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Tanaka T, Oshima K, Kawano K, Tashiro M, Kakiuchi S, Tanaka A, Fujita A, Ashizawa N, Tsukamoto M, Yasuoka A, Teruya K, Izumikawa K. Nationwide Longitudinal Annual Survey of HIV/AIDS Referral Hospitals in Japan From 1999 to 2021: Trend in Non-AIDS-defining Cancers Among Individuals Infected With HIV-1. J Acquir Immune Defic Syndr 2024; 96:1-10. [PMID: 38427920 PMCID: PMC11008444 DOI: 10.1097/qai.0000000000003389] [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: 06/10/2023] [Accepted: 01/03/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Non-AIDS-defining cancers (NADCs) in patients infected with HIV have recently attracted attention because of the improved survival of this patient population. To obtain accurate data, a longitudinal study is warranted for the nationwide surveillance of the current status and national trend of NADCs in patients infected with HIV in Japan. SETTING An annual nationwide surveillance of NADCs in patients infected with HIV-1 in Japan from 1999 to 2021. METHODS An annual questionnaire was sent to 378 HIV/AIDS referral hospitals across Japan to collect data (clusters of differentiation 4-positive lymphocytes, time of onset, outcomes, and antiretroviral therapy status) of patients diagnosed with any of the NADCs between 1999 and 2021. RESULTS The response and case-capture rates for the questionnaires in 2021 were 37.8% and 81.2%, respectively. The number of reported NADC cases subsequently increased since the beginning of this study. Evaluation of the case counts of NADCs demonstrated a high incidence of lung, colorectal, gastric, and liver cancers as the top 4 cancers. Pancreatic cancer (0.63), lung cancer (0.49), and leukemia (0.49) had the highest mortality rates among the NADCs. Trends of NADCs regarding transmission routes were maintained over the years in male individuals who have sex with male individuals compared with heterosexual male individuals and female individuals. CONCLUSIONS We demonstrated an increasing trend in the incidence of NADCs over a period of 23 years in Japan. The current data highlighted the importance of raising awareness regarding cancer management for patients infected with HIV in Japan.
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Affiliation(s)
- Takeshi Tanaka
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki-shi, Nagasaki, Japan
| | - Kazuhiro Oshima
- Department of Internal Medicine, Nagasaki Goto Chuoh Hospital, Goto-shi, Nagasaki, Japan
| | - Kei Kawano
- Department of Hospital Medicine, Urasoe General Hospital, Urasoe-shi, Okinawa, Japan
| | - Masato Tashiro
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki-shi, Nagasaki, Japan
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Science, Nagasaki-shi, Nagasaki, Japan
| | - Satoshi Kakiuchi
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki-shi, Nagasaki, Japan
| | - Akitaka Tanaka
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki-shi, Nagasaki, Japan
| | - Ayumi Fujita
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki-shi, Nagasaki, Japan
| | - Nobuyuki Ashizawa
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki-shi, Nagasaki, Japan
| | - Misuzu Tsukamoto
- Department of Internal Medicine, Zenjinkai Hospital, Miyazaki-shi, Miyazaki, Japan
| | - Akira Yasuoka
- Division of Internal Medicine, Michinoo Hospital, Nagasaki-shi, Nagasaki, Japan; and
| | - Katsuji Teruya
- Department of AIDS Clinical Center, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki-shi, Nagasaki, Japan
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Science, Nagasaki-shi, Nagasaki, Japan
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Liu R, Zhao H, Xiao G, Tao Y, Tang X, Feng L, Liao B, Liu B, Guan J, Li L, Chen Z, He H, You H. Clinical Characteristics and Outcomes of AIDS-Related Burkitt Lymphoma in China: A Retrospective Single-Center Study. Technol Cancer Res Treat 2024; 23:15330338231214236. [PMID: 38179657 PMCID: PMC10771070 DOI: 10.1177/15330338231214236] [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: 06/01/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives: Studies on the prognosis and risk stratification of patients with acquired immune deficiency syndrome (AIDS) - related Burkitt lymphoma (AR-BL) are rare. We aim to construct a novel model to improve the risk assessment of these patients. Methods: We retrospectively analyzed the clinical data of 34 patients over the past 10 years and the factors associated with progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate Cox models. Then, the novel model consisting of screened factors was compared with the existing models. Results: With a 37-month median follow-up, the overall 2-year PFS and OS rates were 40.50% and 36.18%, respectively. The OS of patients who received chemotherapy was better compared with those without chemotherapy (P = .0012). Treatment with an etoposide, prednisone, oncovin, cyclophosphamide, and hydroxydaunorubicin-based regimen was associated with longer OS and PFS compared with a cyclophosphamide, doxorubicin, vincristine, and prednisone-based regimen (OS, P = .0002; PFS, P = .0158). Chemotherapy (hazard ratio [HR] = 0.075; 95% confidence interval [CI], 0.009-0.614) and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 2 to 4 (HR = 4.738; 95% CI, 1.178-19.061) were independent prognostic factors of OS in multivariate analysis and we established a novel prognostic risk stratification model named GZ8H model with chemotherapy and ECOG PS. Conclusion: GZ8H showed better stratification ability than the international prognostic index (IPI) or Burkitt lymphoma IPI (BL-IPI). Furthermore, the C-index of the nomogram used to predict OS was 0.884 in the entire cohort and the calibration curve showed excellent agreement between the predicted and actual results of OS. No human immunodeficiency virus-related factors were found to be associated with OS and PFS of AR-BL patients in our study. Overall, the clinical characteristics and outcomes in AR-BL were shown and prognostic factors for OS and PFS were identified in this study.
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Affiliation(s)
- Rongqiu Liu
- Laboratory for Excellence in Systems Biomedicine of Pediatric Oncology, Department of Pediatric Hematology and Oncology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Han Zhao
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guanying Xiao
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yu Tao
- Laboratory for Excellence in Systems Biomedicine of Pediatric Oncology, Department of Pediatric Hematology and Oncology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoping Tang
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lizhi Feng
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Baolin Liao
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Bo Liu
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jialong Guan
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhimin Chen
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Haolan He
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hua You
- Laboratory for Excellence in Systems Biomedicine of Pediatric Oncology, Department of Pediatric Hematology and Oncology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Children's Hospital of Chongqing Medical University, Chongqing, China
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3
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Phakathi B, Nietz S, Cubasch H, Dickens C, Dix-Peek T, Joffe M, Neugut AI, Jacobson J, Duarte R, Ruff P. Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV. Breast 2021; 59:27-36. [PMID: 34126376 PMCID: PMC8209274 DOI: 10.1016/j.breast.2021.05.014] [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] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Breast cancer outcomes in sub-Saharan Africa is reported to be poor, with an estimated five-year survival of 50% when compared to almost 90% in high-income countries. Although several studies have looked at the effect of HIV in breast cancer survival, the effect of ARTs has not been well elucidated. METHODS All females newly diagnosed with invasive breast cancer from May 2015-September 2017 at Charlotte Maxeke Johannesburg Academic and Chris Hani Baragwanath Academic Hospital were enrolled. We analysed overall survival and disease-free survival, comparing HIV positive and negative patients. Kaplan-Meier survival curves were generated with p-values calculated using a log-rank test of equality while hazard ratios and their 95% confidence intervals (CIs) were estimated using Cox regression models. RESULTS Of 1019 patients enrolled, 22% were HIV positive. The overall survival (95% CI) was 53.5% (50.1-56.7%) with a disease-free survival of 55.8% (52.1-59.3) after 4 years of follow up. HIV infection was associated with worse overall survival (HR (95% CI): 1.50 (1.22-1.85), p < 0.001) and disease-free survival (OR (95% CI):2.63 (1.71-4.03), p < 0.001), especially among those not on ART at the time of breast cancer diagnosis. Advanced stage of the disease and hormone-receptor negative breast cancer subtypes were also associated with poor survival. CONCLUSION HIV infection was associated with worse overall and disease-free survival. HIV patients on ARTs had favourable overall and disease-free survival and with ARTs now being made accessible to all the outcome of women with HIV and breast cancer is expected to improve.
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Affiliation(s)
- Boitumelo Phakathi
- Charlotte Maxeke Surgical Breast Unit. Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Johannesburg, 2196 South Africa; Department of Surgery, University of the Witwatersrand, Faculty of Health Sciences, 7 York Road, Johannesburg 2193 South Africa.
| | - Sarah Nietz
- Department of Surgery, University of the Witwatersrand, Faculty of Health Sciences, 7 York Road, Johannesburg 2193 South Africa; Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Building, Johannesburg, 2193 South Africa
| | - Herbert Cubasch
- Department of Surgery, University of the Witwatersrand, Faculty of Health Sciences, 7 York Road, Johannesburg 2193 South Africa; Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Soweto, 1860 South Africa; Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Building, Johannesburg, 2193 South Africa
| | - Caroline Dickens
- Department of Medicine, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
| | - Therese Dix-Peek
- Department of Medicine, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
| | - Maureen Joffe
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Building, Johannesburg, 2193 South Africa; MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Centre, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Judith Jacobson
- Herbert Irving Comprehensive Cancer Centre, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Raquel Duarte
- Department of Medicine, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
| | - Paul Ruff
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Building, Johannesburg, 2193 South Africa; Department of Medicine, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
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4
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Maiti S, Maiti KB. Gastrointestinal Tuberculosis and HIV Association in Tropics. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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5
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Chammartin F, Lodi S, Logan R, Ryom L, Mocroft A, Kirk O, d'Arminio Monforte A, Reiss P, Phillips A, El-Sadr W, Hatleberg CI, Pradier C, Bonnet F, Law M, De Wit S, Sabin C, Lundgren JD, Bucher HC. Risk for Non-AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy : A Multinational Prospective Cohort Study. Ann Intern Med 2021; 174:768-776. [PMID: 33721519 DOI: 10.7326/m20-5226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non-AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 × 109 cells/L. Consequences of delayed ART on risk for non-AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear. OBJECTIVE To estimate the long-term risk difference for cancer with the immediate ART strategy. DESIGN Multinational prospective cohort study. SETTING The D:A:D (Data collection on Adverse events of anti-HIV Drugs) study, which included HIV-positive persons from Europe, Australia, and the United States. PARTICIPANTS 8318 HIV-positive persons with at least 1 measurement each of CD4 cell count and viral load while ART-naive (study period, 2006 to 2016). MEASUREMENTS The parametric g-formula was used, with adjustment for baseline and time-dependent confounders (CD4 cell count and viral load), to assess the 10-year risk for non-AIDS-defining and AIDS-defining cancer of immediate versus deferred (at CD4 counts <350 and <500 × 109 cells/L) ART initiation strategies. RESULTS During 64 021 person-years of follow-up, 231 cases of non-AIDS-defining cancer and 272 of AIDS-defining cancer occurred among HIV-positive persons with a median age of 36 years (interquartile range, 29 to 43 years). With immediate ART, the 10-year risk for non-AIDS-defining cancer was 2.97% (95% CI, 2.37% to 3.50%) and that for AIDS-defining cancer was 2.50% (CI, 2.37% to 3.38%). Compared with immediate ART initiation, the 10-year absolute risk differences when deferring ART to CD4 counts less than 500 × 109 cells/L and less than 350 × 109 cells/L were 0.12 percentage point (CI, -0.01 to 0.26 percentage point) and 0.29 percentage point (CI, -0.03 to 0.73 percentage point), respectively, for non-AIDS-defining cancer and 0.32 percentage point (CI, 0.21 to 0.44 percentage point) and 1.00 percentage point (CI, 0.67 to 1.44 percentage points), respectively, for AIDS-defining cancer. LIMITATION Potential residual confounding due to observational study design. CONCLUSION In this young cohort, effects of immediate ART on 10-year risk for cancer were small, and further supportive data are needed for non-AIDS-defining cancer. PRIMARY FUNDING SOURCE Highly Active Antiretroviral Therapy Oversight Committee.
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Affiliation(s)
- Frédérique Chammartin
- University Hospital Basel and University of Basel, Basel, Switzerland (F.C., H.C.B.)
| | - Sara Lodi
- Boston University School of Public Health, Boston, Massachusetts (S.L.)
| | - Roger Logan
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (R.L.)
| | - Lene Ryom
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | - Amanda Mocroft
- University College London, London, United Kingdom (A.M., A.P., C.S.)
| | - Ole Kirk
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | | | - Peter Reiss
- Amsterdam University Medical Centers, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, the Netherlands (P.R.)
| | - Andrew Phillips
- University College London, London, United Kingdom (A.M., A.P., C.S.)
| | - Wafaa El-Sadr
- ICAP at Columbia University and Harlem Hospital, New York, New York (W.E.)
| | - Camilla I Hatleberg
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | | | - Fabrice Bonnet
- Hôpital Saint-André and Université de Bordeaux, Bordeaux, France (F.B.)
| | - Matthew Law
- University of New South Wales Sydney, Sydney, Australia (M.L.)
| | - Stéphane De Wit
- Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium (S.D.)
| | - Caroline Sabin
- University College London, London, United Kingdom (A.M., A.P., C.S.)
| | - Jens D Lundgren
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | - Heiner C Bucher
- University Hospital Basel and University of Basel, Basel, Switzerland (F.C., H.C.B.)
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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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7
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Brandão M, Bruzzone M, Franzoi MA, De Angelis C, Eiger D, Caparica R, Piccart-Gebhart M, Buisseret L, Ceppi M, Dauby N, Carrilho C, Lunet N, de Azambuja E, Lambertini M. Impact of HIV infection on baseline characteristics and survival of women with breast cancer. AIDS 2021; 35:605-618. [PMID: 33394680 DOI: 10.1097/qad.0000000000002810] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND As women living with HIV (WLWH) become older, their risk of developing breast cancer increases. Nonetheless, literature is conflicting regarding tumor stage, distribution of subtypes and overall survival among WLWH vs. HIV-negative women with breast cancer. We assessed differences in clinicopathological characteristics and overall survival between these two groups. METHODS Systematic review and meta-analysis using MEDLINE, Scopus, ISI Web of Knowledge, LILACS, SciELO and conference abstracts up to 1 January 2020. Cross-sectional/cohort studies comparing baseline characteristics (stage and/or subtypes) and/or overall survival of WLWH vs. HIV-negative women with breast cancer were included. We performed random-effects meta-analyses to estimate summary statistics and subgroup analyses according to region of the world. RESULTS Eighteen studies [4 from North America, 14 from sub-Saharan Africa (SSA)] were included, with 3174 WLWH and 2 394 598 HIV-negative women. WLWH from North America and SSA were more likely to present with stage III/IV disease compared with HIV-negative women - pooled odds ratio (pOR) 1.76 [95% confidence interval (CI):1.58-1.95] and pOR 1.23 (95% CI: 1.06-1.42), respectively. WLWH from SSA were also less likely to have estrogen receptor-positive/HER2-negative tumors (pOR 0.81; 95% CI: 0.66-0.99). After adjustment, WLWH had worse overall survival compared with HIV-negative women, both in North America [pooled adjusted hazard ratio (aHR) 2.45; 95% CI: 1.11-5.41] and SSA (aHR 1.43; 95% CI: 1.06-1.92). CONCLUSION Compared with HIV-negative women, WLWH are diagnosed with breast cancer at a more advanced stage and have a worse overall survival. These results should raise awareness regarding the detection and survival gap among WLWH with breast cancer and further studies are needed to decipher the reasons behind these disparities.
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Affiliation(s)
- Mariana Brandão
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, Bruxelles, Belgium
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Marco Bruzzone
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Maria-Alice Franzoi
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, Bruxelles, Belgium
| | - Claudia De Angelis
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, Bruxelles, Belgium
| | - Daniel Eiger
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, Bruxelles, Belgium
| | - Rafael Caparica
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, Bruxelles, Belgium
| | - Martine Piccart-Gebhart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, Bruxelles, Belgium
| | - Laurence Buisseret
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, Bruxelles, Belgium
| | - Marcello Ceppi
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Nicolas Dauby
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Bruxelles, Belgium
- Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Rue Adrienne Bolland, Gosselies
- Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Carla Carrilho
- Pathology Department, Faculty of Medicine, University Eduardo Mondlane, Avenida Salvador Allende
- Department of Pathology, Maputo Central Hospital, Avenida Eduardo Mondlane, Maputo, Mozambique
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
| | - Evandro de Azambuja
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, Bruxelles, Belgium
| | - Matteo Lambertini
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
- University of Genova, Genova, Italy
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8
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Silas OA, Musa J, Afolaranmi TO, Sagay AS, Evans CT, Achenbach CJ, Hou L, Murphy RL. Predictors of Mortality From a Population-Based Cancer Registry Data in Jos, Nigeria: A Resource-Limited Setting. Front Med (Lausanne) 2020; 7:227. [PMID: 32582731 PMCID: PMC7287203 DOI: 10.3389/fmed.2020.00227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/04/2020] [Indexed: 11/13/2022] Open
Abstract
Background: It is a well-documented fact that world-wide cancer incidence and mortality remains high in Human Immunodeficiency Virus (HIV) infected population despite potent antiretroviral therapy. With the current capture of HIV status of cancer patients in our cancer registry at Jos Nigeria, this study aims to assess the effect of HIV on cancer mortality outcomes. Methodology: We conducted a 2-year retrospective cohort study of cancer registry data from Jos, north central Nigeria. The cancers were grouped into cervical, breast, liver, hematologic, colonic, AIDS defining, prostate and others in this study. Patients were followed up to determine their patient time contribution from time at initiation of cancer treatment to death or the end of study period. Those lost to follow-up were censored at date of their last known follow-up in clinic. Results: Out of 930 cancer cases evaluated, 52 (5.6%) were HIV positive, 507 (54.5%) were HIV negative and 371 (39.9%) did not know their HIV status. After 525,223 person- days of follow-up, there were 232 deaths leading to a crude mortality rate of 4.3 per 10,000 person-days. Median survival probability for both HIV-infected and HIV uninfected patients were equal (1,013 days). Unadjusted hazard of death was associated with greater age, HR 0.99 (95% CI: 0.98,0.99, p = 0.002); hepatitis virus, HR 2.40 (95% CI: 1.69,3.43, p = 0.001); liver cancer, HR 2.25 (95% CI:1.11,4.55, p = 0.024); prostate cancer, HR 0.17 (95% CI: 0.06,0.393, p = 0.001). In an adjusted model, only prostate cancer AHR 0.23 (95% CI: 0.12, 0.42, p < 0.001) and liver cancer AHR 2.45 (95% CI: 1.78, 5.51, p < 0.001) remained significantly associated with death regardless of HIV status. Conclusion: Having liver cancer increases risk for mortality among our cancer patients. Screening, early detection and treatment are therefore key to improving dismal outcomes.
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Affiliation(s)
| | - Jonah Musa
- Department of Pathology, University of Jos, Jos, Nigeria
| | | | | | | | - Chad J Achenbach
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lifang Hou
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Robert Leo Murphy
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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9
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Trickey A, May MT, Gill MJ, Grabar S, Vehreschild J, Wit FWNM, Bonnet F, Cavassini M, Abgrall S, Berenguer J, Wyen C, Reiss P, Grabmeier-Pfistershammer K, Guest JL, Shepherd L, Teira R, d'Arminio Monforte A, Del Amo J, Justice A, Costagliola D, Sterne JAC. Cause-specific mortality after diagnosis of cancer among HIV-positive patients: A collaborative analysis of cohort studies. Int J Cancer 2020; 146:3134-3146. [PMID: 32003460 PMCID: PMC7187452 DOI: 10.1002/ijc.32895] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Abstract
People living with HIV (PLHIV) are more likely than the general population to develop AIDS-defining malignancies (ADMs) and several non-ADMs (NADMs). Information is lacking on survival outcomes and cause-specific mortality after cancer diagnosis among PLHIV. We investigated causes of death within 5 years of cancer diagnosis in PLHIV enrolled in European and North American HIV cohorts starting antiretroviral therapy (ART) 1996-2015, aged ≥16 years, and subsequently diagnosed with cancer. Cancers were grouped: ADMs, viral NADMs and nonviral NADMs. We calculated cause-specific mortality rates (MR) after diagnosis of specific cancers and compared 5-year survival with the UK and France general populations. Among 83,856 PLHIV there were 4,436 cancer diagnoses. Of 603 deaths after ADM diagnosis, 292 (48%) were due to an ADM. There were 467/847 (55%) and 74/189 (39%) deaths that were due to an NADM after nonviral and viral NADM diagnoses, respectively. MR were higher for diagnoses between 1996 and 2005 versus 2006-2015: ADMs 102 (95% CI 92-113) per 1,000 years versus 88 (78-100), viral NADMs 134 (106-169) versus 111 (93-133) and nonviral NADMs 264 (232-300) versus 226 (206-248). Estimated 5-year survival for PLHIV diagnosed with liver (29% [19-39%]), lung (18% [13-23%]) and cervical (75% [63-84%]) cancer was similar to general populations. Survival after Hodgkin's lymphoma diagnosis was lower in PLHIV (75% [67-81%]). Among ART-treated PLHIV diagnosed with cancer, MR and causes of death varied by cancer type, with mortality highest for liver and lung cancers. Deaths within 5 years of NADM diagnoses were more likely to be from cancer than AIDS.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Margaret T May
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - M John Gill
- Division of Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Sophie Grabar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidemiologie et de Santé Publique (IPLESP), Paris, France.,Unité de Biostatistique et d'Épidémiologie Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Janne Vehreschild
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Ferdinand W N M Wit
- Stichting HIV Monitoring, Amsterdam, The Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Fabrice Bonnet
- University of Bordeaux, ISPED, INSERM U1219, Bordeaux, France.,CHU de Bordeaux, Bordeaux, France
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland.,University of Lausanne, Lausanne, Switzerland
| | - Sophie Abgrall
- Department of Internal Medicine, Antoine Béclère Hospital, Clamart, France.,University of Paris Saclay, Paris-Sud University, UVSQ, Le Kremlin-Bicêtre, France.,CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Christoph Wyen
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | | | - Jodie L Guest
- Rollins School of Public Health, Atlanta, GA.,Emory School of Medicine, Atlanta, GA
| | - Leah Shepherd
- Institute of Global Health, University College London, London, United Kingdom
| | - Ramon Teira
- Unit of Infectious Diseases, Hospital Sierrallana, Torrelavega, Spain
| | | | - Julia Del Amo
- National Epidemiology Center, Carlos III Health Institute, Madrid, Spain
| | - Amy Justice
- Yale University School of Medicine and Public Health, New Haven, CT.,VA Connecticut Healthcare System, West Haven, CT
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidemiologie et de Santé Publique (IPLESP), Paris, France
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10
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Abstract
BACKGROUND Hematological malignancies have continued to be highly prevalent among people living with HIV (PLHIV). This study assessed the occurrence of, risk factors for, and outcomes of hematological and nonhematological malignancies in PLHIV in Asia. METHODS Incidence of malignancy after cohort enrollment was evaluated. Factors associated with development of hematological and nonhematological malignancy were analyzed using competing risk regression and survival time using Kaplan-Meier. RESULTS Of 7455 patients, 107 patients (1%) developed a malignancy: 34 (0.5%) hematological [0.08 per 100 person-years (/100PY)] and 73 (1%) nonhematological (0.17/100PY). Of the hematological malignancies, non-Hodgkin lymphoma was predominant (n = 26, 76%): immunoblastic (n = 6, 18%), Burkitt (n = 5, 15%), diffuse large B-cell (n = 5, 15%), and unspecified (n = 10, 30%). Others include central nervous system lymphoma (n = 7, 21%) and myelodysplastic syndrome (n = 1, 3%). Nonhematological malignancies were mostly Kaposi sarcoma (n = 12, 16%) and cervical cancer (n = 10, 14%). Risk factors for hematological malignancy included age >50 vs. ≤30 years [subhazard ratio (SHR) = 6.48, 95% confidence interval (CI): 1.79 to 23.43] and being from a high-income vs. a lower-middle-income country (SHR = 3.97, 95% CI: 1.45 to 10.84). Risk was reduced with CD4 351-500 cells/µL (SHR = 0.20, 95% CI: 0.05 to 0.74) and CD4 >500 cells/µL (SHR = 0.14, 95% CI: 0.04 to 0.78), compared to CD4 ≤200 cells/µL. Similar risk factors were seen for nonhematological malignancy, with prior AIDS diagnosis showing a weak association. Patients diagnosed with a hematological malignancy had shorter survival time compared to patients diagnosed with a nonhematological malignancy. CONCLUSIONS Nonhematological malignancies were common but non-Hodgkin lymphoma was more predominant in our cohort. PLHIV from high-income countries were more likely to be diagnosed, indicating a potential underdiagnosis of cancer in low-income settings.
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11
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Castilho JL, Turner M, Shepherd BE, Koethe JR, Furukawa SS, Bofill CE, Raffanti S, Sterling TR. CD4/CD8 Ratio and CD4 Nadir Predict Mortality Following Noncommunicable Disease Diagnosis in Adults Living with HIV. AIDS Res Hum Retroviruses 2019; 35:960-967. [PMID: 31407605 DOI: 10.1089/aid.2019.0064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Incidence of noncommunicable diseases (NCDs), including cardiovascular disease (CVD), cirrhosis, and non-AIDS-defining cancers (NADCs), have been associated with HIV viremia, CD4 cell counts, and CD4/CD8 ratio in persons living with HIV (PLWH). This study examined the importance of these markers to mortality risk following NCD diagnosis. We examined factors associated with mortality following incident CVD, cirrhosis, or NADCs in a clinical cohort of PLWH between 1998 and 2015. We calculated Kaplan-Meier estimates and used multivariable Cox proportional hazard models. We included 341 patients with NCDs (CVD = 169, cancer = 103, and cirrhosis = 67), of whom 129 died. Median age at NCD diagnosis was 49 years and median proportion of time before NCD with virologic suppression was 64%. Median survival after CVD was longer than for cancer or cirrhosis (11.6 years vs. 4.8 and 3.4 years, respectively; log rank test p < .001). In multivariable Cox proportional hazard models, higher CD4/CD8 ratio preceding NCD (adjusted hazard ratio [aHR] per 0.1 increase = 0.92 [95% confidence interval 0.85-0.99]) and higher CD4 nadir (aHR per 100 cells/μL = 0.84 [0.72-0.97]) were associated with decreased mortality risk. Neither CD4 cell count before NCD nor HIV viremia was statistically associated with mortality in adjusted models. When restricted to 116 patients with virologic suppression for ≥80% of time before NCD, only CD4 nadir was associated with mortality risk. Low CD4/CD8 ratio and CD4 nadir were associated with increased mortality risk after NCD, suggesting that prior immunosuppression or ongoing immune imbalance remain important for outcomes following serious NCDs.
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Affiliation(s)
- Jessica L. Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John R. Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sally S. Furukawa
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carmen E. Bofill
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen Raffanti
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Timothy R. Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Differences in survival according to malignancy type and degree of immunodeficiency in HIV-infected patients. Med Clin (Barc) 2019; 154:295-300. [PMID: 31471061 DOI: 10.1016/j.medcli.2019.06.019] [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: 02/05/2019] [Revised: 05/28/2019] [Accepted: 06/06/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE After the introduction of antiretroviral therapy, a decrease in AIDS defining cancers (ADCs) is observed, while non-AIDS-defining cancers (NADCs) have increased in HIV-infected patients (HIP). We have little information about the prognosis and associated risk factors. We studied survival and its relationship with immunodeficiency after the diagnosis of ADC or NADC. MATERIAL AND METHODS Observational, retrospective study of 788 HIP of whom 133 developed a malignancy between 2000-2016. Malignancies were divided into ADCs or NADCs and degree of immunodeficiency according to the CD4 T lymphocyte count> or </=200/mm3. Survival was estimated according to the Kaplan Meier method, multivariate COX regression analysis and compared with the log-rank test. RESULTS 149 malignancies were diagnosed in 133 HIP: 41.4% ADCs and 58.6 NADCs. The most frequent tumour was NHL (21.1%), followed by lung carcinoma (15%). HCV was positive in 50.4% and 65.4% were smokers. Thirty-nine point one percent had a CD4 T lymphocyte count </=200/mm3, being 60% in the case of ADCs while in NADCs it was 38.5%. CD4 T lymphocyte count </=200/mm3 is significantly associated with lower survival after diagnosis of ADCs(p=.031) and NADCs (p=.005). CONCLUSIONS The most frequent types of tumours in HIP differ from those in the general population, probably due to oncogenic risk factors. CD4 T lymphocyte count </=200/mm3 is a risk factor related to worse prognosis after NADC or ADC diagnosis.
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13
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Mitchell LR, Shah N, Selwyn PA. Palliative Care in the Management of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in the Primary Care Setting. Prim Care 2019; 46:433-445. [PMID: 31375191 DOI: 10.1016/j.pop.2019.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has metamorphosed in the past 40 years since the first cases were diagnosed. The advent of highly active antiretroviral treatment (HAART) transformed the disease trajectory for many patients with HIV/AIDS and transitioned the course from a terminal disease to a chronic disease model. This article reviews the epidemiology of HIV/AIDS, prognostic indicators, frailty, opportunistic infections, specific AIDS-defining malignancies and non-AIDS-defining malignancies, role of palliative care, advance care planning, and the role of HAART in patients dying of late-stage AIDS.
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Affiliation(s)
- Linda R Mitchell
- Palliative Medicine Program, Department of Family and Social Medicine, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, 3347 Steuben Avenue, Bronx, NY 10467, USA.
| | - Nidhi Shah
- Palliative Medicine Program, Department of Family and Social Medicine, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, 3347 Steuben Avenue, Bronx, NY 10467, USA
| | - Peter A Selwyn
- Department of Family and Social Medicine, Palliative Medicine Program, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, 3544 Jerome Avenue, Bronx, NY 10467, USA
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14
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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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15
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Hodgkin lymphoma at Groote Schuur Hospital, South Africa: the effect of HIV and bone marrow infiltration. Ann Hematol 2018; 98:381-389. [PMID: 30397846 DOI: 10.1007/s00277-018-3533-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
Human immunodeficiency virus (HIV) is associated with an increased risk of developing Hodgkin lymphoma (HL). South Africa (SA) has the highest HIV prevalence rate in the world. There is currently no outcome-based data for HIV-associated HL from SA. A bone marrow database was compiled of all bone marrow biopsies (BMB) reported at National Health Laboratory Service (NHLS) Groote Schuur Hospital (GSH) between January 2005 and December 2012. Patients who had a BMB performed for staging of HL or where HL was diagnosed on the BMB were included for further analysis. Clinical and laboratory data was extracted from medical and laboratory records. Primary outcome measures included histological subtype, bone marrow infiltration (BMI) by HL, CD4 count, HIV-viral load (HIV-VL), tuberculosis (TB) data, treatment with chemotherapy and 5-year overall survival (OS). The database included 6569 BMB and 219 patients of these had HL and were included for analysis. The median age at presentation (32 years) was similar in the HIV+ and HIV- populations. While males predominated in the HIV- group, females predominated in the HIV+ group (male:female ratio of 1.5:1 vs 0.7:1, respectively). The majority of patients (71%) were HIV negative (HIV-) and 29% were HIV positive (HIV+). The diagnosis of HL was made on BMB in 17% of cases. BMI was seen in 37% (82/219) overall, and was found in more HIV+ patients (61%; 39/64) than HIV- patients (28%; 43/155; p = 0.03). The histological subtype varied according to HIV status with nodular sclerosis classical Hodgkin lymphoma (NSCHL) being most frequent in the HIV- group and classical Hodgkin lymphoma (CHL)-unclassifiable the most frequent in the HIV+ group. HIV+ patients had a median CD4 count of 149 × 106/L and 39% were anti-retroviral therapy (cART) naive at HL diagnosis. HIV+ patients had received anti-TB therapy more frequently than HIV- patients (72% vs 17%; p = 0.007). More HIV+ patients did not receive chemotherapy than HIV- patients (31% vs 3%; p = 0.001). The 5-year OS was 56%. HIV+ patients with BMI had a 5-year OS of 18%. BMI, HIV status, low CD4 count, histological subtype and TB therapy had a statistical significant impact on 5-year OS (p < 0.01). The 5-year OS was 56%, with both BMI and HIV+ status being associated with poor survival. BMB provided the diagnosis of HL in 17% of cases, confirming its diagnostic utility in our setting. Our cohort showed similar survival outcomes to other countries in Africa, Asia and Central America with comparable socio-economic constraints to SA.
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16
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Torti C, Raffetti E, Donato F, Castelli F, Maggiolo F, Angarano G, Mazzotta F, Gori A, Sighinolfi L, Pan A, Cauda R, Scalzini A, Quiros-Roldan E, Nasta P, Gregis G, Benatti S, Digiambenedetto S, Ladisa N, Giralda M, Saracino A, Castelnuovo F, Di Pietro M, Lo Caputo S, Lapadula G, Costarelli S, Lorenzotti S, Mazzini N, Paraninfo G, Casari S, Focà E, Pezzoli C, Fabbiani M, Monno L, Pierotti P, Ble C, Leone S, Postorino MC, Fornabaio C, Zacchi F, Zoncada A, Carosi G. Cohort Profile: Standardized Management of Antiretroviral Therapy Cohort (MASTER Cohort). Int J Epidemiol 2018; 46:e12. [PMID: 26445966 DOI: 10.1093/ije/dyv192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 12/14/2022] Open
Affiliation(s)
- Carlo Torti
- Unità di Malattie Infettive e Tropicali, Dipartimento di Scienze Mediche e Chirurgiche, Università Magna Grecia di Catanzaro, Catanzaro, Italia
| | - Elena Raffetti
- Unità di Igiene, Epidemiologia e Sanità Pubblica, Università degli Studi di Brescia, Brescia, Italia
| | - Francesco Donato
- Unità di Igiene, Epidemiologia e Sanità Pubblica, Università degli Studi di Brescia, Brescia, Italia
| | - Francesco Castelli
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Franco Maggiolo
- Malattie Infettive Ospedale Papa Giovanni XXIII, Bergamo, Italia
| | | | | | - Andrea Gori
- Malattie Infettive Ospedale San Gerardo di Monza, Monza, Italia
| | - Laura Sighinolfi
- Malattie Infettive Nuovo Polo Ospedaliero di Cona, Ferrara, Italia
| | - Angelo Pan
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Roberto Cauda
- Clinica di Malattie Infettive Policlinico A. Gemelli-Università Cattolica di Roma, Roma, Italia
| | - Alfredo Scalzini
- Divisione Ospedaliera di Malattie Infettive Spedali Civili, Brescia, Italia and
| | - Eugenia Quiros-Roldan
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Paola Nasta
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | | | - Simone Benatti
- Malattie Infettive Ospedale Papa Giovanni XXIII, Bergamo, Italia
| | - Simona Digiambenedetto
- Clinica di Malattie Infettive Policlinico A. Gemelli-Università Cattolica di Roma, Roma, Italia
| | | | - Mariarosaria Giralda
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | | | - Filippo Castelnuovo
- Divisione Ospedaliera di Malattie Infettive Spedali Civili, Brescia, Italia and
| | | | | | | | | | | | - Nicola Mazzini
- Fondazione Malattie Infettive e Salute Internazionale, Brescia, Italia
| | - Giuseppe Paraninfo
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Salvatore Casari
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Emanuele Focà
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Chiara Pezzoli
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Massimiliano Fabbiani
- Clinica di Malattie Infettive Policlinico A. Gemelli-Università Cattolica di Roma, Roma, Italia
| | - Laura Monno
- Clinica di Malattie Infettive Policlinico di Bari, Bari, Italia
| | | | - Claudio Ble
- Malattie Infettive S.M. Annunziata, Firenze, Italia
| | | | - Maria Concetta Postorino
- Unità di Malattie Infettive e Tropicali, Dipartimento di Scienze Mediche e Chirurgiche, Università Magna Grecia di Catanzaro, Catanzaro, Italia
| | - Chiara Fornabaio
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Fabio Zacchi
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Alessia Zoncada
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Giampiero Carosi
- Fondazione Malattie Infettive e Salute Internazionale, Brescia, Italia
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17
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Sun KY, Gui XE, Deng D, Xiong Y, Deng LP, Gao SC, Zhang YX. [Clinicpathological features and survival of patients with AIDS related non-Hodgkin's lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 38:97-101. [PMID: 28279031 PMCID: PMC7354166 DOI: 10.3760/cma.j.issn.0253-2727.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
目的 分析艾滋病相关非霍奇金淋巴瘤(ARL)患者的临床特征及生存状态。 方法 回顾性分析53例ARL患者的临床资料,按1∶2随机配对对照研究方法,以106例普通非霍奇金淋巴瘤(NHL)患者为对照,比较两组患者的生存率。 结果 53例ARL患者的平均年龄为43(11~67)岁,诊断NHL时CD4+T细胞中位数为(146±20)个/µl。53例患者中B细胞来源者47例(88.7%),T细胞来源者6例(11.3%)。Ann Arbor分期Ⅲ~Ⅳ期者占52.8%(28/53);IPI评分中高危组和高危组患者比例分别为45.3%(24/53)和18.9%(10/53)。ARL诊断后放弃治疗者占37.7%(20/53),抗HIV治疗联合放化疗者占62.3%(33/53)。抗NHL治疗采用CHOP(环磷酰胺、长春新碱、表阿霉素、泼尼松)方案。ARL组患者的总生存(OS)时间显著短于对照组[(6.0±1.3)对(48.0±10.0)个月,P<0.05]。接受抗NHL治疗的患者中,ARL组(33例)和对照组(100例)患者的OS时间差异无统计学意义[(48.0±10.9)对(77.0±11.1)个月,P=0.816];ARL组患者1年OS率低于对照组(60.6%对83.0%,P<0.05),但两组患者的2年(53.5%对60.5%)、3年(48.1%对45.9%)和5年(39.1%对27.5%)OS率差异均无统计学意义(P值均>0.05)。 结论 ARL多见于青壮年,1年内病死率高,抗HIV治疗联合CHOP方案抗NHL治疗能显著改善ARL患者预后。
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Affiliation(s)
| | | | | | | | | | | | - Y X Zhang
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University. Wuhan 430071, China
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18
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Fink VI, Jenkins CA, Castilho JL, Person AK, Shepherd BE, Grinsztejn B, Netto J, Crabtree-Ramirez B, Cortés CP, Padgett D, Jayathilake K, McGowan C, Cahn P. Survival after cancer diagnosis in a cohort of HIV-positive individuals in Latin America. Infect Agent Cancer 2018; 13:16. [PMID: 29760767 PMCID: PMC5941620 DOI: 10.1186/s13027-018-0188-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/25/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study aimed to evaluate trends and predictors of survival after cancer diagnosis in persons living with HIV in the Caribbean, Central, and South America network for HIV epidemiology cohort. METHODS Demographic, cancer, and HIV-related data from HIV-positive adults diagnosed with cancer ≤ 1 year before or any time after HIV diagnosis from January 1, 2000-June 30, 2015 were retrospectively collected. Cancer cases were classified as AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC). The association of mortality with cancer- and HIV-related factors was assessed using Kaplan-Meier curves and Cox proportional hazards models stratified by clinic site and cancer type. RESULTS Among 15,869 patients, 783 had an eligible cancer diagnosis; 82% were male and median age at cancer diagnosis was 39 years (interquartile range [IQR]: 32-47). Patients were from Brazil (36.5%), Argentina (19.9%), Chile (19.7%), Mexico (19.3%), and Honduras (4.6%). A total of 564 ADC and 219 NADC were diagnosed. Patients with NADC had similar survival probabilities as those with ADC at one year (81% vs. 79%) but lower survival at five years (60% vs. 69%). In the adjusted analysis, risk of mortality increased with detectable viral load (adjusted hazard ratio [aHR] = 1.63, p = 0.02), age (aHR = 1.02 per year, p = 0.002) and time between HIV and cancer diagnoses (aHR = 1.03 per year, p = 0.01). CONCLUSION ADC remain the most frequent cancers in the region. Overall mortality was related to detectable viral load and age. Longer-term survival was lower after diagnosis of NADC than for ADC, which may be due to factors unrelated to HIV.
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Affiliation(s)
- Valeria I. Fink
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
| | - Cathy A. Jenkins
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Jessica L. Castilho
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Anna K. Person
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Bryan E. Shepherd
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
| | - Juliana Netto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
| | - Brenda Crabtree-Ramirez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: Unidad del Paciente Ambulatorio (UPA), 5to piso Vasco de Quiroga # 15 Col. Sección XVI Delegación Tlalpan; C.P, 14000 Mexico City, Mexico
| | | | - Denis Padgett
- Instituto Hondureño de Seguridad Social, Barrio la Granja, Tegucigalpa Honduras, Hospital Escuela Universitario: Av La Salud, Tegucigalpa, Honduras
| | - Karu Jayathilake
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Catherine McGowan
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
| | - Pedro Cahn
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
| | - on behalf of CCASAnet
- Fundación Huésped, Pasaje Gianantonio 3932, C1202ABB Buenos Aires, Argentina
- Vanderbilt University School of Medicine, 1161 21st Ave. S A2200 Medical Center North, Nashville, TN 37232 USA
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900 Brasil
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán: Unidad del Paciente Ambulatorio (UPA), 5to piso Vasco de Quiroga # 15 Col. Sección XVI Delegación Tlalpan; C.P, 14000 Mexico City, Mexico
- Fundación Arriarán, Santa Elvira 629, Santiago, Chile
- Instituto Hondureño de Seguridad Social, Barrio la Granja, Tegucigalpa Honduras, Hospital Escuela Universitario: Av La Salud, Tegucigalpa, Honduras
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Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, Arreola-Ornelas H, Gómez-Dantés O, Rodriguez NM, Alleyne GAO, Connor SR, Hunter DJ, Lohman D, Radbruch L, Del Rocío Sáenz Madrigal M, Atun R, Foley KM, Frenk J, Jamison DT, Rajagopal MR. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet 2018; 391:1391-1454. [PMID: 29032993 DOI: 10.1016/s0140-6736(17)32513-8] [Citation(s) in RCA: 599] [Impact Index Per Article: 99.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Felicia Marie Knaul
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Coral Gables, FL, USA; Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL, USA; Tómatelo a Pecho, A.C., Mexico City, Mexico; Fundación Mexicana para la Salud, A.C., Mexico City, Mexico.
| | | | - Eric L Krakauer
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; World Health Organization, Geneva, Switzerland
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, TX, USA
| | - Afsan Bhadelia
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiaoxiao Jiang Kwete
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Héctor Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Tómatelo a Pecho, A.C., Mexico City, Mexico; Fundación Mexicana para la Salud, A.C., Mexico City, Mexico
| | | | - Natalia M Rodriguez
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA
| | - George A O Alleyne
- Pan American Health Organization, Regional Office of WHO, Washington, DC, USA
| | | | - David J Hunter
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Diederik Lohman
- Health and Human Rights Division, Human Rights Watch, Maplewood, NJ, USA
| | - Lukas Radbruch
- International Association for Hospice and Palliative Care, Houston, TX, USA; Department of Palliative Medicine, University Hospital Bonn, Germany; The Malteser Hospital, Bonn, Germany
| | | | - Rifat Atun
- Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Julio Frenk
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Coral Gables, FL, USA; School of Business Administration, University of Miami, Coral Gables, FL, USA
| | | | - M R Rajagopal
- Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Pallium India, Kerala, India
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20
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Wang YH, Shen XD. Human immunodeficiency virus infection and mortality risk among lung cancer patients: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e0361. [PMID: 29642182 PMCID: PMC5908612 DOI: 10.1097/md.0000000000010361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies have suggested that patients with human immunodeficiency virus (HIV) infection are at higher risk of lung cancer, but the impact of HIV infection on the risk of mortality among lung cancer patients is still unclear. We conducted a systematic review and meta-analysis to clarify the association between HIV infection and mortality risk among lung cancer patients. METHODS PubMed and Embase databases were searched to identify studies assessing the association between HIV infection and mortality risk among lung cancer patients. Only studies reporting adjusted relative risk (RR) of mortality among lung cancer patients with HIV infection were included. Meta-analysis of random-effect model was utilized to calculate the pooled RR with 95% confidence interval (CI). RESULTS Twelve cohort studies were finally included. Compared with lung cancer patients without HIV infection, the pooled RR of mortality among lung cancer patients with HIV infection was 1.48 (95% CI, 1.22-1.78, P < .001; I = 88.6%). After excluding 2 studies with low quality, HIV infection was still significantly associated with an elevated risk of mortality among lung cancer patients (RR = 1.51, 95% CI, 1.25-1.82, P < .001; I = 89.8%). Sensitivity analysis showed that the statistical significance of the pooled RR was not changed by excluding any one study. CONCLUSION The outcomes from the meta-analysis provide strong evidence for the elevated risk of mortality among lung cancer patients with HIV infection, and HIV infection is an important prognostic factor in lung cancer patients.
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Affiliation(s)
- Yue-Hua Wang
- Department of Respiration, Jinhua People's Hospital, Jinhua
| | - Xiang-Di Shen
- Faculty of Basic Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
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21
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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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22
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Gizaw M, Addissie A, Getachew S, Ayele W, Mitiku I, Moelle U, Yusuf T, Begoihn M, Assefa M, Jemal A, Kantelhardt EJ. Cervical cancer patients presentation and survival in the only oncology referral hospital, Ethiopia: a retrospective cohort study. Infect Agent Cancer 2017; 12:61. [PMID: 29213299 PMCID: PMC5708091 DOI: 10.1186/s13027-017-0171-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/23/2017] [Indexed: 02/08/2023] Open
Abstract
Background Women infected with Human Immune Deficiency Virus (HIV) are assumed to be at higher risk of developing Cervical Cancer (CC). This is due to a rapid progression of pre-invasive to invasive lesions. However, evidences suggest, due to the availability of antiretroviral therapy (ART) and care services; an improved survival and treatment outcome of CC patients (CCPs) with HIV infection is expected. Objective The aim of this study is to examine the clinical characteristics and survival of of CCPs registered at the radiotherapy center of Tikur Anbessa Specialized Hospital (TASH), Addis Ababa University, Ethiopia. Methods We conducted a retrospective cohort study. Data from 1655 CCPs diagnosed between September 2008 and September 2012 were included. The primary endpoint was death from any cause. Kaplan-Meier estimates were compared using the log-rank test. Cox proportional hazards regression model was used to identify predictors of death. Data were analyzed using STATA version IC/14. Results The mean age of all patients was 49 years (SD = 11.6 years). Of all CCPs, 139 (8.4%) were HIV positive, 372 (22.5%) patients had a known negative HIV status and 1144 (69.1%) patients were asymptomatic with unknown HIV status. Due to late stage and waiting times, only 13.5% of the patients received curative radiotherapy doses. HIV-positive CCPs presented more often with advanced disease compared to HIV negative CCPs ((44.6%) versus 39.7%, p = 0.007). There was no significant difference in survival between HIV-positive and HIV-negative CCPs. Older age (HR = 2.01; 95% CI, 1.01,-4.05), advanced disease (HR = 2.6; 95% CI, 1.67-4.04) and baseline anemia (HR = 1.65; 95% CI, 1.24, 2.20) were independent predictors for higher risk of death. Conclusion Survival rates of CCPs did not differ according to HIV status. The risk of death was higher for patients with older age, advanced disease and anemia. HIV patients should be screened for CC according to guidelines to avoid late presentation.
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Affiliation(s)
- Muluken Gizaw
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany.,Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sefonias Getachew
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany.,Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondimu Ayele
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany.,Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Israel Mitiku
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ulrike Moelle
- Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
| | - Tigist Yusuf
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathias Begoihn
- Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
| | - Mathewos Assefa
- Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmedin Jemal
- Department of Intramural Research, American Cancer Society, Atlanta, GA USA
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany.,Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
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23
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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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24
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Abstract
BACKGROUND Non-AIDS-defining cancers (non-ADCs) have become the leading non-AIDS-related cause of death among people with HIV/AIDS. We aimed to quantify the excess risk of cancer-related deaths among Italian people with AIDS (PWA), as compared with people without AIDS (non-PWA). METHODS A nationwide, population-based, retrospective cohort study was carried out among 5285 Italian PWA, aged 15-74 years, diagnosed between 2006 and 2011. Date of death and multiple-cause-of-death data were retrieved up to December 2011. Excess mortality, as compared with non-PWA, was estimated using sex- and age-standardized mortality ratios (SMRs) and the corresponding 95% confidence intervals (CIs). RESULTS Among 1229 deceased PWA, 10.3% reported non-ADCs in the death certificate, including lung (3.1%), and liver (1.4%), cancers. A 7.3-fold (95% CI: 6.1 to 8.7) excess mortality was observed for all non-ADCs combined. Statistically significant SMRs emerged for specific non-ADCs, ie, anus (5 deaths, SMR = 227.6, 95% CI: 73.9 to 531.0), Hodgkin lymphoma (12 deaths, SMR = 122.0, 95% CI: 63.0 to 213.0), unspecified uterus (4 deaths, SMR = 52.5, 95% CI: 14.3 to 134.5), liver (17 deaths, SMR = 13.2, 95% CI: 7.7 to 21.1), skin melanoma (4 deaths, SMR = 10.9, 95% CI: 3.0 to 27.8), lung (38 deaths, SMR = 8.0, 95% CI: 5.7 to 11.0), head and neck (9 deaths, SMR = 7.8, 95% CI: 3.6 to 14.9), leukemia (5 deaths, SMR = 7.6, 95% CI: 2.4 to 17.7), and colon-rectum (10 deaths, SMR = 5.4, 95% CI: 2.6 to 10.0). SMRs for non-ADCs were particularly elevated among PWA infected through injecting drug use. CONCLUSION This population-based study documented extremely elevated risks of death for non-ADCs among PWA. These findings stress the need of preventive interventions for both virus-related and non-virus-related cancers among HIV-infected individuals.
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25
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Grover S, Martei YM, Puri P, Prabhakar P, Mutebi M, Balogun OD, Price AJ, Freeman AH, Narasimhamurthy M, Rodin D, Rayne S, Zetola NM. Breast Cancer and HIV in Sub-Saharan Africa: A Complex Relationship. J Glob Oncol 2017; 4:1-11. [PMID: 30241185 PMCID: PMC6180795 DOI: 10.1200/jgo.2016.006585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction The number and lifespan of individuals living with HIV have increased
significantly with the scale-up of antiretroviral therapy. Furthermore, the
incidence of breast cancer in women with HIV is growing, especially in
sub-Saharan Africa (SSA). However, the association between HIV infection and
breast cancer is not well understood. Methods A literature search was performed to identify articles published in journals
pertaining to breast cancer and HIV, with an emphasis on SSA. Selected
US-based studies were also identified for comparison. Results Among the 56 studies reviewed, the largest study examined 314 patients with
breast cancer and HIV in the United States. There is no consensus on whether
HIV infection acts as a pro-oncogenic or antioncogenic factor in breast
cancer, and it may have no relation to breast cancer. A higher incidence of
breast cancer is reported in high-income countries than in SSA, although
breast cancer in SSA presents at a younger age and at a more advanced stage.
Some studies show that patients with breast cancer and HIV experience worse
chemotherapy toxicity than do patients without HIV. Data on treatment
outcomes are limited. The largest study showed worse treatment outcomes in
patients with HIV, compared with their counterparts without HIV. Conclusion HIV infection has not been associated with different clinical presentation of
breast cancer. However, some evidence suggests that concurrent diagnosis of
HIV with breast cancer is associated with increased therapy-related toxicity
and worse outcomes. Systematic prospective studies are needed to establish
whether there is a specific association between breast cancer and HIV.
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Affiliation(s)
- Surbhi Grover
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Yehoda M Martei
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Priya Puri
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Pooja Prabhakar
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Miriam Mutebi
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Onyinye D Balogun
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Aryeh J Price
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Alexandra H Freeman
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Mohan Narasimhamurthy
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Danielle Rodin
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Rayne
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola M Zetola
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
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Abstract
PURPOSE OF REVIEW Lung cancer is emerging as a leading cause of death in HIV-infected persons. This review will discuss the latest scientific evidence regarding the mechanisms driving lung cancer risk in HIV infection, the clinical presentation of lung cancer in HIV-infected persons and recent data regarding the outcomes, treatment and prevention of lung cancer in this group. RECENT FINDINGS Increased risk of lung cancer in HIV-infected persons is primarily due to higher smoking rates, but emerging evidence also implicates immunosuppression and inflammatory processes. Lung cancer outcomes may be worse in HIV-infected persons in the antiretroviral era, but this may stem, in part, from treatment disparities. Early detection of lung cancer using chest computed tomography (CT) is being increasingly adopted for smokers in the general population, and recent studies suggest that it may be safe and efficacious in HIV-infected smokers. SUMMARY Lung cancer is an important complication associated with chronic HIV infection. It is associated with unique HIV-related causal mechanisms, and may be associated with worse outcomes in some HIV-infected persons. Smoking cessation and early cancer detection with chest CT are likely to benefit HIV-infected smokers.
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Affiliation(s)
- Keith Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Alain Makinson
- Department of Infectious and Tropical Diseases, U1175-INSERM/UMI 233, IRD, University Montpellier, Montpellier
| | - Jonathan Thaler
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
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Makinson A, Le Moing V, Reynes J, Ferry T, Lavole A, Poizot-Martin I, Pujol JL, Spano JP, Milleron B. Lung Cancer Screening with Chest Computed Tomography in People Living with HIV: A Review by the Multidisciplinary CANCERVIH Working Group. J Thorac Oncol 2016; 11:1644-52. [PMID: 27449803 DOI: 10.1016/j.jtho.2016.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/16/2016] [Accepted: 06/27/2016] [Indexed: 01/16/2023]
Abstract
A shift in mortality and morbidity has been observed in people living with human immunodeficiency virus (PLWHIV) from acquired immunodeficiency syndrome (AIDS) to non-AIDS diseases. Lung cancer has the highest incidence rates among all the non-AIDS-defining malignancies and is associated with mortality rates that exceed those of other cancers. Strategies to increase lung cancer survival in PLWHIV are needed. Lung cancer screening with chest LDCT has been shown to be efficient in the general population at risk. The objective of this review is to discuss lung cancer screening with chest computed tomography in PLWHIV. Lung cancer screening in PLWHIV is feasible. Whether PLWHIV could benefit from an age threshold for screening that is earlier than the minimum age of 55 years usually required in the general population still needs further investigation. Studies evaluating smoking cessation programs and how they could be articulated with lung cancer screening programs are also needed in PLWHIV.
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Affiliation(s)
- Alain Makinson
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France.
| | - Vincent Le Moing
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France
| | - Jacques Reynes
- Department of Infectious and Tropical Diseases, U1175-National Institute of Health and Medical Research/Mixt International Department 233, Development Research Institute, University Montpellier, Montpellier, France
| | - Tristan Ferry
- Infectious and Tropical Disease Unit, University Hospital de la Croix Rousse, Lyon, France
| | - Armelle Lavole
- Department of Pneumology and Reanimation, Hôpital Tenon, Public Assistance-Parisian Hospitals, and Faculté de Médecine Pierre and Marie Curie, University Paris VI, Paris, France
| | - Isabelle Poizot-Martin
- Clinical Immunohaematology Service, University Aix-Marseille, Public Assistance-Hospitals of Marseille Sainte-Marguerite, National Institute of Health and Medical Research, U912 (Economical and Social Sciences of Health and Treatment of Medical Information), Marseille, France
| | - Jean-Louis Pujol
- Thoracic Oncology Unit, University Hospital Montpellier, Montpellier, French Cooperative Thoracic Intergroup, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Public Assistance-Parisian Hospitals, National Institute of Health and Medical Research, Mixt Research Department_S 1136, Institute Pierre Louis Epidemiology and of Public Health, Sorbonne University, University Pierre Marie Curie University Paris 06, Paris, France
| | - Bernard Milleron
- Respiratory Disease Department, Tenon Hospital APHP, Paris VI University, French Cooperative Thoracic Intergroup, Paris, France
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Efficacy of an Anti-transferrin Receptor 1 Antibody Against AIDS-related Non-Hodgkin Lymphoma: A Brief Communication. J Immunother 2016; 38:307-10. [PMID: 26325374 PMCID: PMC4592199 DOI: 10.1097/cji.0000000000000092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The transferrin receptor 1 (TfR1), also known as CD71, is a target for antibody-based cancer immunotherapy due to its high expression on the surface of cancer cells and its ability to internalize. We have previously developed a mouse/human chimeric IgG3 specific for human TfR1 genetically fused to avidin, as a vector to deliver biotinylated anticancer agents into malignant cells. However, we found that this fusion protein (ch128.1Av), and to a lesser extent the same antibody without avidin (ch128.1), exhibits direct cytotoxic activity in vitro against certain malignant hematopoietic cells through the induction of TfR1 degradation and lethal iron starvation. Importantly, both ch128.1 and ch128.1Av have also shown significant anticancer activity in 2 xenograft models of the B-cell malignancy multiple myeloma. It is interesting to note that ch128.1 exhibited superior anticancer activity in both models compared with ch128.1Av, even against malignant cells that show no sensitivity to ch128.1 in vitro. In the present study, we evaluated the efficacy of ch128.1 against an AIDS-related human Burkitt lymphoma cell line (2F7) to determine if ch128.1 can eliminate these cells in vitro and in an in vivo model of AIDS-related non-Hodgkin lymphoma (AIDS-NHL). Even though 2F7 cells expressed high TfR1 levels, these cells lacked sensitivity to the cytotoxicity induced by ch128.1 in vitro. However, ch128.1 showed significant anticancer activity against these AIDS-NHL cells in vivo by significantly prolonging the survival of immunodeficient mice bearing 2F7 tumors. Therefore, ch128.1 warrants further study as a candidate for the treatment of AIDS-NHL and other B-cell malignancies.
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Makinson A, Eymard-Duvernay S, Raffi F, Abgrall S, Bommart S, Zucman D, Valour F, Cheret A, Poizot-Martin I, Duvivier C, Mauboussin JM, Bonnet F, Tattevin P, Reynes J, Le Moing V. Feasibility and efficacy of early lung cancer diagnosis with chest computed tomography in HIV-infected smokers. AIDS 2016; 30:573-82. [PMID: 26829006 DOI: 10.1097/qad.0000000000000943] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Lung cancer screening with chest computed tomography (CT) is beneficial in smokers aged 55 to 74 years. We studied the risks, benefits and feasibility of early lung cancer diagnosis with CT in HIV-infected smokers. DESIGN AND SETTING French, multicentre, single round chest CT study in France, realized between February 2011 and June 2012. PARTICIPANTS Patients were HIV-infected smokers at least 40 years, at least 20 pack-years, with a CD4 T-lymphocyte nadir count below 350 cells/μl. INTERVENTION Single chest CT with a proposed standardized workup algorithm of positive images. MAIN OUTCOME MEASURE The outcome was the number of histologically proven lung cancers diagnosed by CT with a 2-year follow-up. RESULTS Median age of the 442 included patients was 49.8 years, 81.6% were under 55 years, 84% were men, median smoking was 30 pack-years, median nadir and last CD4 cell counts were 168 and 574 cells/μl, respectively, and 90% of patients had a plasma HIV RNA below 50 copies/ml. A positive image at baseline was reported in 94 (21%) patients, and 15 (3.4%) patients had 18 invasive procedures with no serious adverse events. Lung cancer was diagnosed in 10 patients (six at early stages), of which nine (2.0%, 95% confidence interval: 0.9-3.8) were CT detected, and eight in patients below 55 years. CONCLUSION Early lung cancer diagnosis with CT in HIV-infected smokers was feasible, safe, and yielded a significant number of cancers. Lung cancer screening of HIV-infected smokers with an important history of immunodeficiency revealed a substantial number of cancers at younger ages than the targeted range in the general population.
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Yang J, Su S, Zhao H, Wang D, Wang J, Zhang F, Zhao Y. Prevalence and mortality of cancer among HIV-infected inpatients in Beijing, China. BMC Infect Dis 2016; 16:82. [PMID: 26883427 PMCID: PMC4756453 DOI: 10.1186/s12879-016-1416-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 02/05/2016] [Indexed: 01/29/2023] Open
Abstract
Background Cancer is responsible for elevated HIV-related morbidity and mortality. Research on HIV-infected patients with concurrent cancer is rare in China. The purpose of our study was to investigate the prevalence and risk factors associated with cancer among HIV-infected inpatients in Beijing, and to investigate the mortality and risk factors among HIV-infected inpatients with cancer. Methods Hospital records from a total of 1946 HIV-infected patients were collected from the Beijing Ditan Hospital. The data, from 2008 to 2013, were collected retrospectively. The cancer diagnoses included AIDS-defining cancers (ADC) and non-AIDS defining cancers (NADC). Logistic regression was used to identify risk factors predicting the concurrence of cancer with HIV. Mortality was examined using Kaplan-Meier estimates and Cox proportional hazards models. Results 7.7 % (149 cases) of all HIV-infected inpatients had concurrent cancer at their first hospital admission; of those, 33.6 % (50 cases) had ADCs, and 66.4 % (99 cases) had NADCs. The most prevalent NADCs were Hodgkin’s lymphoma, gastrointestinal cancer, liver cancer, and lung cancer. Patients who did not accept antiretroviral therapy (ART) were more likely to suffer from cancer [AOR = 2.07 (1.42–3.01), p = 0.001]. Kaplan-Meier curves indicated that the survival probability of HIV-positive cancer patients was significantly lower than that of HIV-positive cancer-free patients (log-rank test, p < 0.001). For patients diagnosed with cancer, the mortality was also higher among those who did not receive ART [AHR = 2.19 (1.84–2.61), p < 0.001]. Conclusion The prevalence of cancer concurrence among hospitalized HIV-infected patients was 7.7 %. Concurrent cancer also increased mortality among HIV-infected patients. ART was protective against concurrent cancer as well as mortality among HIV-infected cancer patients. These results highlight the importance of promoting cancer screening and early ART initiation among HIV-infected patients.
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Affiliation(s)
- Jun Yang
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shu Su
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongxin Zhao
- Beijing Ditan Hospital, Capital Medical University, Beijing, China.
| | - Dennis Wang
- School of Public Health, Yale University, New Haven, CT, USA
| | - Jiali Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Raffetti E, Donato F, Castelli F, Maggiolo F, Carosi G, Quiros-Roldan E. The predictive role of NLR and PLR for solid non-AIDS defining cancer incidence in HIV-infected subjects: a MASTER cohort study. Infect Agent Cancer 2015; 10:34. [PMID: 26442127 PMCID: PMC4593208 DOI: 10.1186/s13027-015-0032-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/02/2015] [Indexed: 12/18/2022] Open
Abstract
Background The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), two low cost, routinely available inflammatory indices, have been found to be associated with risk of death in patients with solid cancer, in both general population and HIV-positive subjects. However, no study investigated the role of NLR and PLR as predictive of cancer incidence so far. Methods The aim of our study was to assess the association of PLR and NLR with risk of developing solid non-AIDS defining cancer (NADC) in HIV-infected subjects. We conducted a multicenter Italian cohort study from 2000 to 2012 including HIV-infected subjects naïve at antiretroviral treatment at enrollment. The associations of NLR and PLR with NADC incidence were evaluated by univariate and multivariate analyses using both time independent and time dependent Cox proportional hazard models. Results Thirteen thousand five hundred fifty-nine patients (73.3 % males) with a mean age of 36.0 years (SD 10.0) were included. The median (inter-quartile range) of NLR and PLR at baseline were 1.47 (1.03–2.17) and 109.9 (79.6–155.3), respectively. During a median follow-up of 3.9 years, 337 subjects had a first diagnosis of solid NADC. The crude and age- and gender-standardized incidence rates were 3.57 and 3.91 per 1000 person-years, respectively. No statistically significant association was found between NLR and PLR and NADC incidence, using multivariate models, including also time-dependent Cox models with a cubic-spline for NLR and PLR. Conclusion This study does not sustain the hypothesis that NRL and PLR may be useful for predicting the risk of cancer in HIV positive subjects. Electronic supplementary material The online version of this article (doi:10.1186/s13027-015-0032-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena Raffetti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Francesco Donato
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Franco Maggiolo
- Clinical Infectious Diseases, Ospedale Papa Giovanni XXIII of Bergamo, Bergamo, Italy
| | - Giampiero Carosi
- Fondazione Malattie Infettive e Salute Internazionale, Brescia, Italy
| | - Eugenia Quiros-Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
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Systemic Inflammation-Based Biomarkers and Survival in HIV-Positive Subject With Solid Cancer in an Italian Multicenter Study. J Acquir Immune Defic Syndr 2015; 69:585-92. [PMID: 26167619 DOI: 10.1097/qai.0000000000000682] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recently, some systemic inflammation-based biomarkers have been demonstrated useful for predicting risk of death in patients with solid cancer independently of tumor characteristics. This study aimed to investigate the prognostic role of systemic inflammation-based biomarkers in HIV-infected patients with solid tumors and to propose a risk score for mortality in these subjects. METHODS Clinical and pathological data on solid AIDS-defining cancer (ADC) and non-AIDS-defining cancer (NADC), diagnosed between 1998 and 2012 in an Italian cohort, were analyzed. To evaluate the prognostic role of systemic inflammation- and nutrition-based markers, univariate and multivariable Cox regression models were applied. To compute the risk score equation, the patients were randomly assigned to a derivation and a validation sample. RESULTS A total of 573 patients (76.3% males) with a mean age of 46.2 years (SD = 10.3) were enrolled. 178 patients died during a median of 3.2 years of follow-up. For solid NADCs, elevated Glasgow Prognostic Score, modified Glasgow Prognostic Score, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and Prognostic Nutritional Index were independently associated with risk of death; for solid ADCs, none of these markers was associated with risk of death. For solid NADCs, we computed a mortality risk score on the basis of age at cancer diagnosis, intravenous drug use, and Prognostic Nutritional Index. The areas under the receiver operating characteristic curve were 0.67 (95% confidence interval: 0.58 to 0.75) in the derivation sample and 0.66 (95% confidence interval: 0.54 to 0.79) in the validation sample. CONCLUSIONS Inflammatory biomarkers were associated with risk of death in HIV-infected patients with solid NADCs but not with ADCs.
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Brugnaro P, Morelli E, Cattelan F, Petrucci A, Panese S, Eseme F, Cavinato F, Barelli A, Raise E. Non-acquired immunodeficiency syndrome definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era. World J Virol 2015; 4:209-218. [PMID: 26279983 PMCID: PMC4534813 DOI: 10.5501/wjv.v4.i3.209] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/02/2015] [Accepted: 05/28/2015] [Indexed: 02/05/2023] Open
Abstract
Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection has been widely available in industrialized countries since 1996; its widespread use determined a dramatic decline in acquired immunodeficiency syndrome (AIDS)-related mortality, and consequently, a significant decrease of AIDS-defining cancers. However the increased mean age of HIV-infected patients, prolonged exposure to environmental and lifestyle cancer risk factors, and coinfection with oncogenic viruses contributed to the emergence of other malignancies that are considered non-AIDS-defining cancers (NADCs) as a relevant fraction of morbidity and mortality among HIV-infected people twenty years after HAART introduction. The role of immunosuppression in the pathogenesis of NADCs is not well defined, and future researches should investigate the etiology of NADCs. In the last years there is a growing evidence that intensive chemotherapy regimens and radiotherapy could be safely administrated to HIV-positive patients while continuing HAART. This requires a multidisciplinary approach and a close co-operation of oncologists and HIV-physicians in order to best manage compliance of patients to treatment and to face drug-related side effects. Here we review the main epidemiological features, risk factors and clinical behavior of the more common NADCs, such as lung cancer, hepatocellular carcinoma, colorectal cancer and anal cancer, Hodgkin’s lymphoma and some cutaneous malignancies, focusing also on the current therapeutic approaches and preventive screening strategies.
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Chen CH, Chung CY, Wang LH, Lin C, Lin HL, Lin HC. Risk of cancer among HIV-infected patients from a population-based nested case-control study: implications for cancer prevention. BMC Cancer 2015; 15:133. [PMID: 25885746 PMCID: PMC4369071 DOI: 10.1186/s12885-015-1099-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/20/2015] [Indexed: 12/31/2022] Open
Abstract
Background The burden of cancer is likely to increase among the human immunodeficiency virus (HIV)-positive population as it ages due to successful antiretroviral therapy (ART). The purpose of this study was to determine the risk of cancer in HIV-infected patients. Methods This study was a matched nested case–control study. It was performed using the National Health Insurance Research Database of Taiwan. The control group included non–HIV-infected patients matched by sex, age, and year of enrollment. Logistic regression analyses were performed and simultaneously adjusted for potential confounders (income, urbanization, and Charslon index of comorbidity to evaluate HIV infection as an independent risk of cancer. We calculated the overall and sex-specific standardized incidence ratios (SIR) to investigate the pattern of cancer risk and overall cancer risk in the patients with HIV infection. Results Of the 1,115 HIV-infected patients, 104 (9.33%) developed cancer during the 11-year follow-up period. The risk of cancer for patients with HIV infection was significant (adjusted odds ratio = 3.89, 95% confidence interval [CI] = 2.92–5.19) after adjustment for potential confounders. There was a significantly increased risk of developing non-Hodgkin lymphoma (SIR = 25.73, 95% CI = 6.83-90.85), cervical cancer (SIR = 4.01, 95% CI = 1.0-16.06), lymphoma (SIR = 20.26, 95% CI = 5.86-70.10), and respiratory and intrathoracic cancer (SIR = 20.09, 95% CI = 2.34-172.09) compared with the control group. In addition, HIV-infected patients were at significant risk for renal, oral, breast, liver, skin, and colorectal cancer. Conclusions Patients with HIV infection are at increased risk for several specific cancers. Our results support the implementation of an active and accelerated cancer screening schedule for patients with HIV infection to increase their life span.
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Affiliation(s)
- Chang-Hua Chen
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan. .,College of Medicine & Nursing, Hung Kuang University, Taichung City, Taiwan.
| | - Chih-Yuan Chung
- Division of Hematology and Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
| | - Li-Hsuan Wang
- Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan. .,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
| | - Che Lin
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. .,Department of Environmental Engineering, National Chung-Hsing University, Taichung, Taiwan.
| | - Hsiu-Li Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. .,Department of Neurology, General Cathay Hospital, Sijhih Branch, New Taipei City, Taiwan.
| | - Hsiu-Chen Lin
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing Street, 11031, Taipei, Taiwan. .,Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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Raffetti E, Donato F, Castelnuovo F, Ladisa N, Paraninfo G, Di Filippo E, Segala D, Cologni G, Bandera A, Zacchi F, Digiambenedetto S, Di Pietro M, Castelli F, Quiros-Roldan E. The prognostic role of systemic inflammatory markers on HIV-infected patients with non-Hodgkin lymphoma, a multicenter cohort study. J Transl Med 2015; 13:89. [PMID: 25886534 PMCID: PMC4562103 DOI: 10.1186/s12967-015-0446-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/24/2015] [Indexed: 01/04/2023] Open
Abstract
Background The systemic inflammatory response has been postulated as having prognostic significance in a wide range of different cancer types. We aimed to assess the prognostic role of inflammatory markers on survival in HIV-infected patients with Non-Hodgkin Lymphoma (NHL), and to compute a prognostic score based on inflammatory biomarkers. Methods We evaluated data on HIV patients with NLH diagnosis between 1998 and 2012 in a HIV Italian Cohort. Using Cox proportional regression model, we assessed the prognostic role of Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI), and Prognostic Nutritional Index (PNI). We also computed a risk score equation, assigning patients to a derivation and a validation sample. The area under the curve (AUC) was use to evaluate the predictive ability of this score. Results 215 non-Hodgkin lymphoma cases (80.0% males) with a mean age of 43.2 years were included. Deaths were observed in 98 (45.6%) patients during a median follow up of 5 years. GPS, mGPS, PI and PNI were independently associated with risk of death. We also computed a mortality risk score which included PNI and occurrence of an AIDS event within six months from NHL diagnosis. The AUCs were 0.69 (95% CI 0.58 to 0.81) and 0.69 (95% CI 0.57 to 0.81) at 3 and 5 years of the follow-up, respectively. Conclusions GPS, mGPS, PI and PNI are independent prognostic factors for survival of HIV patients with NHL.
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Affiliation(s)
- Elena Raffetti
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Francesco Donato
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Filippo Castelnuovo
- Hospital Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
| | - Nicoletta Ladisa
- Department of Infectious Diseases, Polyclinic of Bari, University of Bari, Bari, Italy.
| | - Giuseppe Paraninfo
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Elisa Di Filippo
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Daniela Segala
- Department of Infectious Diseases, S. Anna Hospital, Ferrara, Italy.
| | - Giuliana Cologni
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Alessandra Bandera
- Department of Infectious Diseases, San Gerardo de' Tintori" Hospital, Monza, Italy.
| | - Fabio Zacchi
- Clinical Infectious Diseases, Istituti Ospitalieri, Cremona, Italy.
| | - Simona Digiambenedetto
- Institute of Clinical Infectious Diseases, Polyclinic A. Gemelli, University of Sacred Heart, Rome, Italy.
| | - Massimo Di Pietro
- Department of Infectious Diseases, SM. Annunziata Hospital, Florence, Italy.
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Eugenia Quiros-Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
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Marcus JL, Chao C, Leyden WA, Xu L, Yu J, Horberg MA, Klein D, Towner WJ, Quesenberry CP, Abrams DI, Silverberg MJ. Survival among HIV-infected and HIV-uninfected individuals with common non-AIDS-defining cancers. Cancer Epidemiol Biomarkers Prev 2015; 24:1167-73. [PMID: 25713023 DOI: 10.1158/1055-9965.epi-14-1079] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/12/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Non-AIDS-defining cancers increasingly contribute to mortality among human immunodeficiency virus (HIV)-infected individuals. However, few studies have compared cancer prognosis by HIV status with adjustment for risk factors. METHODS We conducted a cohort study of HIV-infected and HIV-uninfected adults in Kaiser Permanente California during 1996 to 2011, following subjects diagnosed with Hodgkin lymphoma or anal, prostate, colorectal, or lung cancers. We used Kaplan-Meier curves and Cox regression to assess cancer-related mortality within 5 years, comparing HIV-infected with HIV-uninfected subjects. Adjusted models included age, race/ethnicity, sex, cancer stage, cancer treatment, and smoking. RESULTS Among HIV-infected and HIV-uninfected subjects, there were 68 and 51 cases of Hodgkin lymphoma, 120 and 28 of anal cancer, 150 and 2,050 of prostate cancer, 53 and 646 of colorectal cancer, and 80 and 507 of lung cancer, respectively. Five-year cancer-related survival was reduced for HIV-infected compared with HIV-uninfected subjects, reaching statistical significance for lung cancer (10% vs. 19%, P = 0.002) but not Hodgkin lymphoma (83% vs. 89%, P = 0.40) or anal (64% vs. 74%, P = 0.38), prostate (86% vs. 92%, P = 0.074), or colorectal cancers (49% vs. 58%, P = 0.55). Adjusted results were similar, with lung cancer [HR, 1.3; 95% confidence interval (CI), 1.0-1.7] and prostate cancer (HR, 2.1; 95% CI, 1.1-4.1) reaching significance. CONCLUSIONS Cancer-related mortality was higher among HIV-infected compared with HIV-uninfected individuals for prostate and lung cancers, but not Hodgkin lymphoma, anal cancer, or colorectal cancer. IMPACT Our findings emphasize the need for a focus on prevention, early detection, and adequate treatment of cancer among HIV-infected individuals.
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Affiliation(s)
- Julia L Marcus
- Kaiser Permanente Northern California, Oakland, California
| | - Chun Chao
- Kaiser Permanente Southern California, Pasadena, California
| | - Wendy A Leyden
- Kaiser Permanente Northern California, Oakland, California
| | - Lanfang Xu
- Kaiser Permanente Southern California, Pasadena, California
| | - Jeanette Yu
- Kaiser Permanente Northern California, Oakland, California
| | | | - Daniel Klein
- Kaiser Permanente Northern California, San Leandro, California
| | | | | | - Donald I Abrams
- San Francisco General Hospital, San Francisco, California. University of California San Francisco, San Francisco, California
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