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Rojas Rojas T, Poizot-Martin I, Rey D, Duvivier C, Bani-Sadr F, Cabie A, Delobel P, Jacomet C, Allavena C, Ferry T, Pugliese P, Valantin MA, Lamaury I, Hustache-Matthieu L, Fresard A, Houyou T, Huleux T, Cheret A, Makinson A, Obry-Roguet V, Lions C, Carrieri MP, Protopopescu C. Incidence of cervical, breast and colorectal cancers between 2010 and 2015 in people living with HIV in France. PLoS One 2022; 17:e0261069. [PMID: 35333883 PMCID: PMC8956191 DOI: 10.1371/journal.pone.0261069] [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: 05/04/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to evaluate the incidence rates between 2010 and 2015 for invasive cervical cancer (ICC), breast cancer (BC), and colorectal cancer (CRC) in people living with HIV (PLWH) in France, and to compare them with those in the French general population. These cancers are targeted by the national cancer-screening program. SETTING This is a retrospective study based on the longitudinal data of the French Dat'AIDS cohort. METHODS Standardized incidence ratios (SIR) for ICC and BC, and incidence rates for all three cancers were calculated overall and for specific sub-populations according to nadir CD4 cell count, HIV transmission category, HIV diagnosis period, and HCV coinfection. RESULTS The 2010-2015 CRC incidence rate was 25.0 [95% confidence interval (CI): 18.6-33.4] per 100,000 person-years, in 44,642 PLWH (both men and women). Compared with the general population, the ICC incidence rate was significantly higher in HIV-infected women both overall (SIR = 1.93, 95% CI: 1.18-3.14) and in the following sub-populations: nadir CD4 ≤ 200 cells/mm3 (SIR = 2.62, 95% CI: 1.45-4.74), HIV transmission through intravenous drug use (SIR = 5.14, 95% CI: 1.93-13.70), HCV coinfection (SIR = 3.52, 95% CI: 1.47-8.47) and HIV diagnosis before 2000 (SIR = 2.06, 95% CI: 1.07-3.97). Conversely, the BC incidence rate was significantly lower in the study sample than in the general population (SIR = 0.56, 95% CI: 0.42-0.73). CONCLUSION The present study showed no significant linear trend between 2010 and 2015 in the incidence rates of the three cancers explored in the PLWH study sample. Specific recommendations for ICC screening are still required for HIV-infected women and should focus on sub-populations at greatest risk.
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Affiliation(s)
- Teresa Rojas Rojas
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
| | - Isabelle Poizot-Martin
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - David Rey
- Le Trait d’Union, HIV-Infection Care Center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
- Institut Cochin—CNRS 8104—INSERM U1016—RIL Team: Retrovirus, Infection and Latency, Université de Paris, Paris, France
- Centre Médical de l’Institut Pasteur, Institut Pasteur, Paris, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital, Reims, France
| | - André Cabie
- Université des Antilles, CHU de Martinique, Fort-de-France, Martinique, France
| | - Pierre Delobel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales-INSERM, UMR 1043- Université Toulouse III Paul Sabatier, Toulouse, France
| | - Christine Jacomet
- Clermont-Ferrand University Hospital Infectious and Tropical disease Department, Clermont Ferrand, France
| | - Clotilde Allavena
- Infectious Diseases Department, CHU Hôtel-Dieu, INSERM UIC 1413, CHU Nantes, Nantes, France
| | - Tristan Ferry
- Service de Maladies Infectieuses, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | | | - Marc-Antoine Valantin
- GHPS Pitié Salpêtrière APHP, Infectious Diseases, Paris, France
- Sorbonne Universités UPMC Université Paris 6-INSERM-IPLESP, Paris, France
| | - Isabelle Lamaury
- Department of Infectious and Tropical Diseases, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
| | | | - Anne Fresard
- Department of Infectious and Tropical Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Tamazighth Houyou
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional De La Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Thomas Huleux
- Service Universitaire des Maladies Infectieuses et du Voyageur—Centre Hospitalier G. DRON Tourcoing, Tourcoing, France
| | - Antoine Cheret
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Internal Medicine, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Alain Makinson
- Department of Infectious Diseases, Montpellier University Hospital, INSERM U1175/IRD UMI 233, Montpellier, France
| | - Véronique Obry-Roguet
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
| | - Caroline Lions
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
| | - Maria Patrizia Carrieri
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional De La Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Camelia Protopopescu
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional De La Santé Provence-Alpes-Côte d’Azur, Marseille, France
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[HIV and cancer: Update 2020]. Bull Cancer 2020; 107:21-29. [PMID: 31980144 DOI: 10.1016/j.bulcan.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
The HIV infection remains a serious public health concern in France and around the world. Cancers are frequent among people living with HIV (PLWH) and have become the leading cause of mortality among this population in France. Certain non-AIDS-defining cancers are much more common among PLWH, such as anal carcinoma, Hodgkin lymphoma, hepatocellular carcinoma and lung cancer. The incidence of cancer among PLWH depending on various factors, virological control under combined antiretrovial therapies (cART), exposure prevention to oncogenic virus and toxics are of utmost importance, such as the implementation of specific screening programmes. Drug interactions between cART and oncologic treatments can lead to serious adverse effects or to a reduction in the therapeutic effects, therefore they require a close monitoring. The PLWH have been excluded from the oncologic clinical trials assessing the efficacy and toxicity profile of the immune checkpoints inhibitors (ICPi) because of an increased theoretical risk of inducing adverse events and a feared lack of efficacy in the immunocompromised population. However, the mostly retrospective clinical data reporting the use of ICPi among PLWH are somewhat reassuring with a safety and efficacy profile similar to what observed in HIV-negative patients. Regarding the "shock and kill" anti-HIV effects of ICPi, the preliminary clinical data available are still modest and relatively disappointing despite encouraging results obtained in vitro. HIV-associated cancers represent a particular care challenge due to the multiple comorbidities in the population and the high risk of drug interactions, thus the CANCERVIH national network is of particular interest within this context.
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Coghill AE, Engels EA, Schymura MJ, Mahale P, Shiels MS. Risk of Breast, Prostate, and Colorectal Cancer Diagnoses Among HIV-Infected Individuals in the United States. J Natl Cancer Inst 2019. [PMID: 29529223 DOI: 10.1093/jnci/djy010] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Although people living with HIV or AIDS (PLWHA) are at higher risk for many cancers, breast, prostate, and colorectal cancer rates are lower in this patient population. Because these tumors are often screen-detected, these inverse associations could be driven by HIV-related differences in utilization of cancer screening. Methods We ascertained incident breast, prostate, and colorectal cancer in PLWHA using data from the HIV/AIDS Cancer Match Study (1996-2012). Comparisons with general population cancer rates were made using standardized incidence ratios (SIRs), overall and stratified by tumor stage/size, breast cancer estrogen receptor status, and colorectal site. We also examined the potential effect of study design and unmeasured confounding on inverse standardized incidence ratios. Results Compared with the general population, PLWHA had lower rates of invasive breast (SIR = 0.63, 95% confidence interval [CI] = 0.58 to 0.68), prostate (SIR = 0.48, 95% CI = 0.46 to 0.51), proximal colon (SIR = 0.67, 95% CI = 0.59 to 0.75), distal colon (SIR = 0.51, 95% CI = 0.43 to 0.59), and rectal cancers (SIR = 0.69, 95% CI = 0.61 to 0.77). Reduced risk persisted across tumor stage/size for prostate and colorectal cancers. Although distant-stage breast cancer rates were not reduced (SIR = 0.94, 95% CI = 0.73 to 1.20), HIV-infected women had lower rates of large (>5 cm) breast tumors (SIR = 0.65, 95% CI = 0.50 to 0.83). The magnitude of these inverse standardized incidence ratios could not plausibly be attributed to case underascertainment, out-migration, or unmeasured confounding. Conclusions Breast, prostate, and colorectal cancer rates are markedly lower among PLWHA, including rates of distant-stage/large tumors that are not generally screen-detected. This set of inverse HIV-cancer associations is therefore unlikely to be due primarily to differential screening and may instead represent biological relationships requiring future investigation.
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Affiliation(s)
- Anna E Coghill
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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Chirkut S. Breast cancer, human immunodeficiency virus and highly active antiretroviral treatment; implications for a high-rate seropositive region. Oncol Rev 2019; 13:376. [PMID: 30713605 PMCID: PMC6335972 DOI: 10.4081/oncol.2019.376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Sub-Saharan Africa is the region in the world with the most people infected with the human immunodeficiency virus (HIV). The incidence of breast cancer is also rising in the region. This transcript focusses on the burden of these two diseases when they converge in the same populace. This comprehensive literature review of the topic suggests a trend towards an increasing incidence of breast cancer in the HIV-infected population, and the rationale for such a tendency is hypothesized, especially in the context of the availability of highly active antiretroviral therapy. Besides the age at diagnosis, all other clinical characteristics appear to be similar in HIV-positive and HIV-negative breast cancer populations. Outcomes of the different treatment modalities for breast cancer in HIV-positive patients are also appraised and finally innovative areas of future research are suggested along with plausible recommendations.
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Affiliation(s)
- Subash Chirkut
- King Edward VIII Hospital, Durban; Department of General Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal (UKZN), South Africa
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McCormack VA, Febvey-Combes O, Ginsburg O, Dos-Santos-Silva I. Breast cancer in women living with HIV: A first global estimate. Int J Cancer 2018; 143:2732-2740. [PMID: 29992553 DOI: 10.1002/ijc.31722] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022]
Abstract
There is a growing population of older women living with HIV/AIDS (WLWHA). Breast cancer is a common cancer in women worldwide, but the global number of breast cancers in WLWHA is not known. We estimated, for each UN sub-region, the number and age distribution of WLWHA who were diagnosed with breast cancer in 2012, by combining IARC-GLOBOCAN estimates of age-country specific breast cancer incidence with corresponding UNAIDS HIV prevalence. Primary analyses assumed no HIV-breast cancer association, and a breast cancer risk reduction scenario was also considered. Among 16.0 million WLWHA aged 15+ years, an estimated 6,325 WLWHA were diagnosed with breast cancer in 2012, 74% of whom were in sub-Saharan Africa, equally distributed between Eastern, Southern and Western Africa. In most areas, 70% of HIV-positive breast cancers were diagnosed under age 50. Among all breast cancers (regardless of HIV status), HIV-positive women constituted less than 1% of the clinical burden, except in Eastern, Western and Middle Africa where they comprised 4-6% of under age 50 year old breast cancer patients, and in Southern Africa where this patient subgroup constituted 26 and 8% of breast cancers diagnosed under and over age 50 respectively. If a deficit of breast cancer occurs in WLWHA, the global estimate would reduce to 3,600. In conclusion, worldwide, the number of HIV-positive women diagnosed with breast cancer was already substantial in 2012 and with an expected increase within the next decade, early detection and treatment research targeted to this population are needed.
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Affiliation(s)
- Valerie A McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Olivia Febvey-Combes
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
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van Zyl N, Minné C, Mokone DH. Human immunodeficiency virus infection in breast cancer patients: The prevalence thereof and its effect on breast cancer characteristics at Dr. George Mukhari Academic Hospital Breast Clinic, Ga-Rankuwa, South Africa. SA J Radiol 2018; 22:1361. [PMID: 31754516 PMCID: PMC6837778 DOI: 10.4102/sajr.v22i2.1361] [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: 05/04/2018] [Accepted: 07/01/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Since the advent of highly active anti-retroviral therapy, improved immune functioning and prolonged survival of Human immunodeficiency virus (HIV)-positive patients has been accompanied by an increased incidence of non-AIDS-defining cancers (NADC). Breast cancer is the most prevalent NADC among HIV-positive women. However, data regarding the interaction between these two diagnoses remain limited. OBJECTIVES To determine the effect of HIV status on the presentation of breast cancer patients at Dr. George Mukhari Academic Hospital (DGMAH). METHODS The age, gender, HIV status, CD4 count and tumour node metastases stage at presentation were recorded from the files of patients with histologically proven breast carcinoma, who had presented to the breast clinic at DGMAH from 01 January 2013 to 30 November 2017. Histological subtypes and molecular markers were retrieved from the National Health Laboratory Service. Prevalence of HIV among breast cancer patients was calculated. Cross-tabulations compared the variables between HIV-positive and HIV-negative groups. Statistical significance was assessed using Fisher's Exact Test. RESULTS HIV status was determined in 129 breast cancer patients. Eighty (62.02%) were HIV-negative and 49 (37.98%) were HIV-positive. All patients were female. The mean age at presentation with breast cancer in the HIV-positive group was approximately 10 years younger, compared to the entire population and to the HIV-negative group (p < 0.0001). No further statistically significant associations were observed concerning HIV status and other variables. CONCLUSION HIV-positive women present with breast cancer at a significantly younger mean age. Breast cancer screening protocols may need to be adjusted accordingly in such patients.
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Affiliation(s)
- Nikoli van Zyl
- Department of Diagnostic Radiology, Dr. George Mukhari Academic Hospital, South Africa
| | - Cornelia Minné
- Department of Diagnostic Imaging, Dr. George Mukhari Academic Hospital, South Africa
| | - Dikeledi H. Mokone
- Department of Surgery, Dr. George Mukhari Academic Hospital, South Africa
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7
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Valencia Ortega M. Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases? Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
The number of women living with HIV continues to increase. Thirty years into the
AIDS epidemic, we now expect those with access to highly active antiretroviral
to survive into their seventh decade of life or beyond. Increasingly, the focus
of HIV care is evolving from preventing opportunistic infections and treating
AIDS-defining malignancies to strategies that promote longevity. This holistic
approach to care includes detection of malignancies that are associated with
certain viral infections, with chronic inflammation, and with lifestyle choices.
The decision to screen an HIV-infected women for cancer should include an
appreciation of the individualized risk of cancer, her life expectancy, and an
attempt to balance these concerns with the harms and benefits associated with
specific cancer screening tests and their potential outcome. Here, we review
cancer screening strategies for women living with HIV/AIDS with a focus on
cancers of the lung, breast, cervix, anus, and liver.
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Affiliation(s)
- David M Aboulafia
- 1 Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA.,2 Division of Hematology, University of Washington, Seattle, WA, USA
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9
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Valencia Ortega ME. Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases? Rev Clin Esp 2017; 218:149-155. [PMID: 28874261 DOI: 10.1016/j.rce.2017.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/17/2017] [Accepted: 07/30/2017] [Indexed: 12/26/2022]
Abstract
Since the start of the human immunodeficiency virus (HIV) epidemic, tumour disease among patients has been significant. The collection of malignancies can be divided primarily into 2 groups: those associated with HIV (all of which are related to viral diseases) and those not associated with HIV (only some of which are associated with viral diseases). The origin of these malignancies is multifactorial, and the main causes that have led to an increase in tumour disease are immunosuppression, coinfection with oncogenic viruses and life prolongation secondary to the use of antiretroviral therapy. Establishing the general characteristics of the undiagnosed AIDS tumours is difficult, mainly because they are a highly heterogeneous group formed by malignancies of a diverse nature. The treatments do not differ from those used in the general population, although the management can be more difficult due to the late diagnosis, drug interactions and associated comorbidities.
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Affiliation(s)
- M E Valencia Ortega
- Servicio de Medicina Interna-Unidad de VIH, Hospital Universitario La Paz, Madrid, España.
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10
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Abstract
HIV infection is related to an increased risk of cancer compared with general population, both AIDS-defining cancers (Kaposi's sarcoma, non Hodgkin's lymphoma, invasive cervical cancer) and non-AIDS-defining cancers. Although the advent of the highly active antiretroviral therapy era has decreased the Kaposi's sarcoma and non-Hodgkin's lymphoma incidences, non-AIDS-defining malignancies, such as lung cancer, hepatocarcinoma, anal cancer and skin cancers, remain a major cause of morbidity and death in the HIV-infected population. The clinical presentation is often different between the infected and non-infected populations, often with a more advanced stage at diagnosis, a more aggressive pathology, and associated morbidities like immunosuppression, leading to poorer outcomes. Numerous studies have focused on HIV-related malignancies' treatment, however specific guidelines are still missing. Practitioners have to be careful with interactions between antiretroviral and antineoplastic drugs, particularly through the cytochrome P 450. Because of this, a national multidisciplinary approach, "Cancer and HIV, " was started in 2013 thanks to the National Institute of Cancer (INCa). The aim of this review is to present a scientific update about AIDS-and non-AIDS-defining malignancies, both in their clinical aspects and regarding their specific therapeutic management.
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Abstract
OBJECTIVE Evaluate the risk of female breast cancer associated with HIV-CXCR4 (X4) tropism as determined by various genotypic measures. METHODS A breast cancer case-control study, with pairwise comparisons of tropism determination methods, was conducted. From the Women's Interagency HIV Study repository, one stored plasma specimen was selected from 25 HIV-infected cases near the breast cancer diagnosis date and 75 HIV-infected control women matched for age and calendar date. HIV-gp120 V3 sequences were derived by Sanger population sequencing (PS) and 454-pyro deep sequencing (DS). Sequencing-based HIV-X4 tropism was defined using the geno2pheno algorithm, with both high-stringency DS [false-positive rate (3.5) and 2% X4 cutoff], and lower stringency DS (false-positive rate, 5.75 and 15% X4 cutoff). Concordance of tropism results by PS, DS, and previously performed phenotyping was assessed with kappa (κ) statistics. Case-control comparisons used exact P values and conditional logistic regression. RESULTS In 74 women (19 cases, 55 controls) with complete results, prevalence of HIV-X4 by PS was 5% in cases vs 29% in controls (P = 0.06; odds ratio, 0.14; confidence interval: 0.003 to 1.03). Smaller case-control prevalence differences were found with high-stringency DS (21% vs 36%, P = 0.32), lower stringency DS (16% vs 35%, P = 0.18), and phenotyping (11% vs 31%, P = 0.10). HIV-X4 tropism concordance was best between PS and lower stringency DS (93%, κ = 0.83). Other pairwise concordances were 82%-92% (κ = 0.56-0.81). Concordance was similar among cases and controls. CONCLUSIONS HIV-X4 defined by population sequencing (PS) had good agreement with lower stringency DS and was significantly associated with lower odds of breast cancer.
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Gomez A, Montero AJ, Hurley J. Clinical outcomes in breast cancer patients with HIV/AIDS: a retrospective study. Breast Cancer Res Treat 2015; 149:781-8. [PMID: 25663516 PMCID: PMC7102268 DOI: 10.1007/s10549-015-3275-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/29/2022]
Abstract
The purpose of the study is to describe what is the presentation of breast cancer in women with HIV, their tolerance to therapy, the most common complications of treatment and their outcomes. Retrospective chart review of patients with HIV diagnosed with breast cancer between January 1, 1989 and December 31, 2013 at the University of Miami/Jackson Memorial Hospital (UM/JMH) 47 females and 1 male were included in the analysis. The median age of diagnosis was 46 years (IQR 41–52) and 64 % of the women were premenopausal. Median CD4+ count was 330 cells/µL (IQR 131–589 cells/µL). 41 % had AIDS at time of diagnosis. 94 % of patients presented with locoregional disease and 6 % with late stage breast cancer. 52 % had ER+ tumors. 6 % had HER-2/neu tumor expression and 21 % had triple negative disease. The 5 year PFS was 50 % (95 % CI 34–64 %), the 5 year OS was 44 % (95 % CI 29–58 %), and the Breast cancer-specific survival was 57 % (95 % CI 40–70 %). Death was attributed to breast cancer in 22 patients, AIDS progression in 6 patients, other medical condition in 1, and for 4, the cause was unknown. Serious adverse events were documented in 46 % of patients treated with chemotherapy. Targeted therapy was well tolerated. Patients with HIV/AIDS and breast cancer pose a major challenge for oncologists. Surgery, radiation, and endocrine therapy are well tolerated. Standard dose chemotherapy can have life-threatening side effects which can be managed with growth factor support and antimicrobial prophylaxis. All cancer therapy can be given while continuing with antiviral therapy at full dose.
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Affiliation(s)
- Alexandra Gomez
- Internal Medicine Resident, University of Miami/Jackson Memorial Hospital, 1475 NW 12th Ave, Miami, FL, 33136, USA,
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Parameswaran L, Taur Y, Shah MK, Traina TA, Seo SK. Tolerability of chemotherapy in HIV-infected women with breast cancer: are there prognostic implications? AIDS Patient Care STDS 2014; 28:358-64. [PMID: 24839993 DOI: 10.1089/apc.2013.0370] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Breast cancer is the most commonly diagnosed malignancy in women, but little is known about therapeutic outcomes in patients with both breast cancer and HIV. We performed a retrospective cohort study of women with or without HIV undergoing treatment for breast cancer from 1996 to 2011. Cases with HIV were 1:2 matched to non-HIV controls based on age, sex, race, and date of cancer diagnosis. Dose reduction and/or delay during chemotherapy, overall survival, and development of metastatic disease were studied outcomes. 156 (52 HIV, 104 non-HIV) subjects were analyzed. The majority of breast cancers in both groups were clinical stages 0, I, II, and III (73%). HIV infection preceded cancer diagnosis by a median of 13 years. Median CD4 count at time of cancer diagnosis was 417 cells/mcL. Approximately 87% (45/52) were on HAART, mostly protease inhibitor-based (57%) therapy. HIV-infected women needed more dose reductions and/or delays to chemotherapy due to toxicity (56% vs. 30%; p=0.03). Stage at diagnosis, triple negative receptor status, and dose reduction and/or delay were predictors of metastatic disease and death. HIV-infected women experienced more adverse events during breast cancer treatment, and a potential causative factor could be drug-drug interactions between HAART and chemotherapy.
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Affiliation(s)
- Lalitha Parameswaran
- Division of Hospital Medicine, New York Presbyterian-Weill Cornell Medical Center, New York City, New York
| | - Ying Taur
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Monika K. Shah
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Tiffany A. Traina
- Breast Cancer Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Susan K. Seo
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York
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Abstract
PURPOSE OF REVIEW The growing burden of non-AIDS defining malignancies (non-ADMs) among people living with HIV/AIDS (PLWHA) highlights the need for cancer prevention and early detection. In this article, we propose screening guidelines for non-ADMs in PLWHA. RECENT FINDINGS A number of recent findings may help direct cancer screening guidelines in PLWHA. Screening for lung cancer with low-dose helical chest computerized tomography (LDCT) in the National Lung Screening Trial data demonstrated a decrease in lung cancer and all-cause mortality. Recent studies have demonstrated a favorable experience among PLWHA with liver transplantation. Overdiagnosis is common with breast and prostate cancer screening. Anal cancer rates were substantially higher for HIV-infected MSM, other men and women than for HIV-uninfected individuals. SUMMARY Screening recommendations for the general population can be applied to PLWHA patients for breast, colon and prostate cancer. Screening for lung cancer with LDCT could be considered in PLWHA at risk. American Association for the Study of Liver Diseases screening recommendations with biennial ultrasonography may be applied to at-risk PLWHA for hepatocellular carcinoma. All HIV-infected adults should be offered anal cancer screening as part of clinical care at specialized centres.
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Affiliation(s)
- Deepthi Mani
- Division of Internal Medicine, Multicare Good Samaritan Hospital, Puyallup, WA, USA
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[Consensus statement on assistance to women with human immunodeficiency virus infection in the health care sector. National AIDS Plan (PNS) and AIDS Study Group (GeSIDA)]. Enferm Infecc Microbiol Clin 2013; 32:99.e1-99.e14. [PMID: 23896395 DOI: 10.1016/j.eimc.2013.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 04/12/2013] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To develop a consensus document on clinical recommendations for the health care of women with human immunodeficiency virus (HIV) infection. METHODS We assembled a panel of experts appointed by the Secretariat of the National AIDS Plan and GeSIDA that included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists, and two panel members acting as coordinators. Scientific information was reviewed in publications and conference reports up to October 2012. In keeping with the criteria of the Infectious Disease Society of America, two levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C), and the level of empirical evidence (i, ii, iii), already used in previous documents from SPNS/GeSIDA. RESULTS We provide multiple recommendations for the clinical management of women with HIV infection, considering both the diagnostic and possible therapeutic strategies. The consensus recommends gender mainstreaming in health care, and promoting training for healthcare professionals in order to avoid gender bias. With currently available data it seems that the effectiveness of the treatment is the same in both men and women, there being no limitation as to the use of any antiretroviral for this reason. Women have more treatments suspended for reasons other than virological failure, thus they require better monitoring. CONCLUSIONS This document presents recommendations for addressing women with HIV infection. This must be multidisciplinary, taking into account the differences that can be found in the diagnosis, disease development, and treatment between men and women.
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Cubasch H, Joffe M, Hanisch R, Schuz J, Neugut AI, Karstaedt A, Broeze N, van den Berg E, McCormack V, Jacobson JS. Breast cancer characteristics and HIV among 1,092 women in Soweto, South Africa. Breast Cancer Res Treat 2013; 140:177-86. [PMID: 23801159 PMCID: PMC3706733 DOI: 10.1007/s10549-013-2606-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 06/08/2013] [Indexed: 02/16/2023]
Abstract
In the low-income HIV-endemic regions of sub-Saharan Africa, malignancies related to HIV have long been recognized as a major public health problem. However, epithelial malignancies associated with older age, such as breast cancer, are also rising dramatically in those regions. We compared consecutive HIV-positive and -negative black women diagnosed with breast cancer at a large public hospital in Soweto, South Africa, on age, year of diagnosis, stage, grade, and receptor status, and grouped HIV-positive patients by CD4 cell counts. We computed prevalence ratios of the associations of HIV status and CD4 category with stage, grade, receptor status, and among the HIV-positive patients, receipt of ART, controlling for age and year of diagnosis. Of 1,092 patients, 765 were tested for HIV; 151 (19.7 %) tested positive, a prevalence similar to that in the source population. Although, HIV-positive patients were younger than HIV-negative patients (p < 0.001), HIV status was not associated with the tumor characteristics. Thirty-seven women (25.9 %) had CD4 cell counts <200 cells/μl. Patients in that severely immunocompromised group were older than those in the other groups (p = 0.01). This study is the first to analyze the association of HIV with breast cancer in a large sample. Based on similar HIV prevalence in our sample and the population of the hospital's catchment area, clinicians serving HIV-endemic communities should promote routine HIV testing of younger breast cancer patients and immediate treatment of those who test positive, prior to the initiation of chemotherapy. Research is needed on treatment and outcomes given HIV and low CD4 cell count.
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Affiliation(s)
- Herbert Cubasch
- University of the Witwatersrand, Johannesburg, South Africa
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Maureen Joffe
- University of the Witwatersrand, Johannesburg, South Africa
- Wits Health Consortium, Johannesburg, South Africa
| | - Rachel Hanisch
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, 69008 France
| | - Joachim Schuz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, 69008 France
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, Room 732, New York, NY 10032 USA
| | - Alan Karstaedt
- University of the Witwatersrand, Johannesburg, South Africa
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Nadine Broeze
- University of the Witwatersrand, Johannesburg, South Africa
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Eunice van den Berg
- University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, 69008 France
| | - Judith S. Jacobson
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, Room 732, New York, NY 10032 USA
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Risk of cancers in HIV infection. Enferm Infecc Microbiol Clin 2013; 31:275-6. [DOI: 10.1016/j.eimc.2013.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 11/19/2022]
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Spano JP, Lanoy E, Mounier N, Katlama C, Costagliola D, Heard I. Breast cancer among HIV infected individuals from the ONCOVIH study, in France: therapeutic implications. Eur J Cancer 2012; 48:3335-41. [PMID: 22766516 DOI: 10.1016/j.ejca.2012.05.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/15/2012] [Accepted: 05/15/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND The cross-sectional ONCOVIH study prospectively enrolled HIV-infected adults and children with newly diagnosed malignancies in France in 2006. METHOD We report the characteristics HIV-infected patients with breast cancer from the ONCOVIH study. Standardised questionnaires included characteristics of HIV infection and malignancy. Survival was estimated using Kaplan-Meier estimates. RESULTS Overall, 21 patients with breast cancer (two men and 19 women) were included with a median age of 43.8 years, (range: 30.1-65.5). At time of tumour diagnosis, the median CD4 count was 384/mm(3) (range: 180-1039) the median duration of known seropositivity 7.7 years (range: 0-20.3); 14 patients were under combined antiretroviral therapy for a median duration of 5.7 years (range: 1.1-10.6), of whom 11 had a controlled viral load (<500 copies/mL). The median tumour size was 1.8 cm (range: 1.0-7.0). In women, 17 (89.5%) had invasive ductal carcinoma, 17 (89.5%) with HER2 negative receptors, 8 (42.1%) with ER+ expression, and 7 (36.8%) with PR+ expression. A majority of women received chemotherapy (73.7%), surgery (68.4%) and radiotherapy (57.9%). Their one-year survival rate was estimated as 77.8% (95%confidence interval (CI): 58.6-97.0%). CONCLUSIONS We discuss the risk of breast cancer in infected patients, and the importance of taking into account the different contributing factors for breast cancer in HIV-infected individuals.
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Affiliation(s)
- Jean-Philippe Spano
- AP-HP, Groupe Hospitalier Pitié-Salpétrière, Département d'Oncologie Médicale du Prof. David Khayat, 47 Boulevard de l'Hôpital, Paris, France.
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[Non-AIDS defining malignancies, or the sleeping giant: an update]. Enferm Infecc Microbiol Clin 2012; 31:319-27. [PMID: 22658412 DOI: 10.1016/j.eimc.2012.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/14/2012] [Accepted: 03/16/2012] [Indexed: 12/25/2022]
Abstract
Non-AIDS defining malignancies (NADM) are a very heterogeneous group of cancers with increasing importance in subjects with HIV infection. They develop in patients that are younger than general population and their clinical manifestations are usually atypical, with higher tumour grades, more aggressive clinical behaviour and metastatic disease. The outcome is poor, with rapid progression, a high rate of relapse, and a poor response to treatment. There are several factors that influence their development: HIV infection, chronic immunosuppression, and co-infection with some oncogenic viruses. The most frequent NADM are those associated with human papillomavirus infection, lung cancer, hepatic cancer, and Hodgkin lymphoma. Their management is based on three essential points: the treatment of the specific malignancy, the use of antiretroviral therapy, and the prophylaxis and treatment of opportunistic infections. The two factors significantly associated with prevention of NADM are a CD4+ lymphocyte count more than 500/mm(3), and an undetectable viral load.
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Priority issues concerning HIV infection among women. Womens Health Issues 2012; 21:S266-71. [PMID: 22055678 DOI: 10.1016/j.whi.2011.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 07/11/2011] [Accepted: 08/08/2011] [Indexed: 11/22/2022]
Abstract
During the last decade, the enormous impact the global HIV epidemic was having on women's health was fully recognized. However, this recognition has not wholly extended to the domestic setting; in much of the United States, the dominant focus remains on HIV infection among men who have sex with men. The relatively low prevalence of HIV infection among U.S. women (a huge population group) versus men who have sex with men and injection drug users (much smaller groups) contributes to the perception that HIV is not a major domestic women's health consideration.
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Goedert JJ, Pfeiffer R, Zhu M, Yang XR, Garcia-Closas M, Lissowska J, Kopp WC. Peripheral blood immunologic phenotype of population-based breast cancer cases and matched controls. Eur J Clin Invest 2012; 42:572-4. [PMID: 22073930 PMCID: PMC3288213 DOI: 10.1111/j.1365-2362.2011.02610.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- James J. Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD
- Corresponding author: James J. Goedert, M.D., 6120 Executive Boulevard, Room 7068, Rockville MD 20852. FAX: 301-402-0817
| | - Ruth Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD
| | - Mingzhu Zhu
- Clinical Support Lab, SAIC-Frederick, Inc., Frederick, MD
| | - Xiaohong R. Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD
| | | | - Jolanta Lissowska
- Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland
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Abstract
Non-AIDS-defining cancers are a rising health concern among HIV-infected patients. Cancer screening is now an important component of health maintenance in HIV clinical practice. The decision to screen an HIV-infected patient for cancer should include an assessment of individualized risk for the particular cancer, life expectancy, and the harms and benefits associated with the screening test and its potential outcome. HIV-infected patients are at enhanced risk of several cancers compared to the general population; anal cancer, hepatocellular carcinoma, Hodgkin's lymphoma, and lung cancer all have good evidence demonstrating an enhanced risk in HIV-infected persons. A number of cancer screening interventions have shown benefit for specific cancers in the general population, but data on the application of these tests to HIV-infected persons are limited. Here we review the epidemiology and background literature relating to cancer screening interventions in HIV-infected persons. We then use these data to inform a conceptual model for evaluating HIV-infected patients for cancer screening.
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Mbulaiteye SM, Bhatia K, Adebamowo C, Sasco AJ. HIV and cancer in Africa: mutual collaboration between HIV and cancer programs may provide timely research and public health data. Infect Agent Cancer 2011; 6:16. [PMID: 22004990 PMCID: PMC3223125 DOI: 10.1186/1750-9378-6-16] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 10/17/2011] [Indexed: 01/02/2023] Open
Abstract
The eruption of Kaposi sarcoma (KS) and aggressive non-Hodgkin lymphoma (NHL) in young homosexual men in 1981 in the West heralded the onset of the human immunodeficiency virus (HIV) infection epidemic, which remains one of the biggest challenges to global public health and science ever. Because KS and NHL were increased >10,000 and 50-600 times, respectively, with HIV, they were designated AIDS defining cancers (ADC). Cervical cancer (CC), increased 5-10 times was also designated as an ADC. A few other cancers are elevated with HIV, including Hodgkin lymphoma (10 times), anal cancer (15-30 times), and lung cancer (4 times) are designated as non-AIDS defining cancers (NADCs). Since 1996 when combination antiretroviral therapy (cART) became widely available in the West, dramatic decreases in HIV mortality have been observed and substantial decrease in the incidence of ADCs. Coincidentally, the burden of NADCs has increased as people with HIV age with chronic HIV infection. The impact of HIV infection on cancer in sub-Saharan Africa, where two thirds of the epidemic is concentrated, remains poorly understood. The few studies conducted indicate that risks for ADCs are also increased, but quantitatively less so than in the West. The risks for many cancers with established viral associations, including liver and nasopharynx, which are found in Africa, do not appear to be increased. These data are limited because of competing mortality, and cancer is under diagnosed, pathological confirmation is rare, and cancer registration not widely practiced. The expansion of access to life-extending cART in sub-Saharan Africa, through programs such as the Global Fund for AIDS, Malaria, and Tuberculosis and the US President's Emergency Program for AIDS Relief (PEPFAR), is leading to dramatic lengthening of life of HIV patients, which will likely influence the spectrum and burden of cancer in patients with HIV. In this paper, we review current literature and explore merits for integrating cancer research in established HIV programs to obtain timely data about the incidence and burden of cancer in HIV-infected persons in Africa.
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Affiliation(s)
- Sam M Mbulaiteye
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD 20852, USA.
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Dauby N, De Wit S, Delforge M, Necsoi VC, Clumeck N. Characteristics of non-AIDS-defining malignancies in the HAART era: a clinico-epidemiological study. J Int AIDS Soc 2011; 14:16. [PMID: 21443771 PMCID: PMC3072916 DOI: 10.1186/1758-2652-14-16] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 03/28/2011] [Indexed: 12/12/2022] Open
Abstract
Background Non-AIDS-defining malignancies (NADM) are becoming a major cause of mortality in the era of highly active antiretroviral therapy. We wished to investigate the incidence, risks factors and outcome of NADM in an urban cohort. Methods We carried out an observational cohort of HIV patients with 12,746 patient-years of follow up between January 2002 and March 2009. Socio-demographics and clinical characteristics of patients diagnosed with NADM were retrospectively compared with the rest of the cohort. Causes of death and risk factors associated with NADM were assessed using logistic regression. Survival analyses were performed with Kaplan-Meier estimates. Cancer incidences were compared with those of the general population of the Brussels-Capital Region using the standardized incidence ratio (SIR). Results Forty-five NADM were diagnosed. At inclusion in the study, patients with NADM were older than patients without NADM (47 years vs. 38 years, p < 0.001), had a longer history of HIV infection (59 months vs. 39 months, p = 0.0174), a lower nadir CD4 count (110 cells/mm3 vs. 224 cells/mm3, p < 0.0001) and a higher rate of previous AIDS events (33% vs. 20%, p = 0.0455) and of hepatitis C virus co-infection (22.2% vs. 10%, p = 0.0149). In multivariate analysis, age over 45 at baseline (OR 3.25; 95% CI 1.70-6.22) and a nadir CD4 count of less than 200 cells/mm3 (OR 3.10; 95% CI 1.40-6.87) were associated with NADM. NADM were independently associated with higher mortality in the cohort (OR 14.79; 95% CI 6.95-31.49). Women with cancer, the majority of whom were of sub-Saharan African origin, had poorer survival compared with men. The SIR for both sexes were higher than expected for Hodgkin's lymphoma (17.78; 95% CI 6.49-38.71), liver cancers (8.73; 95% CI 2.35-22.34), anal cancers (22.67; 95% CI 8.28-49.34) and bladder cancers (3.79; 95% CI 1.02-9.70). The SIR for breast cancer was lower in women (SIR 0.29; 95% CI 0.06-0.85). Conclusions Age over 45 and a nadir CD4 count of less than 200 cells/mm3 were predictive of NADM in our cohort. Mortality was high, especially in sub-Saharan African women. Cancers with increased incidences were Hodgkin's lymphoma and anal, bladder and liver cancers in both sexes; women had a lower incidence of breast cancer.
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Affiliation(s)
- Nicolas Dauby
- Division of Infectious Diseases, CHU St-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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