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Sirera G, Videla S, Saludes V, Castellà E, Sanz C, Ariza A, Clotet B, Martró E. Prevalence of HPV-DNA and E6 mRNA in lung cancer of HIV-infected patients. Sci Rep 2022; 12:13196. [PMID: 35915124 PMCID: PMC9343353 DOI: 10.1038/s41598-022-17237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 07/22/2022] [Indexed: 11/27/2022] Open
Abstract
HIV-infected individuals could be at a greater risk for developing lung cancer than the general population due to the higher prevalence in the former of human papillomavirus (HPV) in the oral cavity and higher smoking rates. Our aim was to assess HPV prevalence and E6 viral oncogene transcription in lung cancer samples from HIV-infected individuals. This was a single-center, retrospective study of a cohort of HIV-1-infected patients diagnosed with and treated for lung cancer. Pathological lung samples archived as smears or formalin-fixed paraffin-embedded blocks were subjected to HPV genotyping, detection of human p16 protein and assessment for HPV E6 mRNA expression. Lung cancer samples from 41 patients were studied, including squamous cell carcinoma (32%), adenocarcinoma (34%), non-small cell cancer (27%), and small cell cancer (7%). HPV DNA was detected in 23 out of 41 (56%, 95% CI 41–70%) of samples and high-risk (HR)-HPV types were detected in 16 out of 41 (39%, 95% CI 26–54%), HPV-16 being the most prevalent [13/16 (81.3%, 95% CI 57.0–93%]. In samples with sufficient material left: expression of p16 was detected in 3 out of 10 (30%) of HR-HPV DNA-positive tumors and in 3 out of 7 (43%) of the negative ones; and E6 mRNA was detected in 2 out of 10 (20%) of HPV-16-positive samples (squamous lung cancers). These two patients had a background of a previous HPV-related neoplasia and smoking. HR-HPV DNA detection was prevalent in lung cancers in HIV-infected patients. However, viral oncogene expression was limited to patients with previous HPV-related cancers.
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Affiliation(s)
- Guillem Sirera
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Infectious Diseases Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Sebastián Videla
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,Clinical Research Support Unit (HUB-IDIBELL: Bellvitge University Hospital & Bellvitge Biomedical Research Institute), Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain.,Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Verónica Saludes
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Eva Castellà
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Carolina Sanz
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Aurelio Ariza
- Department of Pathology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Bonaventura Clotet
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain.,IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Elisa Martró
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain. .,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
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2
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Reynolds G, Haeusler G, Slavin MA, Teh B, Thursky K. Latent infection screening and prevalence in cancer patients born outside of Australia: a universal versus risk-based approach? Support Care Cancer 2021; 29:6193-6200. [PMID: 33763725 DOI: 10.1007/s00520-021-06116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Contention surrounds how best to screen patients for latent and undiagnosed infection prior to cancer treatment. Early treatment and prophylaxis against reactivation may improve infection-associated morbidity. This study sought to examine rates of screening and prevalence of latent infection in overseas-born patients receiving cancer therapies. METHODS A single-centre retrospective audit of 952 overseas-born patients receiving chemotherapy, targeted agents and immunotherapy between January 1 and December 31 2019 was undertaken at Peter MacCallum Cancer Centre. Pre-treatment screening for hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV), latent tuberculosis (LTBI), toxoplasmosis and strongyloidiasis was audited. RESULTS Approximately half of our overseas-born patients were screened for HBV (58.9%) and HCV (50.7%). Fewer patients were screened for HIV (30.5%), LTBI (18.3%), strongyloidiasis (8.6%) or toxoplasmosis (8.1%). Although 59.7% of our patients were born in countries with high epidemiological risk for latent infection, according to World Health Organization data, 35% were not screened for any infection prior to commencement of therapy. CONCLUSION The prevalence of latent infections amongst overseas-born patients with cancer, and complexities associated with risk-based screening, likely supports universal latent infection screening amongst this higher-risk cohort.
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Affiliation(s)
- Gemma Reynolds
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.
| | - Gabrielle Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
- Department of Infectious Diseases, Royal Children's Hospital, Melbourne, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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3
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Mapanga W, Norris SA, Chen WC, Blanchard C, Graham A, Baldwin-Ragaven L, Boyles T, Donde B, Greef L, Huddle K, Khumalo B, Leepile E, Lubuzo B, Makhutle R, Mayet Y, Tsitsi M, Mistri P, Mmoledi K, Ratshikana-Moloko M, Morer R, Pretorius L, Punwasi J, Richards GA, Ruff P, Shabalala D, Sibadela M, Soma N, Wong M, Joffe M. Consensus study on the health system and patient-related barriers for lung cancer management in South Africa. PLoS One 2021; 16:e0246716. [PMID: 33571312 PMCID: PMC7877667 DOI: 10.1371/journal.pone.0246716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 01/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Lung cancer is the highest incident cancer globally and is associated with significant morbidity and mortality particularly if identified at a late stage. Poor patient outcomes in low- and middle-income countries (LMIC's) might reflect contextual patient and health system constraints at multiple levels, that act as barriers to prevention, disease recognition, diagnosis, and treatment. Lung cancer screening, even for high-risk patients, is not available in the public health sector in South Africa (SA), where the current HIV and tuberculosis (TB) epidemics often take precedence. Yet, there has been no formal assessment of the individual and health-system related barriers that may delay patients with lung cancer from seeking and accessing help within the public health care system and receiving the appropriate and effective diagnosis and treatment. This study aimed to derive consensus from health-system stakeholders in the urban Gauteng Province of SA on the most important challenges faced by the health services and patients in achieving optimum lung cancer management and to identify potential solutions. METHODS The study was undertaken among 27 participant stakeholders representing clinical managers, clinicians, opinion leaders from the public health sector and non-governmental organisation (NGO) representatives. The study compromised two components: consensus and engagement. For the consensus component, the Delphi Technique was employed with open-ended questions and item ranking from five rounds of consensus-seeking, to achieve collective agreement on the most important challenges faced by patients and the health services in achieving optimal lung cancer management. For the engagement component, the Nominal Group Technique was used to articulate ideas and reach an agreement on the group's recommendations for solution strategies and approaches. RESULTS Public health sector stakeholders suggested that a lack of knowledge and awareness of lung cancer, and the apparent stigma associated with the disease and its risk factors, as well as symptoms and signs, are critical to treatment delay. Furthermore, delays in up-referral of patients with suspected lung cancer from district health care level were attributed to inadequate knowledge arising from a lack of in-service training of nurses and doctors regarding oncologic symptoms, risk factors, need for further investigation, interpretation of x-rays and available treatments. At a tertiary level, participants suggested that insufficient availability of specialised diagnostic resources (imaging, cytological and pathological services including biomolecular assessment of lung cancer), theatres, cardiothoracic surgeons, and appropriate therapeutic modalities (chemotherapeutic agents and radiation oncology) are the main barriers to the provision of optimal care. It was suggested that a primary prevention programme initiated by the government that involves private-public partnerships may improve lung cancer management nationally. CONCLUSIONS Considerable barriers to the early identification and treatment of lung cancer exist. Finding solutions to overcome both individual and health-system level obstacles to lung cancer screening and management are vital to facilitate early identification and treatment, and to improve survival. Furthermore, research on inexpensive biomarkers for asymptomatic disease detection, the introduction of diagnostic imaging tools that utilise artificial intelligence to compensate for inadequate human resources and improving clinical integration across all levels of the healthcare system are essential.
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Affiliation(s)
- Witness Mapanga
- Division of the Wits Health Consortium, Non-Communicable Diseases Research (NCDR), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- Division of the Wits Health Consortium, Non-Communicable Diseases Research (NCDR), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenlong C. Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charmaine Blanchard
- Division of the Wits Health Consortium, Non-Communicable Diseases Research (NCDR), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Palliative Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Anita Graham
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laurel Baldwin-Ragaven
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tom Boyles
- Helen Joseph Hospital, Auckland Park, Johannesburg, Gauteng, South Africa
- ANOVA Health Institute, Johannesburg, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bernard Donde
- Division Radiation Oncology, Department of Radiation Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Greef
- The Cancer Alliance, Johannesburg, South Africa
| | - Ken Huddle
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Busisiwe Khumalo
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth Leepile
- Gauteng Department of Health, Tladi Provincial Clinic, Johannesburg, South Africa
| | - Buhle Lubuzo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of the KwaZulu Natal, Durban, South Africa
| | - Raynolda Makhutle
- Division of the Wits Health Consortium, Non-Communicable Diseases Research (NCDR), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yusuf Mayet
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Merika Tsitsi
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Preethi Mistri
- CANSA Association South Africa, Johannesburg, South Africa
| | - Keletso Mmoledi
- Division of the Wits Health Consortium, Non-Communicable Diseases Research (NCDR), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mpho Ratshikana-Moloko
- Division of the Wits Health Consortium, Non-Communicable Diseases Research (NCDR), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Palliative Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Rajen Morer
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jayshina Punwasi
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy A. Richards
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Ruff
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dineo Shabalala
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maureen Sibadela
- Alpha World Ministries Social Care Centre, Johannesburg, South Africa
| | - Nita Soma
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Michelle Wong
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maureen Joffe
- Division of the Wits Health Consortium, Non-Communicable Diseases Research (NCDR), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Marima R, Hull R, Dlamini Z, Penny C. Efavirenz induces DNA damage response pathway in lung cancer. Oncotarget 2020; 11:3737-3748. [PMID: 33110481 PMCID: PMC7566803 DOI: 10.18632/oncotarget.27725] [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: 04/14/2020] [Accepted: 07/16/2020] [Indexed: 12/17/2022] Open
Abstract
The cell-cycle related genes are potential gene targets in understanding the effects of efavirenz (EFV) in lung cancer. The present study aimed at investigating the expression changes of cell-cycle related genes in response to EFV drug treatment in human non-small cell lung carcinoma (A549) and normal lung fibroblast (MRC-5) cells. The loss in nuclear integrity in response to EFV was detected by 4', 6-diamidino-2-phenylindole (DAPI) staining. Gene expression profiling was performed using human cell cycle PathwayFinder RT2 Profiler™ PCR Array. The expression changes of 84 genes key to the cell cycle pathway in humans following EFV treatment was examined. The R2 PCR Array analysis revealed a change in expression of selected gene targets (including MAD2L2, CASP3, AURKB). This change in gene expression was at least a two-fold between test (EFV treated) and the control. RT-qPCR confirmed the PCR array data. In addition to this, the ATM signaling pathway was shown to be upregulated following EFV treatment in MRC-5 cells. In particular, ATM's upstream activation resulted in p53 upregulation in normal lung fibroblasts. Interestingly, the p53 signaling pathway was activated irrespective of the repressed ATM pathway in A549 cells as revealed by the Ingenuity Pathway Analysis (IPA). These EFV effects are similar to those of ionizing radiation and this suggests that EFV has anti-tumour properties.
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Affiliation(s)
- Rahaba Marima
- SA-MRC/UP Precision Prevention and Novel Drug Targets for HIV-Associated Cancers Extramural Unit, Pan African Cancer Research Institute, Faculty of Health Sciences, University of Pretoria, Hatfield 0028, South Africa.,Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa
| | - Rodney Hull
- SA-MRC/UP Precision Prevention and Novel Drug Targets for HIV-Associated Cancers Extramural Unit, Pan African Cancer Research Institute, Faculty of Health Sciences, University of Pretoria, Hatfield 0028, South Africa
| | - Zodwa Dlamini
- SA-MRC/UP Precision Prevention and Novel Drug Targets for HIV-Associated Cancers Extramural Unit, Pan African Cancer Research Institute, Faculty of Health Sciences, University of Pretoria, Hatfield 0028, South Africa.,Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa
| | - Clement Penny
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa
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Hillyer GC, Mapanga W, Jacobson JS, Graham A, Mmoledi K, Makhutle R, Osei-Fofie D, Mulowayi M, Masuabi B, Bulman WA, Neugut AI, Joffe M. Attitudes toward tobacco cessation and lung cancer screening in two South African communities. Glob Public Health 2020; 15:1537-1550. [PMID: 32406331 DOI: 10.1080/17441692.2020.1761425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Among men in South Africa, the prevalence of tobacco smoking is as high as 33%. Although smoking is responsible for most lung cancer in South Africa, occupational and environmental exposures contribute greatly to risk. We conducted a tobacco and lung cancer screening needs assessment and administered surveys to adults who smoked >100 cigarettes in their lifetime in Johannesburg (urban) and Kimberley (rural). We compared tobacco use, risk exposure, attitudes toward and knowledge of, and receptivity to cessation and screening, by site. Of 324 smokers, nearly 85% of current smokers had a <30 pack-year history of smoking; 58.7% had tried to stop smoking ≥1 time, and 78.9% wanted to quit. Kimberley smokers more often reported being advised by a healthcare provider to stop smoking (56.5% vs. 37.3%, p=0.001) than smokers in Johannesburg but smokers in Johannesburg were more willing to stop smoking if advised by their doctor (72.9% vs. 41.7%, p<0.001). Findings indicate that tobacco smokers in two geographic areas of South Africa are motivated to stop smoking but receive no healthcare support to do so. Developing high risk criteria for lung cancer screening and creating tobacco cessation infrastructure may reduce tobacco use and decrease lung cancer mortality in South Africa.
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Affiliation(s)
- Grace C Hillyer
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Witness Mapanga
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Judith S Jacobson
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Anita Graham
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Keletso Mmoledi
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Raynolda Makhutle
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | | | | | | | - William A Bulman
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alfred I Neugut
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.,Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Maureen Joffe
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
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Medina-Moreno S, Zapata JC, Cottrell ML, Le NM, Tao S, Bryant J, Sausville E, Schinazi RF, Kashuba AD, Redfield RR, Heredia A. Disparate effects of cytotoxic chemotherapy on the antiviral activity of antiretroviral therapy: implications for treatments of HIV-infected cancer patients. Antivir Ther 2020; 24:177-186. [PMID: 30574873 DOI: 10.3851/imp3285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cancer is a leading cause of death in HIV-infected patients in the era of combination antiretroviral therapy (cART). Yet, there are no specific guidelines for the combined use of cART and chemotherapy in HIV-infected cancer patients. The cellular enzyme thymidylate synthase (TS) catalyses the conversion of dUMP to TMP, which is converted to TDP and ultimately to TTP, a building block in DNA synthesis. TS inhibitors are recommended in some cancers, particularly non-small cell lung cancer (NSCLC). Because TS inhibitors modulate intracellular concentrations of endogenous 2'-deoxynucleotides, we hypothesized that TS inhibitors could impact the anti-HIV activity of nucleoside analogue reverse transcriptase inhibitors (NRTIs). METHODS We evaluated gemcitabine and pemetrexed, two approved TS inhibitors, on the anti-HIV activities of NRTIs in infectivity assays using peripheral blood mononuclear cells (PBMCs) and in humanized mice. RESULTS Gemcitabine enhanced the anti-HIV activities of tenofovir, abacavir and emtricitabine (FTC) in PBMCs. In contrast, pemetrexed had no effect on tenofovir, enhanced abacavir and, unexpectedly, decreased FTC and lamivudine (3TC) activities. Pemetrexed inhibitory effects on FTC and 3TC may be due to lower concentrations of active metabolites (FTCtp and 3TCtp) relative to their competing endogenous nucleotide (dCTP), as shown by decreases in FTCtp/dCTP ratios. Gemcitabine enhanced tenofovir while pemetrexed abrogated FTC antiviral activity in humanized mice. CONCLUSIONS Chemotherapy with TS inhibitors can have opposing effects on cART, potentially impacting control of HIV and thereby development of viral resistance and size of the reservoir in HIV-infected cancer patients. Combinations of cART and chemotherapy should be carefully selected.
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Affiliation(s)
- Sandra Medina-Moreno
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Juan C Zapata
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mackenzie L Cottrell
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Nhut M Le
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sijia Tao
- Department of Pediatrics, Center for AIDS Research, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph Bryant
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward Sausville
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond F Schinazi
- Department of Pediatrics, Center for AIDS Research, Emory University School of Medicine, Atlanta, GA, USA
| | - Angela Dm Kashuba
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Robert R Redfield
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alonso Heredia
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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7
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Calkins KL, Chander G, Joshu CE, Visvanathan K, Fojo AT, Lesko CR, Moore RD, Lau B. Immune Status and Associated Mortality After Cancer Treatment Among Individuals With HIV in the Antiretroviral Therapy Era. JAMA Oncol 2020; 6:227-235. [PMID: 31804663 PMCID: PMC6902188 DOI: 10.1001/jamaoncol.2019.4648] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
Importance Immunologic decline associated with cancer treatment in people with HIV is not well characterized. Quantifying excess mortality associated with cancer treatment-related immunosuppression may help inform cancer treatment guidelines for persons with HIV. Objective To estimate the association between cancer treatment and CD4 count and HIV RNA level in persons with HIV and between posttreatment CD4 count and HIV RNA trajectories and all-cause mortality. Design, Setting, and Participants This observational cohort study included 196 adults with HIV who had an incident first cancer and available cancer treatment data while in the care of The Johns Hopkins HIV Clinic from January 1, 1997, through March 1, 2016. The study hypothesized that chemotherapy and/or radiotherapy in people with HIV would increase HIV RNA levels owing to treatment tolerability issues and would be associated with a larger initial decline in CD4 count and slower CD4 recovery compared with surgery or other treatment. An additional hypothesis was that these CD4 count declines would be associated with higher mortality independent of baseline CD4 count, antiretroviral therapy use, and risk due to the underlying cancer. Data were analyzed from December 1, 2017, through April 1, 2018. Exposures Initial cancer treatment category (chemotherapy and/or radiotherapy vs surgery or other treatment). Main Outcomes and Measures Post-cancer treatment longitudinal CD4 count, longitudinal HIV RNA level, and all-cause mortality. Results Among the 196 participants (135 [68.9%] male; median age, 50 [interquartile range, 43-55] years), chemotherapy and/or radiotherapy decreased initial CD4 count by 203 cells/μL (95% CI, 92-306 cells/μL) among those with a baseline CD4 count of greater than 500 cells/μL. The decline for those with a baseline CD4 count of no greater than 350 cells/μL was 45 cells/μL (interaction estimate, 158 cells/μL; 95% CI, 31-276 cells/μL). Chemotherapy and/or radiotherapy had no detrimental association with HIV RNA levels. After initial cancer treatment, every 100 cells/μL decrease in CD4 count resulted in a 27% increase in mortality (hazard ratio, 1.27; 95% CI, 1.08-1.53), adjusting for HIV RNA level. No significant increase in mortality was associated with a unit increase in log10 HIV RNA after adjusting for CD4 count (hazard ratio, 1.24; 95% CI, 0.94-1.65). Conclusions and Relevance In this study, chemotherapy and/or radiotherapy was associated with significantly reduced initial CD4 count in adults with HIV compared with surgery or other treatment. Lower CD4 count after cancer treatment was associated with an increased hazard of mortality. Further research is necessary on the immunosuppressive effects of cancer treatment in adults with HIV and whether health care professionals must consider the balance of cancer treatment efficacy against the potential cost of further immunosuppression. Monitoring of immune status may also be helpful given the decrease in CD4 count after treatment and the already immunocompromised state of patients with HIV.
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Affiliation(s)
- Keri L. Calkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Corinne E. Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medical Oncology, The Johns Hopkins University, Baltimore, Maryland
| | - Anthony T. Fojo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard D. Moore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
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Pichardo R, Go RF, Qu L, Hussein L, Gupta S. HIV-associated Non-small-cell Lung Cancer with Rearrangement of the Anaplastic Lymphoma Kinase Gene: A Report of Two Patients. Cureus 2019; 11:e5466. [PMID: 31523585 PMCID: PMC6721879 DOI: 10.7759/cureus.5466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/22/2019] [Indexed: 12/03/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) is the most common non-AIDS defining cancer in patients infected with HIV and has the highest mortality rate among all cancers in this patient population. Treatment of NSCLC in HIV-positive patients is similar to that in HIV-negative patients, but less is known about the molecular characteristics of NSCLC in HIV-positive patients. This report describes two patients with HIV-associated NSCLC and rearrangements of the anaplastic lymphoma kinase (ALK) gene. The disease followed an indolent course in both patients.
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Affiliation(s)
- Rayli Pichardo
- Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, USA
| | | | - Lang Qu
- Internal Medicine, West China School of Medicine, Sichuan University, Chengdu, CHN
| | - Lily Hussein
- Hematology / Oncology, John H Stroger Jr. Hospital of Cook County, Chicago, USA
| | - Shweta Gupta
- Hematology / Oncology, John H Stroger, Jr. Hospital of Cook County, Chicago, USA
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Thaler J, Sigel C, Beasley MB, Wisnivesky J, Crothers K, Bauml J, Hysell K, Emu B, Borsu L, Sigel K. Clinically significant mutations in HIV-infected patients with lung adenocarcinoma. Br J Cancer 2017; 117:1392-1395. [PMID: 28934759 PMCID: PMC5672933 DOI: 10.1038/bjc.2017.333] [Citation(s) in RCA: 5] [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: 05/08/2017] [Revised: 08/06/2017] [Accepted: 08/30/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Lung cancer is a major cause of death in HIV-infected (HIV+) persons. In this study, we compared the prevalence of tumour EGFR and KRAS mutations in a cohort of lung adenocarcinoma patients by HIV status. METHODS We collected data from 55 HIV+ patients with lung adenocarcinoma matched to 136 uninfected comparators. We compared the prevalence of EGFR and KRAS mutations by HIV status. We then compared survival by HIV status and by cancer mutation status among HIV+ subjects. RESULTS Presence of KRAS and EGFR genetic alterations did not vary by HIV status (all P>0.1). There was no difference in overall survival by HIV status or by mutation status among HIV+ subjects. CONCLUSIONS We found no major differences in the prevalence of EGFR or KRAS lung adenocarcinoma mutations by HIV status, suggesting that mutational testing should be conducted similarly regardless of the HIV status.
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Affiliation(s)
- Jonathan Thaler
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Carlie Sigel
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mary Beth Beasley
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Juan Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kristina Crothers
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Joshua Bauml
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kristen Hysell
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Brinda Emu
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Laetitia Borsu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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