. In low-income countries, cervical cancer is often the leading cause of cancer-related morbidity and mortality. Women living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are at a particularly high risk of cervical cancer because of an impaired immune response to human papillomavirus, the obligate cause of virtually all cervical cancers. Globally, approximately 1 in 20 cervical cancers is attributable to HIV; in sub-Saharan Africa, approximately 1 in 5 cervical cancers is due to HIV. Here, the authors provide a critical appraisal of the evidence to date on the impact of HIV disease on cervical cancer risk, describe key methodologic issues, and frame the key outstanding research questions, especially as they apply to ongoing global efforts for prevention and control of cervical cancer. Expanded efforts to integrate HIV care with cervical cancer prevention and control, and vice versa, could assist the global effort to eliminate cervical cancer as a public health problem.
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Affiliation(s)
- Philip E. Castle
- Division of Cancer PreventionNational Cancer InstituteNational Institutes of HealthRockvilleMaryland
- Division of Cancer Epidemiology and GeneticsNational Cancer InstituteNational Institutes of HealthRockvilleMaryland
| | - Mark H. Einstein
- Department of Obstetrics, Gynecology, and Reproductive HealthRutgers New Jersey Medical SchoolNewarkNew Jersey
| | - Vikrant V. Sahasrabuddhe
- Division of Cancer PreventionNational Cancer InstituteNational Institutes of HealthRockvilleMaryland
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29
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Wiggill T, Mayne E, Perner Y, Vaughan J. Changing Patterns of Lymphoma in the Antiretroviral Therapy Era in Johannesburg, South Africa. J Acquir Immune Defic Syndr 2021; 88:252-260. [PMID: 34354010 DOI: 10.1097/qai.0000000000002768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND South Africa has a high HIV prevalence, which associates with an increased risk of lymphoma. Antiretroviral therapy (ART) became accessible in 2004, but the program has substantially expanded. Changes in lymphoma patterns are documented in high-income countries after wide-scale ART including declining high-grade B-cell non-Hodgkin lymphomas (HG B-NHLs), particularly diffuse large B-cell lymphoma, and increased Hodgkin lymphoma (HL). There are limited data from Africa. This study aimed to compare HG B-NHL characteristics in the early (2007) and later (2017) ART era. METHODS All incident lymphomas at the National Health Laboratory Service, Johannesburg, were identified using the laboratory information system, and data were collected for each patient. RESULTS The total number of lymphoma cases increased from 397 (2007) to 582 (2017). This was associated with improved lymphoma classification and patient referral for oncological care. HG B-NHL remained the most diagnosed lymphoma subtype in 2017 comprising 70% of HIV-associated lymphomas, followed by HL (24%). Diffuse large B-cell lymphoma comprised 65% of all HG B-NHLs and 45% of all lymphomas in people with HIV in 2017. Significantly more patients were on ART in 2017, with improvements in virological control documented. Despite this, 47.6% of patients were not virologically suppressed, and 37.5% of patients were ART-naive at time of diagnosis in 2017. Immunological reconstitution was suboptimal, which may reflect late initiation of ART. CONCLUSION Public health initiatives to initiate ART as early as possible and to retain patients in ART programs may assist in decreasing the number of HIV-associated lymphomas in our setting.
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Affiliation(s)
| | | | - Yvonne Perner
- Anatomical Pathology, Faculty of Health Sciences, University of Witwatersrand, and National Health Laboratory Service, Johannesburg, South Africa
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30
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Dhokotera T, Bohlius J, Egger M, Spoerri A, Ncayiyana JR, Naidu G, Olago V, Zwahlen M, Singh E, Muchengeti M. Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study. BMJ Open 2021; 11:e043941. [PMID: 34663647 PMCID: PMC8524277 DOI: 10.1136/bmjopen-2020-043941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the spectrum of cancers in adolescents and young adults (AYAs) living with and without HIV in South Africa. DESIGN Cross-sectional study with cancer records provided by the National Cancer Registry (NCR) and HIV records from the National Health Laboratory Service (NHLS). SETTING AND PARTICIPANTS The NHLS is the largest provider of pathology services in the South African public sector. The NCR is a division of the NHLS. We included AYAs (aged 10-24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8479). HIV status was obtained through record linkages and text mining. PRIMARY AND SECONDARY OUTCOMES We determined the spectrum of cancers by HIV status in AYAs. We used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex, ethnicity and calendar period. We imputed (post hoc) the HIV status for AYA with unknown HIV status. RESULTS 8479 AYAs were diagnosed with cancer, HIV status was known for 45% (n=3812). Of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi's sarcoma (adjusted OR (aOR) 218, 95% CI 89.9 to 530), cervical cancer (aOR 2.18, 95% CI 1.23 to 3.89), non-Hodgkin's lymphoma (aOR 2.12, 95% CI 1.69 to 2.66) and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27 to 5.86) than AYAs without HIV. About 44% (n=1062) of AYAs with HIV-related cancers had not been tested for HIV. CONCLUSIONS Targeted HIV testing for AYAs diagnosed with cancer, followed by immediate start of antiretroviral therapy, screening for cervical precancer and vaccination against human papilloma virus is needed to decrease cancer burden in AYAs living with HIV in South Africa.
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Affiliation(s)
- Tafadzwa Dhokotera
- National Cancer Registry, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town School of Public Health and Family Medicine, Observatory, Western Cape, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jabulani Ronnie Ncayiyana
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town School of Public Health and Family Medicine, Observatory, Western Cape, South Africa
| | - Gita Naidu
- Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Victor Olago
- National Cancer Registry, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Division of Epidemiology and Biostatistics, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- South African DSI-NRF Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
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31
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Okello CD, Niyonzima N, Ferraresso M, Kadhumbula S, Ddungu H, Tarlock K, Balagadde-Kambugu J, Omoding A, Ngendahayo L, Karagu A, Mwaiselage J, Harlan JM, Uldrick TS, Turner SD, Orem J. Haematological malignancies in sub-Saharan Africa: east Africa as an example for improving care. Lancet Haematol 2021; 8:e756-e769. [PMID: 34481552 DOI: 10.1016/s2352-3026(21)00198-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
Haematological malignancies account for almost 10% of all cancers diagnosed in sub-Saharan Africa, although the exact incidences and treatment outcomes are difficult to discern because population-based cancer registries in the region are still underdeveloped. More research on haematological malignancies in sub-Saharan Africa is required to establish whether these cancers have a natural history similar to those diagnosed in high-income countries, about which more is known. Several factors negatively affect the outcome of haematological malignancies in sub-Saharan Africa, showcasing a need for improved understanding of the clinicobiological profile of these cancers to facilitate prevention, early detection, diagnosis, and appropriate treatment through increased capacity building, infrastructure, community awareness, coordinated resource mobilisation, and collaboration across the world. The east African governments have pooled resources for common investments to tackle non-communicable diseases, developing the East Africa's Centres of Excellence for Skills and Tertiary Education project funded by the African Development Bank, an initiative that could be replicated for the care of haematological malignancies in other countries in sub-Saharan Africa. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | | | | | | | - Katherine Tarlock
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | | | | | - Louis Ngendahayo
- Anatomical Pathology Service, University Teaching Hospital of Kamenge, Bujumbura, Burundi
| | | | | | | | - Thomas S Uldrick
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA
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32
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Kuguyo O, Dube Mandishora RS, Thomford NE, Makunike-Mutasa R, Nhachi CFB, Matimba A, Dandara C. High-risk HPV genotypes in Zimbabwean women with cervical cancer: Comparative analyses between HIV-negative and HIV-positive women. PLoS One 2021; 16:e0257324. [PMID: 34582476 PMCID: PMC8478215 DOI: 10.1371/journal.pone.0257324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/30/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND High-risk human papillomavirus HPV (HR-HPV) modifies cervical cancer risk in people living with HIV, yet African populations are under-represented. We aimed to compare the frequency, multiplicity and consanguinity of HR-HPVs in HIV-negative and HIV-positive Zimbabwean women. METHODS This was a cross-sectional study consisting of women with histologically confirmed cervical cancer attending Parirenyatwa Group of Hospitals in Harare, Zimbabwe. Information on HIV status was also collected for comparative analysis. Genomic DNA was extracted from 258 formalin fixed paraffin embedded tumour tissue samples, and analysed for 14 HR-HPV genotypes. Data was analysed using Graphpad Prism and STATA. RESULTS Forty-five percent of the cohort was HIV-positive, with a median age of 51 (IQR = 42-62) years. HR-HPV positivity was detected in 96% of biospecimens analysed. HPV16 (48%), was the most prevalent genotype, followed by HPV35 (26%), HPV18 (25%), HPV58 (11%) and HPV33 (10%), irrespective of HIV status. One third of the cohort harboured a single HPV infection, and HPV16 (41%), HPV18 (21%) and HPV35 (21%) were the most prevalent. HIV status did not influence the prevalence and rate of multiple HPV infections (p>0.05). We reported significant (p<0.05) consanguinity of HPV16/18 (OR = 0.3; 95% CI = 0.1-0.9), HPV16/33 (OR = 0.3; 95% CI = 0.1-1.0), HPV16/35 (OR = 3.3; 95% CI = 2.0-6.0), HPV35/51 (OR = 6.0; 95%CI = 1.8-15.0); HPV39/51 (OR = 6.4; 95% CI = 1.8-15), HPV31/52 (OR = 6.2; 95% CI = 1.8-15), HPV39/56 (OR = 11 95% CI = 8-12), HPV59/68 (OR = 8.2; 95% CI = 5.3-12.4), HPV66/68 (OR = 7; 95% CI = 2.4-13.5), independent of age and HIV status. CONCLUSION We found that HIV does not influence the frequency, multiplicity and consanguinity of HR-HPV in cervical cancer. For the first time, we report high prevalence of HPV35 among women with confirmed cervical cancer in Zimbabwe, providing additional evidence of HPV diversity in sub-Saharan Africa. The data obtained here probes the need for larger prospective studies to further elucidate HPV diversity and possibility of selective pressure on genotypes.
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Affiliation(s)
- Oppah Kuguyo
- Department of Clinical Pharmacology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
- Division of Human Genetics, Department of Pathology, Pharmacogenomics and Drug Metabolism Group, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Racheal S. Dube Mandishora
- Faculty of Health Sciences, Department of Medical Microbiology Unit, University of Zimbabwe College of Health Sciences, Harare Zimbabwe University of Zimbabwe, Medical Microbiology Unit, Harare, Zimbabwe
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Nicholas Ekow Thomford
- Division of Human Genetics, Department of Pathology, Pharmacogenomics and Drug Metabolism Group, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, Cape Town, South Africa
- Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, PMB, Ghana
| | - Rudo Makunike-Mutasa
- Department of Pathology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Charles F. B. Nhachi
- Department of Clinical Pharmacology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Alice Matimba
- Advanced Courses and Scientific Conferences, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology, Pharmacogenomics and Drug Metabolism Group, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, Cape Town, South Africa
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33
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Jaquet A, Boni SP, Boidy K, Tine J, Tchounga B, Touré SA, Koffi JJ, Dial C, Monnereau A, Diomande I, Tanon A, Seydi M, Dabis F, Diop S, Koffi G. Chronic viral hepatitis, HIV infection and Non-Hodgkin lymphomas in West Africa, a case-control study. Int J Cancer 2021; 149:1536-1543. [PMID: 34124779 DOI: 10.1002/ijc.33709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/09/2022]
Abstract
Non-Hodgkin lymphomas (NHL) are underestimated causes of cancer in West Africa where chronic viral hepatitis and HIV are endemic. While the association with HIV infection has already been characterized, limited information is available on the association between chronic viral hepatitis and NHL in sub-Saharan Africa. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire) and Dakar (Senegal). Cases of NHL were matched with controls on age, gender and participating site. The diagnosis of NHL relied on local pathological examination completed with immunohistochemistry. HIV, HBV and HCV serology tests were systematically performed. A conditional logistic regression model estimated the associations by the Odds Ratio (OR) with their 95% confidence interval (CI). A total of 117 NHL cases (Abidjan n = 97, Dakar n = 20) and their 234 matched controls were enrolled. Cases were predominantly men (68.4%) and had a median age of 50 years (IQR 37-57). While Diffuse Large B-cell lymphoma were the most reported morphological type (n = 35) among mature B-cell NHL, the proportion mature T-cell NHL (30%) was high. The prevalence figures of HBV, HCV and HIV infection were 12.8%, 7.7% and 14.5%, respectively among cases of NHL. In multivariate analysis, HBV, HCV and HIV were independently associated with NHL with OR of 2.23 (CI 1.05-4.75), 4.82 (CI 1.52-15.29) and 3.32 (CI 1.54-7.16), respectively. Chronic viral hepatitis B and C were significantly associated with NHL in West Africa. Timely preventive measures against HBV infection and access to curative anti-HCV treatment might prevent a significant number of NHL.
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Affiliation(s)
- Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Simon P Boni
- Programme National de Lutte Contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire.,Programme PACCI/Site ANRS Abidjan, Abidjan, Côte d'Ivoire
| | - Kouakou Boidy
- Service d'hématologie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Judicaël Tine
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Boris Tchounga
- Programme PACCI/Site ANRS Abidjan, Abidjan, Côte d'Ivoire.,Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Sokhna A Touré
- Service d'hématologie, Centre National de Transfusion Sanguine, Dakar, Senegal
| | | | - Cherif Dial
- Service Anatomopathologie, Hôpital de Grand Yoff, Dakar, Senegal
| | - Alain Monnereau
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Isidore Diomande
- Service Anatomopathologie, Centre Hospitalier Universitaire Cocody, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - François Dabis
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Saliou Diop
- Service d'hématologie, Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Gustave Koffi
- Service d'hématologie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
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34
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Chiao EY, Coghill A, Kizub D, Fink V, Ndlovu N, Mazul A, Sigel K. The effect of non-AIDS-defining cancers on people living with HIV. Lancet Oncol 2021; 22:e240-e253. [PMID: 34087151 PMCID: PMC8628366 DOI: 10.1016/s1470-2045(21)00137-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
Non-AIDS-defining cancers are a growing source of morbidity for people with HIV globally. Although people living with HIV have a disproportionately increased risk of developing virally mediated cancers, cancer burden for common non-AIDS-defining cancers that are not virally associated and are linked to ageing, such as prostate cancer, is becoming higher than for virally mediated cancers. Ageing, behavioural, and HIV-specific factors drive the incidence and affect the outcomes of non-AIDS-defining cancers, presenting different challenges for addressing global morbidity and mortality from non-AIDS-defining cancer. Although large population-based studies have shown that people living with HIV with non-AIDS-defining cancers have poorer cancer outcomes than do people without HIV, current guidelines emphasise that people living with HIV with non-AIDS-defining cancers should receive standard, guideline-based treatment, and infectious disease and oncology providers should work closely to address potential drug interactions between antiretroviral therapy and antineoplastic treatment. Most trials target preventive measures focusing on non-AIDS-defining cancers. However, treatment trials for the optimal management of people living with HIV and non-AIDS-defining cancer, including interventions such as immunotherapies, are needed to improve non-AIDS-defining cancer outcomes.
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Affiliation(s)
- Elizabeth Y Chiao
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Anna Coghill
- Cancer Epidemiology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Center for Immunization and Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Darya Kizub
- Department of General Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valeria Fink
- Clinical Research, Fundación Huésped, Buenos Aires, Argentina
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Angela Mazul
- Department of Otolaryngology, Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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35
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A proposed new generation of evidence-based microsimulation models to inform global control of cervical cancer. Prev Med 2021; 144:106438. [PMID: 33678235 PMCID: PMC8041229 DOI: 10.1016/j.ypmed.2021.106438] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 01/30/2023]
Abstract
Health decision models are the only available tools designed to consider the lifetime natural history of human papillomavirus (HPV) infection and pathogenesis of cervical cancer, and the estimated long-term impact of preventive interventions. Yet health decision modeling results are often considered a lesser form of scientific evidence due to the inherent needs to rely on imperfect data and make numerous assumptions and extrapolations regarding complex processes. We propose a new health decision modeling framework that de-emphasizes cytologic-colposcopic-histologic diagnoses due to their subjectivity and lack of reproducibility, relying instead on HPV type and duration of infection as the major determinants of subsequent transition probabilities. We posit that the new model health states (normal, carcinogenic HPV infection, precancer, cancer) and corollary transitions are universal, but that the probabilities of transitioning between states may vary by population. Evidence for this variability in host response to HPV infections can be inferred from HPV prevalence patterns in different regions across the lifespan, and might be linked to different average population levels of immunologic control of HPV infections. By prioritizing direct estimation of model transition probabilities from longitudinal data (and limiting reliance on model-fitting techniques that may propagate error when applied to multiple transitions), we aim to reduce the number of assumptions for greater transparency and reliability. We propose this new microsimulation model for critique and discussion, hoping to contribute to models that maximally inform efficient strategies towards global cervical cancer elimination.
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36
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Abstract
PURPOSE OF REVIEW Historically, conjunctival cancer has been associated with HIV particularly in sub-Saharan Africa. The human papilloma virus (HPV) has been implicated as a potential causative agent without conclusive evidence. This review covers recent evidence of the epidemiology, diagnosis and treatment of conjunctival cancer in people living with HIV (PLWH). RECENT FINDINGS HIV infection has been attributed to 33% of squamous cell carcinoma of the conjunctiva in sub-Saharan Africa. Although clear evidence of the effect of immunodeficiency on conjunctival cancer risk has been demonstrated, the role of HPV on conjunctival cancer development is still unclear. Biomarkers such as the p16 protein are not always indicative of HPV infection. The Epstein-Barr virus (EBV) might potentially be another infectious agent of interest in the development of conjunctival cancer. There is some evidence of increased conjunctival cancer recurrence post treatment as well as increased probability of metastasis in PLWH. SUMMARY Immunodeficiency increases the risk of conjunctival cancer in PLWH. Symptomatic screening of conjunctival cancer in PLWH should be encouraged. Research on HPV involvement should remain a priority and EBV considered as another etiologic agent of interest. More studies on treatment modalities in PLWH should be considered.
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Affiliation(s)
- Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern
- Swiss Tropical and Public Health Institute, University of Basel, Basel
| | - Tafadzwa G Dhokotera
- National Cancer Registry, National Health Laboratory Service
- Institute of Social and Preventive Medicine, University of Bern, Bern
- Swiss Tropical and Public Health Institute, University of Basel, Basel
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
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Nnaji CA, Moodley J. Impact of the COVID-19 pandemic on cancer diagnosis, treatment and research in African health systems: a review of current evidence and contextual perspectives. Ecancermedicalscience 2021; 15:1170. [PMID: 33680084 PMCID: PMC7929764 DOI: 10.3332/ecancer.2021.1170] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has immensely disrupted health care services globally. The pandemic has been particularly disruptive for cancer services and more so in low-resource settings. In this narrative review, we highlight the reported impact of the COVID-19 pandemic on cancer prevention, screening, diagnosis, treatment and research across the African continent. We also explore ways in which identified structural and contextual constraints can be navigated for the re-escalation of oncological activities, while discussing how the pandemic has necessitated the reimagination of how oncology services can be delivered now and in the future. We conducted a literature search of MEDLINE (via PubMed) and Scopus for relevant articles and synthesised the findings thematically. In spite of the dearth of data, available evidence suggests a substantial impact of the pandemic on the various aspects of cancer management in African countries. Aggravating factors include pre-existing health system and cancer management gaps in many countries within the region, which are typically faced with inadequate availability of oncology resources, oncologists and other vital resources; in addition to the acute and lingering consequences of social distancing, movement restrictions and other public health measures implemented to contain the spread of the virus. As the pandemic evolves and movement restrictions are eased, there is a need for the timely and safe return to normal oncological care. This will require a risk-adjusted and multidisciplinary approach, with the aim of mitigating the further impact of the disruption on cancer patients, their families and healthcare providers.
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Affiliation(s)
- Chukwudi A Nnaji
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town; Anzio Road, Observatory, 7925 Cape Town, South Africa.,Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa
| | - Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town; Anzio Road, Observatory, 7925 Cape Town, South Africa.,Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa.,SAMRC Gynaecology Cancer Research Centre, University of Cape Town, 7925 Cape Town, South Africa
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Galati L, Combes JD, Gupta P, Sen R, Robitaille A, Brancaccio RN, Atsou K, Cuenin C, McKay-Chopin S, Tornesello ML, Buonaguro FM, Clifford G, Gheit T, Tommasino M. Detection of a large spectrum of viral infections in conjunctival premalignant and malignant lesions. Int J Cancer 2020; 147:2862-2870. [PMID: 32525572 DOI: 10.1002/ijc.33149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
To study the interaction between HIV and other carcinogenic infections in conjunctival squamous cell carcinoma (SCC), we evaluated the presence of a broad spectrum of human viruses in conjunctiva specimens. Beta Human papillomavirus (HPV; n = 46), gamma HPV (n = 52), polyomaviruses (n = 12) and herpes viruses (n = 3) was determined in DNA extracted from 67 neoplastic and 55 non-neoplastic conjunctival tissues of HIV-positive and HIV negative subjects by Luminex-based assays. Next-generation sequencing (NGS) was also used to further characterize the presence of cutaneous HPVs. Detection of beta-2 HPV infections was associated with the risk of neoplasia (adjusted odds ratio [aOR] 3.0; 95% confidence interval [CI] 1.3-6.8), regardless of HIV status (HIV positive, aOR 2.6, 95% CI 0.9-7.7; HIV negative, aOR 3.5, 95% CI 0.9-14.4). EBV was strongly associated with the risk of neoplasia (aOR 12.0, 95% CI 4.3-33.5; P < .01) mainly in HIV individuals (HIV positive, aOR 57.5; 95% CI: 10.1-327.1; HIV negative aOR 2.6; 95% CI: 0.2-34.7). NGS allowed to identify 13 putative novel HPVs in cases and controls. Our findings suggest a role of beta HPV types and EBV, in conjunctival SCC. However, additional studies of viral expression in tumor tissue are required to confirm the causal association.
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Affiliation(s)
- Luisa Galati
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Jean Damien Combes
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Purnima Gupta
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Rajdip Sen
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Alexis Robitaille
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Rosario Nicola Brancaccio
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Kueshivi Atsou
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Cyrille Cuenin
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Sandrine McKay-Chopin
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Maria Lina Tornesello
- Molecular Biology and Viral Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS "Fondazione Pascale", Naples, Italy
| | - Franco Maria Buonaguro
- Molecular Biology and Viral Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS "Fondazione Pascale", Naples, Italy
| | - Gary Clifford
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Tarik Gheit
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
| | - Massimo Tommasino
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon Cedex 08, France
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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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Sun D, Cao M, Li H, Ren J, Shi J, Li N, Chen W. Risk of prostate cancer in men with HIV/AIDS: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2020; 24:24-34. [PMID: 32801354 DOI: 10.1038/s41391-020-00268-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although previous studies have shown a decreased incidence of prostate cancer in men with HIV/AIDS, the consensus has not been reached. Our aim is to conduct a systematic review and meta-analysis to assess the risk of prostate cancer among people with HIV/AIDS. METHODS We systematically searched PubMed, Web of Science, Embase, and Cochrane Library until March 2020. Cohort studies were included if they compared the prostate cancer risk between people with HIV/AIDS and uninfected controls or the general population. The summary standardized incidence ratio (SIR) and 95% confidence interval (CI) were calculated using a random-effects model. RESULTS A total of 27 studies were included for analysis, with more than 2780 males with HIV/AIDS developing prostate cancer. The results showed that HIV infection was associated with a decreased risk of prostate cancer incidence (SIR, 0.76; 95% CI, 0.64-0.91; P = 0.003), with significant heterogeneity (P < 0.001; I2 = 91.6%). A range of sensitivity analyzes did not significantly change the results. CONCLUSIONS Our study shows that people with HIV/AIDS have a lower incidence of prostate cancer compared with the general population. However, significant heterogeneity exists among the included studies. Further prospective studies with better designs are needed to elucidate the association between HIV infection and prostate cancer.
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Affiliation(s)
- Dianqin Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Maomao Cao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - He Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Jiansong Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Jufang Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Ni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
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Activation-induced cytidine deaminase: in sickness and in health. J Cancer Res Clin Oncol 2020; 146:2721-2730. [PMID: 32772231 DOI: 10.1007/s00432-020-03348-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/04/2020] [Indexed: 12/17/2022]
Abstract
Activation Induced cytidine Deaminase (AID) is an essential enzyme of the adaptive immune system. Its canonical activity is restricted to B lymphocytes, playing an essential role in the diversification of antibodies by enhancing specificity and changing affinity. This is possible through its DNA deaminase function, leading to mutations in DNA. In the last decade, AID has been assigned an additional function: that of a powerful DNA demethylator. Adverse cellular conditions such as chronic inflammation can lead to its deregulation and overexpression. It is an important driver of B-cell lymphoma due to its natural ability to modify DNA through deamination, leading to mutations and epigenetic changes. However, the deregulation of AID is not restricted to lymphoid cells. Recent findings have provided new insights into the role that this protein plays in the development of non-lymphoid cancers, with some research shedding light on novel AID-driven mechanisms of cellular transformation. In this review, we provide an updated narrative of the normal physiological functions of AID. Additionally, we review and discuss the recent research studies that have implicated AID in carcinogenesis in varying tissue types including lymphoid and non-lymphoid cancers. We review the mechanisms, whereby AID promotes carcinogenesis and highlight important areas of future research.
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Chammartin F, Dao Ostinelli CH, Anastos K, Jaquet A, Brazier E, Brown S, Dabis F, Davies MA, Duda SN, Malateste K, Nash D, Wools-Kaloustian K, von Groote PM, Egger M. International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019. BMJ Open 2020; 10:e035246. [PMID: 32414825 PMCID: PMC7232622 DOI: 10.1136/bmjopen-2019-035246] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/21/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The objectives of the International epidemiology databases to evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and coinfections and (iv) to examine the pregnancy-related and HIV-related outcomes of women on ART and their infants exposed to HIV or ART in utero or via breast milk. PARTICIPANTS IeDEA is organised in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled. FINDINGS TO DATE The data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in PLWHIV-1 or PLWHIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of coinfection with hepatitis B and C, and the epidemiology of different cancers and of (multidrug resistant) tuberculosis, renal disease and of mental illness. The adoption of 'Treat All', making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic. FUTURE PLANS IeDEA has formulated several research priorities for the 'Treat All' era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.
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Affiliation(s)
| | - Cam Ha Dao Ostinelli
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Antoine Jaquet
- French National Research Institute for Sustainable Development (IRD), Inserm, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Steven Brown
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Francois Dabis
- French National Research Institute for Sustainable Development (IRD), Inserm, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Karen Malateste
- French National Research Institute for Sustainable Development (IRD), Inserm, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Per M von Groote
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
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43
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da Silva Neto MM, Brites C, Borges ÁH. Cancer during HIV infection. APMIS 2020; 128:121-128. [PMID: 31990100 DOI: 10.1111/apm.13020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/24/2019] [Indexed: 12/11/2022]
Abstract
HIV+ persons have a significantly increased risk of cancer when compared to the general population. The excess cancer risk observed during HIV infection is particularly higher for infection-related malignancies. Mechanisms underlying this remain unclear, but both HIV-related and HIV-unrelated factors have been postulated to play a role. Here, we (i) review newly published data on cancer burden in the setting of HIV infection with a focus on HIV-related risk factors for cancer; (ii) discuss emerging data on cancer among HIV+ persons living in low- and middle-income countries; and (iii) review guideline recommendations for cancer screening among HIV+ persons and discuss ongoing studies investigating strategies for cancer screening among HIV+ patients.
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Affiliation(s)
- Marinho Marques da Silva Neto
- Department of Life Sciences, Bahia State University, Salvador, Bahia, Brazil.,Health Sciences School, Salvador University, Laureate International Universities, Salvador, Bahia, Brazil
| | - Carlos Brites
- LAPI - Laboratório de Pesquisa em Infectologia, Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Álvaro H Borges
- Department of Infectious Diseases Immunology, Statens Serum Institut, Copenhagen, Denmark
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de Wet J, Steyn M, Jordaan HF, Smith R, Claasens S, Visser WI. An Analysis of Biopsies for Suspected Skin Cancer at a Tertiary Care Dermatology Clinic in the Western Cape Province of South Africa. J Skin Cancer 2020; 2020:9061532. [PMID: 32411476 PMCID: PMC7204328 DOI: 10.1155/2020/9061532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/11/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Skin cancer is a growing health concern worldwide. It is the most common malignancy in South Africa and places a large burden on the public healthcare sector. There is a paucity of published scientific data on skin cancer in South Africa. OBJECTIVES To report the findings of biopsies performed in patients with suspected skin cancer attending the Tygerberg Academic Hospital (TAH) Dermatology outpatient department (OPD) in the Western Cape Province of South Africa. Methodology: A retrospective chart review identified all patients who underwent a biopsy for a suspected skin cancer diagnosis between September 2015 and August 2016 at the TAH dermatology OPD. RESULTS A total number of 696 biopsies from 390 participants were identified, of which 460 were histologically confirmed as malignant lesions. The proportion of clinically suspected skin cancers that were histologically confirmed as cancer was 68%. The most commonly occurring malignancies were basal cell carcinoma (BCC) (54.8%), squamous cell carcinoma (SCC) (18.9%), squamous cell carcinoma in-situ (SCCI) (8.0%), Kaposi's sarcoma (KS) (6.7%), malignant melanoma (MM) (6.1%), and keratoacanthoma (KA) (4.6%). The number needed to treat (NTT) for all cancers diagnosed and for MM was 1.5 and 4 respectively. BCC (89.3%) and KS (67.7%) was the most common skin cancer in the white and black population respectively. The ratio of BCC to SCC was 2.03. CONCLUSION This study provides valuable scientific data on the accuracy of skin cancer diagnosis, distribution and patient demographics in the Western Cape Province of South Africa, on which further research can be based. The study highlights the burden of skin cancer on this specific population group and calls for standardised reporting methods and increased surveillance of skin cancers.
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Affiliation(s)
- Johann de Wet
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Minette Steyn
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Henry F. Jordaan
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Rhodine Smith
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Saskya Claasens
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Willem I. Visser
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
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