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D’Souza G, Tewari SR, Troy T, Webster-Cyriaque J, Wiley DJ, Lahiri CD, Palella FJ, Gillison ML, Strickler HD, Struijk L, Waterboer T, Ho K, Kwait J, Lazar J, Weber KM, Fakhry C. Oncogenic Oral Human Papillomavirus Clearance Patterns over 10 Years. Cancer Epidemiol Biomarkers Prev 2024; 33:516-524. [PMID: 38294704 PMCID: PMC10990780 DOI: 10.1158/1055-9965.epi-23-1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/06/2023] [Accepted: 01/29/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Effective screening for oropharyngeal cancer is lacking. Four oncogenic HPV clearance definitions were explored to understand long-term natural history for persistent oncogenic oral HPV (oncHPV), the precursor of oropharyngeal cancer. METHODS Prospective multicenter cohort of participants living with/at-risk for HIV, with oral rinse and gargle samples collected every 6 to 12 months for up to 10 years and tested for oncHPV. HPV clearance definitions included 1 (clear1), 2 (clear2), 3 (clear3) consecutive negatives, or being negative at last two visits (clearlast). RESULTS Median time to clearance of oncHPV exceeded 2 years for conservative definitions (clear3: 2.38, clearlast: 2.43), but not lenient (clear1: 0.68, clear2: 1.15). By clear3, most incident infections cleared at 2, 5, 8 years (55.1%, 75.6%, 79.1%), contrary to prevalent infections (37.1%, 52.5%, 59.5%, respectively). In adjusted analysis, prevalent oncHPV, older age, male sex, and living with HIV were associated with reduced clearance. Of 1,833 subjects screened, 13.8% had prevalent oncHPV and 47.5% of those infections persisted ≥5 years, representing 6.5% of persons screened. Two men with prevalent oral HPV16 developed incident oropharyngeal cancer [IR = 1.62 per 100 person-years; 95% confidence interval (CI), 0.41-6.4]. Many with oral HPV16 persisted ≥5 years (and/or developed HPV-oropharyngeal cancer) among those with 2 (72.2%), ≥2 of first 3 (65.7%), or 3 (80.0%) consecutive positive oHPV16 tests, but not after 1 (39.4%). CONCLUSIONS In our 10-year study, most incident infections cleared quickly. However, half of prevalent oncHPV persisted ≥5 years, suggesting increased risk with persistent oncHPV at >2 visits. IMPACT We identified groups with persistent oncHPV at increased risk of oropharyngeal cancer and contextualized risk levels for those with oral HPV16 infection.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | - Sakshi R. Tewari
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Tanya Troy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
| | | | - Dorothy J. Wiley
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Cecile Delille Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Frank Joseph Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maura L. Gillison
- Department of Thoracic-Head and neck medical oncology, MD Anderson Cancer Center
| | - Howard D. Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Linda Struijk
- Viroclinics-DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Jason Lazar
- Department of Medical Education, SUNY Downstate Health Science University
| | | | - Carole Fakhry
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine
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2
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Althoff KN, Stewart C, Humes E, Gerace L, Boyd C, Gebo K, Justice AC, Hyle EP, Coburn SB, Lang R, Silverberg MJ, Horberg MA, Lima VD, Gill MJ, Karris M, Rebeiro PF, Thorne J, Rich AJ, Crane H, Kitahata M, Rubtsova A, Wong C, Leng S, Marconi VC, D’Souza G, Kim HN, Napravnik S, McGinnis K, Kirk GD, Sterling TR, Moore RD, Kasaie P. The forecasted prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030: A modeling study. PLoS Med 2024; 21:e1004325. [PMID: 38215160 PMCID: PMC10833859 DOI: 10.1371/journal.pmed.1004325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/01/2024] [Accepted: 11/22/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Estimating the medical complexity of people aging with HIV can inform clinical programs and policy to meet future healthcare needs. The objective of our study was to forecast the prevalence of comorbidities and multimorbidity among people with HIV (PWH) using antiretroviral therapy (ART) in the United States (US) through 2030. METHODS AND FINDINGS Using the PEARL model-an agent-based simulation of PWH who have initiated ART in the US-the prevalence of anxiety, depression, stage ≥3 chronic kidney disease (CKD), dyslipidemia, diabetes, hypertension, cancer, end-stage liver disease (ESLD), myocardial infarction (MI), and multimorbidity (≥2 mental or physical comorbidities, other than HIV) were forecasted through 2030. Simulations were informed by the US CDC HIV surveillance data of new HIV diagnosis and the longitudinal North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data on risk of comorbidities from 2009 to 2017. The simulated population represented 15 subgroups of PWH including Hispanic, non-Hispanic White (White), and non-Hispanic Black/African American (Black/AA) men who have sex with men (MSM), men and women with history of injection drug use and heterosexual men and women. Simulations were replicated for 200 runs and forecasted outcomes are presented as median values (95% uncertainty ranges are presented in the Supporting information). In 2020, PEARL forecasted a median population of 670,000 individuals receiving ART in the US, of whom 9% men and 4% women with history of injection drug use, 60% MSM, 8% heterosexual men, and 19% heterosexual women. Additionally, 44% were Black/AA, 32% White, and 23% Hispanic. Along with a gradual rise in population size of PWH receiving ART-reaching 908,000 individuals by 2030-PEARL forecasted a surge in prevalence of most comorbidities to 2030. Depression and/or anxiety was high and increased from 60% in 2020 to 64% in 2030. Hypertension decreased while dyslipidemia, diabetes, CKD, and MI increased. There was little change in prevalence of cancer and ESLD. The forecasted multimorbidity among PWH receiving ART increased from 63% in 2020 to 70% in 2030. There was heterogeneity in trends across subgroups. Among Black women with history of injection drug use in 2030 (oldest demographic subgroup with median age of 66 year), dyslipidemia, CKD, hypertension, diabetes, anxiety, and depression were most prevalent, with 92% experiencing multimorbidity. Among Black MSM in 2030 (youngest demographic subgroup with median age of 42 year), depression and CKD were highly prevalent, with 57% experiencing multimorbidity. These results are limited by the assumption that trends in new HIV diagnoses, mortality, and comorbidity risk observed in 2009 to 2017 will persist through 2030; influences occurring outside this period are not accounted for in the forecasts. CONCLUSIONS The PEARL forecasts suggest a continued rise in comorbidity and multimorbidity prevalence to 2030, marked by heterogeneities across race/ethnicity, gender, and HIV acquisition risk subgroups. HIV clinicians must stay current on the ever-changing comorbidities-specific guidelines to provide guideline-recommended care. HIV clinical directors should ensure linkages to subspecialty care within the clinic or by referral. HIV policy decision-makers must allocate resources and support extended clinical capacity to meet the healthcare needs of people aging with HIV.
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Affiliation(s)
- Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cameron Stewart
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lucas Gerace
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cynthia Boyd
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kelly Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Amy C. Justice
- Yale Schools of Medicine and Public Health, New Haven, Connecticut, United States of America
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Emily P. Hyle
- Harvard Medical School and the Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research, Boston, Massachusetts, United States of America
| | - Sally B. Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA and Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, United States of America
| | - Viviane D. Lima
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Maile Karris
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Peter F. Rebeiro
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Jennifer Thorne
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Heidi Crane
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Mari Kitahata
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Anna Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Cherise Wong
- Division of Worldwide Research and Development, Pfizer Inc., New York City, New York, United States of America
| | - Sean Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Vincent C. Marconi
- Division of Infectious Disease, Emory School of Medicine, Atlanta, Georgia, United States of America
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia, United States of America
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hyang Nina Kim
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathleen McGinnis
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Timothy R. Sterling
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Richard D. Moore
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Punjabi NM, Brown TT, Abreu AR, Aurora RN, Patel SR, Stosor V, Cho JHJ, D’Souza G, Wallace D, Margolick JB. Sleep-Disordered Breathing and Prevalent Hypertension in Men With and Without HIV. J Acquir Immune Defic Syndr 2023; 94:349-354. [PMID: 37643405 PMCID: PMC10824508 DOI: 10.1097/qai.0000000000003276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a known risk factor for hypertension. Despite the well-established link between HIV infection and hypertension, it remains to be determined whether HIV infection modifies the association between SDB and hypertension. SETTING The Multicenter AIDS Cohort Study. METHODS SDB was assessed using in-home polysomnography in 779 men (436 with and 343 without HIV). The apnea-hypopnea index (AHI) based on oxyhemoglobin desaturation threshold of ≥3% or arousal (AHI 3a ) and ≥4% (AHI 4 ) along with oxygen desaturation index (ODI) were used to quantify SDB severity. Hypertension was defined as a blood pressure ≥140/90 mm Hg, use of antihypertensive medication, or self-report of a clinical diagnosis. The associations between HIV, SDB, and hypertension were characterized using multivariable logistic regression. RESULTS The prevalence of hypertension and SDB (AHI 3a ≥ 5 events/hr) was high, with estimates of 53.8% and 82.8%, respectively. Among men without SDB, HIV was independently associated with hypertension, with an adjusted odds ratio (OR) of 3.05 [95% confidence interval (CI): 1.33 to 7.01]. In men without HIV, SDB was associated with hypertension (OR: 2.93; 95% CI: 1.46 to 5.86). No significant increase in the odds of hypertension was noted in men with both HIV and SDB compared with men with either factor alone, with an OR of 3.24 (95% CI: 1.62 to 6.47). These results were consistent across different measures used to define SDB (AHI 3a , AHI 4 , ODI 3 , and ODI 4 ). CONCLUSIONS Predictors of hypertension differed by HIV status. SDB was associated with hypertension in men without HIV, but not in men with HIV. Among men with HIV, SDB did not affect the odds of hypertension.
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Banerjee T, Frongillo EA, Turan JM, Sheira LA, Adedimeji A, Wilson T, Merenstein D, Cohen M, Adimora AA, Ofotokun I, Metsch L, D’Souza G, Fischl MA, Fisher M, Tien PC, Weiser SD. Association of Higher Intake of Plant-Based Foods and Protein With Slower Kidney Function Decline in Women With HIV. J Acquir Immune Defic Syndr 2023; 94:203-210. [PMID: 37850979 PMCID: PMC10593493 DOI: 10.1097/qai.0000000000003269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND We investigated whether there exists an association between dietary acid load and kidney function decline in women living with HIV (WLWH) receiving antiretroviral therapy (ART). SETTING One thousand six hundred eight WLWH receiving ART in the WIHS cohort with available diet data and a baseline estimated glomerular filtration rate (eGFR) ≥15 mL/minute/1.73 m2. METHODS A brief dietary instrument conducted from 2013 to 2016 under the Food Insecurity Sub-Study was used for assessing fruits and vegetables (FV) and protein intake. A mixed-effects model with random intercept and slope was used to estimate subjects' annual decline rate in eGFR and the association between FV intake and eGFR decline, adjusting for sociodemographics, serum albumin, comorbidities, time on ART, ART drugs, HIV markers, and baseline eGFR. We evaluated whether markers of inflammation mediated the effect of FV intake on decline in eGFR, using causal mediation analysis. RESULTS We found a dose-response relationship for the association of FV intake and eGFR decline, with lesser annual decline in eGFR in the middle and highest tertiles of FV intake. An increase of 5 servings of FV intake per day was associated with a lower annual eGFR decline (-1.18 [-1.43, -0.94]). On average, 39% of the association between higher FV intake and slower eGFR decline was explained by decreased levels of inflammation. CONCLUSIONS Plant-rich diet was associated with slower decline in kidney function. Inflammation is a potential path through which diet may affect kidney function. The findings support an emerging body of literature on the potential benefits of plant-rich diets for prevention of chronic kidney disease.
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Affiliation(s)
- Tanushree Banerjee
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco CA
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina
| | - Janet M. Turan
- School of Public Health, University of Alabama at Birmingham
| | - Lila A. Sheira
- School of Nursing, University of California, San Francisco
| | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine
| | - Tracey Wilson
- School of Public Health, SUNY Downstate Health Sciences University
| | | | | | - Adaora A. Adimora
- School of Public Health, University of North Carolina at Chapel Hill
| | | | - Lisa Metsch
- School of Public Health, Columbia University
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | | | - Molly Fisher
- Department of Medicine, Albert Einstein College of Medicine
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Wei F, Goodman MT, Xia N, Zhang J, Giuliano AR, D’Souza G, Hessol NA, Schim van der Loeff MF, Dai J, Neukam K, de Pokomandy A, Poynten IM, Geskus RB, Burgos J, Etienney I, Moscicki AB, Donà MG, Gillison ML, Nyitray AG, Nowak RG, Yunihastuti E, Zou H, Hidalgo-Tenorio C, Phanuphak N, Molina JM, Schofield AM, Kerr S, Fan S, Lu Y, Ong JJ, Chikandiwa AT, Teeraananchai S, Squillace N, Wiley DJ, Palefsky JM, Georges D, Alberts CJ, Clifford GM. Incidence and Clearance of Anal Human Papillomavirus Infection in 16 164 Individuals, According to Human Immunodeficiency Virus Status, Sex, and Male Sexuality: An International Pooled Analysis of 34 Longitudinal Studies. Clin Infect Dis 2023; 76:e692-e701. [PMID: 35869839 PMCID: PMC10226739 DOI: 10.1093/cid/ciac581] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding the natural history of anal high-risk human papillomavirus (hrHPV) infection is key for designing anal cancer prevention programs but has not been systematically characterized. METHODS We reanalyzed data from 34 studies including 16 164 individuals in 6 risk groups defined by human immunodeficiency virus (HIV) status, sex, and male sexuality: men who have sex with men (MSM) and people with HIV (MSMWH), HIV-negative MSM, women with HIV (WWH), HIV-negative women, men who have sex with women (MSW) with HIV (MSWWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their determinants. RESULTS Human papillomavirus (HPV) 16 had the highest incidence-clearance ratio of the hrHPV types. MSMWH had the highest hrHPV incidence (eg, 15.5% newly HPV-16 infected within 2 years), followed by HIV-negative MSM (7.5%), WWH (6.6%), HIV-negative women (2.9%), MSWWH (1.7%), and HIV-negative MSW (0.7%). Determinants of HPV-16 incidence included HIV status and number of sexual partners for MSM, women, and MSW, and anal sex behavior for MSM only. HPV-16 clearance was lower for people with HIV (PWH) and lower for prevalent than incident infection. Among MSM, increasing age was associated with lower clearance of prevalent, but not incident, HPV-16 infection. CONCLUSIONS This robust and unifying analysis of anal hrHPV natural history is essential to designing and predicting the impact of HPV vaccination and HPV-based screening programs on anal cancer prevention, particularly in MSM and PWH. Importantly, it demonstrates the higher carcinogenic potential of longstanding anal prevalent hrHPV infection than more recent incident infection.
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Affiliation(s)
- Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Marc T Goodman
- Cancer Prevention and Control Program, Cedars Cancer, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, Florida, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of CaliforniaSan Francisco, California, USA
| | | | - Jianghong Dai
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Medicina Preventiva, UCEIMP, Instituto de Biomedicina de Sevilla, CSIC, Universidad de Sevilla, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - I Mary Poynten
- The Kirby Institute, University of New South Wales, Kensington, Sydney, New South Wales, Australia
| | - Ronald B Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Joaquin Burgos
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Vall d’Hebron Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Maria Gabriella Donà
- Sexually Transmitted Infections (STI)/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maura L Gillison
- Thoracic Head and Neck Medical Oncology Department, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alan G Nyitray
- Center for AIDS Intervention Research and Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Evy Yunihastuti
- Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Carmen Hidalgo-Tenorio
- Early Clinical Trial Unit. Biosanitary Institute (IBS.Granada). Infectious Diseases Unit. University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Jean-Michel Molina
- Department of Infectious diseases, University of Paris Cité, St-Louis Hospital, Paris, France
| | - Alice M Schofield
- Institute of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Stephen Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, and Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Yong Lu
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
| | - Admire T Chikandiwa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sirinya Teeraananchai
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Nicola Squillace
- Infectious Diseases Unit ASST-Monza, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Dorothy J Wiley
- School of Nursing, University of California, Los Angeles, California, USA
| | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California, USA
| | - Damien Georges
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Catharina J Alberts
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Gary M Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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Drummond MB, Edmonds A, Ramirez C, Stosor V, Barjaktarevic I, Morris A, McCormack MC, Bhatt SP, Alcaide ML, Cribbs SK, D’Souza G, Bhandari N, Kunisaki KM, Huang L, Kassaye SG, Foronjy R, Sharma A, Westreich DJ, Adimora AA. Association Between HIV and Prevalence and Manifestations of Asthma: Analysis of the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. J Acquir Immune Defic Syndr 2022; 91:419-428. [PMID: 36083508 PMCID: PMC9649933 DOI: 10.1097/qai.0000000000003088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The association between HIV and asthma prevalence and manifestations remains unclear, with few studies including women. SETTING A retrospective observational cohort study from the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. METHODS Asthma was defined in 2 ways: (1) self-report and (2) robust criteria requiring all the following: lack of fixed airflow obstruction, presence of wheeze on the St. George's Respiratory Questionnaire (SGRQ), and report of asthma therapies. Estimates of asthma prevalence and asthma-related manifestations were compared by HIV serostatus. RESULTS A total of 1815 men and 2122 women were included. Asthma prevalence did not differ between people with HIV (PWH) and people without HIV regardless of definition: self-report (men, 12.0% vs. 11.2%; women, 24.3% vs. 27.5%) and robust criteria (men, 5.0% vs. 3.4%; women, 12.8% vs. 13.2%). Among men with asthma, worse respiratory symptom burden was reported among those with HIV, regardless of asthma definition. Among women with self-reported asthma, those with HIV had less respiratory symptom burden. Regardless of serostatus, women with robust-defined asthma had similar respiratory symptoms across SGRQ domains and similar frequencies of phlegm, shortness of breath, and wheezing. CONCLUSIONS Among PWH and people without HIV, asthma prevalence was 2-fold to 3-fold higher using self-reported definition rather than robust definition. In men and women, HIV was not associated with increased asthma prevalence. In men, HIV was associated with more respiratory symptoms when asthma was self-reported; the relationship was attenuated with the robust criteria. Further studies are needed to explore asthma phenotypes among PWH.
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Affiliation(s)
- M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catalina Ramirez
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Valentina Stosor
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Chicago, IL
| | - Igor Barjaktarevic
- Division of Pulmonary Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Alison Morris
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meredith C. McCormack
- Division of Pulmonary Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Maria L. Alcaide
- Department of Medicine, OB/GYN, and Public Health, University of Miami Miller School of Medicine, Miami, FL
| | - Sushma K. Cribbs
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, USA; Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Neha Bhandari
- Division of Pulmonary and Critical Care Medicine, Cook County Health, Chicago, IL
| | - Ken M. Kunisaki
- Pulmonary, Allergy, Critical Care and Sleep Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Laurence Huang
- Divisions of Pulmonary and Critical Care Medicine and HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA
| | - Seble G. Kassaye
- Department of Medicine, Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Robert Foronjy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Anjali Sharma
- Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel J. Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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7
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Jefferson C, Watson E, Certa JM, Gordon KS, Park LS, D’Souza G, Benning L, Abraham AG, Agil D, Napravnik S, Silverberg MJ, Leyden WA, Skarbinski J, Williams C, Althoff KN, Horberg MA. Differences in COVID-19 testing and adverse outcomes by race, ethnicity, sex, and health system setting in a large diverse US cohort. PLoS One 2022; 17:e0276742. [PMID: 36417366 PMCID: PMC9683575 DOI: 10.1371/journal.pone.0276742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Racial/ethnic disparities during the first six months of the COVID-19 pandemic led to differences in COVID-19 testing and adverse outcomes. We examine differences in testing and adverse outcomes by race/ethnicity and sex across a geographically diverse and system-based COVID-19 cohort collaboration. METHODS Observational study among adults (≥18 years) within six US cohorts from March 1, 2020 to August 31, 2020 using data from electronic health record and patient reporting. Race/ethnicity and sex as risk factors were primary exposures, with health system type (integrated health system, academic health system, or interval cohort) as secondary. Proportions measured SARS-CoV-2 testing and positivity; attributed hospitalization and death related to COVID-19. Relative risk ratios (RR) with 95% confidence intervals quantified associations between exposures and main outcomes. RESULTS 5,958,908 patients were included. Hispanic patients had the highest proportions of SARS-CoV-2 testing (16%) and positivity (18%), while Asian/Pacific Islander patients had the lowest portions tested (11%) and White patients had the lowest positivity rates (5%). Men had a lower likelihood of testing (RR = 0.90 [0.89-0.90]) and a higher positivity risk (RR = 1.16 [1.14-1.18]) compared to women. Black patients were more likely to have COVID-19-related hospitalizations (RR = 1.36 [1.28-1.44]) and death (RR = 1.17 [1.03-1.32]) compared with White patients. Men were more likely to be hospitalized (RR = 1.30 [1.16-1.22]) or die (RR = 1.70 [1.53-1.89]) compared to women. These racial/ethnic and sex differences were reflected in both health system types. CONCLUSIONS This study supports evidence of disparities by race/ethnicity and sex during the COVID-19 pandemic that persisted even in healthcare settings with reduced barriers to accessing care. Further research is needed to understand and prevent the drivers that resulted in higher burdens of morbidity among certain Black patients and men.
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Affiliation(s)
- Celeena Jefferson
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America
| | - Eric Watson
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America
- * E-mail:
| | - Julia M. Certa
- United Health Group, Fredrick, Maryland, United States of America
| | - Kirsha S. Gordon
- Yale School of Medicine, Department of General Internal Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Lesley S. Park
- Stanford Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alison G. Abraham
- Department of Epidemiology, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, United States of America
| | - Deana Agil
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Wendy A. Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Carolyn Williams
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Mid-Atlantic Permanente Research Institute, Rockville, Maryland, United States of America
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8
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Janorkar DA, Long DM, Weber KM, Sharma A, Lin GH, D’Souza G, Edmonds A, Kassaye S, Lahiri CD, Konkle-Parker D. Association between BMI and periodontitis in women living with or at risk for HIV. Spec Care Dentist 2022; 42:486-493. [PMID: 35279851 PMCID: PMC9867927 DOI: 10.1111/scd.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/30/2021] [Accepted: 02/19/2022] [Indexed: 02/03/2023]
Abstract
AIMS Currently, there is no data available assessing the association between body mass index (BMI) and periodontitis among women living with HIV (WLWH). This study aims to investigate this association among WLWH and women at risk for HIV (WRH) in the United States. METHODS AND RESULTS Data from 351 WLWH and 52 WRH participants from the Women's Interagency HIV Study having pocket depths and clinical periodontal attachment loss assessments in 2003-2004 were included. Multinomial logistic regression analyses in the full sample assessed the relationship between BMI (underweight/normal, overweight, or obese) and periodontitis by severity (mild, moderate, severe), adjusting for study sites, age, education, annual household income, smoking, alcohol consumption, and diabetes. Overall, 75.2% women (76.0% WLWH; 69.0% WRH) had periodontitis. Moreover, 75.0% obese and 75.3% overweight women were affected by periodontitis. In the full sample, adjusted odds ratio (aOR) of having mild, moderate, and severe periodontitis in obese women were: 1.14 (95% confidence interval [CI]: 0.51-2.52), 1.02 (95% CI: 0.46-2.29), and 0.24 (95% CI: 0.06-1.07), respectively, and in overweight women: 0.70 (95% CI: 0.31-1.58), 0.85 (95% CI: 0.38-1.90), and 0.31 (95% CI: 0.08-1.15), respectively. CONCLUSIONS Even with high prevalence of periodontitis among women with or without HIV infection in this cohort, this study does not provide evidence of an association between BMI and periodontitis.
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Affiliation(s)
- Deepti A. Janorkar
- Department of Advanced General Dentistry, School of Dentistry, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Dustin M. Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kathleen M. Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Anjali Sharma
- Department of Medicine I Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Guo-Hao Lin
- Division of Periodontology, School of Dentistry, University of California San Francisco, San Francisco, California, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Seble Kassaye
- Department of Medicine I Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Cecile D. Lahiri
- Department of Medicine I Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
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9
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Tewari SR, D’Souza G, Troy T, Wright H, Struijk L, Waterboer T, Fakhry C. Association of Plasma Circulating Tumor HPV DNA With HPV-Related Oropharynx Cancer. JAMA Otolaryngol Head Neck Surg 2022; 148:488-489. [PMID: 35323891 PMCID: PMC8949748 DOI: 10.1001/jamaoto.2022.0159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Sakshi R. Tewari
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tanya Troy
- Department of Otolaryngology Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hannah Wright
- Department of Otolaryngology Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Linda Struijk
- Viroclinics-DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carole Fakhry
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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10
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Punjabi NM, Brown T, Aurora RN, Patel SR, Stosor V, Cho JHJ, Helgadóttir H, Ágústsson JS, D’Souza G, Margolick JB. Methods for home-based self-applied polysomnography: the Multicenter AIDS Cohort Study. Sleep Adv 2022; 3:zpac011. [PMID: 35601080 PMCID: PMC9119085 DOI: 10.1093/sleepadvances/zpac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/23/2022] [Indexed: 11/12/2022]
Abstract
Study Objectives Along with multiple chronic comorbidities, sleep disorders are prevalent in people living with human immunodeficiency virus (HIV) infection. The goal of this study was to establish methods for assessing sleep quality and breathing-related disorders using self-applied home polysomnography in people with and without HIV. Methods Self-applied polysomnography was conducted on 960 participants in the Multicenter AIDS Cohort Study (MACS) using the Nox A1 recorder to collect data on the frontal electroencephalogram (EEG), bilateral electrooculograms, and a frontalis electromyogram during sleep. Breathing patterns were characterized using respiratory inductance plethysmography bands and pulse oximetry. Continuous recordings of the electrocardiogram were also obtained. All studies were scored centrally for sleep stages and disordered breathing events. Results Successful home polysomnography was obtained in 807 of 960 participants on the first attempt and 44 participants on the second. Thus, a successful polysomnogram was obtained in 851 (88.6%) of the participants. Reasons for an unsuccessful study included less than 3 h of data on oximetry (34.6%), EEG (28.4%), respiratory inductance plethysmography (21.0%), or two or more of these combined (16.0%). Of the successful studies (N = 851), signal quality was rated as good, very good, or excellent in 810 (95.2%). No temporal trends in study quality were noted. Independent correlates of an unsuccessful study included black race, current smoking, and cocaine use. Conclusions Home polysomnography was successfully completed in the MACS demonstrating its feasibility in a community cohort. Given the burden of in-lab polysomnography, the methods described herein provide a cost-effective alternative for collecting sleep data in the home.
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Affiliation(s)
- Naresh M Punjabi
- Corresponding author. Naresh M. Punjabi, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami, Miller School of Medicine, 1600 NW 10th Avenue, Miami, FL 33136, USA.
| | - Todd Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - R Nisha Aurora
- Division of Pulmonary and Critical Care Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Sanjay R Patel
- Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Valentina Stosor
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua Hyong-Jin Cho
- Department of Psychiatry and Biobehavioral Sciences, University of California (Los Angeles), David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | - Gypsyamber D’Souza
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Brown AL, Matthews DD, Meanley S, Brennan-Ing M, Haberlen S, D’Souza G, Ware D, Egan J, Shoptaw S, Teplin LA, Friedman M, Plankey M. The Effect of Discrimination and Resilience on Depressive Symptoms among Middle-Aged and Older Men who have Sex with Men. Stigma Health 2022; 7:113-121. [PMID: 35935592 PMCID: PMC9355118 DOI: 10.1037/sah0000327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigated if homophobic and racist discrimination increased depressive symptoms among 960 middle-aged and older men who have sex with men (MSM) and how resilience moderated these relationships. We used five waves of longitudinal data from the Healthy Aging sub-study of the Multicenter AIDS Cohort Study (MACS). We used linear regression analyses to model depressive symptoms as a function of discrimination. We used linear mixed analyses to model changes in mean resilience scores across visits. We used linear regression analyses to model depressive symptoms as a function of changes in resilience and to test the moderation effects of resilience on the relationship between discrimination and depressive symptoms. The models accounted for repeated measures of resilience. Men who experienced external and internal homophobia had greater depressive symptoms (β: 2.08; 95% Confidence Interval: 0.65, 3.51; β: 1.60; 95% Confidence Interval: 0.76, 2.44). Men experienced significant changes in mean resilience levels across visits (F = 2.84, p = 0.02). Men with a greater positive change in resilience had lower depressive symptoms (β: -0.95; 95% Confidence Interval: -1.47, -0.43). Men with higher average resilience levels had lower depressive symptoms (β: -5.08; 95% Confidence Interval: -5.68, -4.49). Men's resilience did not moderate the relationship between homophobia and depressive symptoms. Significant associations of external and internal homophobia with greater depressive symptoms present targets for future research and interventions among middle-aged and older MSM. Significant associations of average and positive changes in resilience with lower depressive symptoms provide aims for future research and interventions with this population.
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Affiliation(s)
- Andre L. Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | | | | | - Mark Brennan-Ing
- Roosevelt House Public Policy Institute at Hunter College, City University of New York
| | | | | | - Deanna Ware
- Department of Epidemiology, Georgetown University
| | - James Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | - Steve Shoptaw
- Department of Family Medicine, University of California Los Angeles
| | - Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University
| | - Mackey Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh
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12
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Zhang Y, D’Souza G, Fakhry C, Bigelow EO, Usyk M, Burk RD, Zhao N. Oral Human Papillomavirus Associated With Differences in Oral Microbiota Beta Diversity and Microbiota Abundance. J Infect Dis 2022; 226:1098-1108. [PMID: 35038733 PMCID: PMC9492316 DOI: 10.1093/infdis/jiac010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although cervicovaginal microbiome has been associated with cervical human papillomavirus (HPV) infection, little is known regarding the association of oral microbiome with oral HPV, a cause of oropharyngeal cancer. METHODS A cross-sectional analysis of 495 participants from the Men and Women Offering Understanding of Throat HPV study was conducted. 16S rRNA gene amplicon sequencing was performed on saliva samples. HPV DNA in oral rinse samples was tested. Associations of oral microbiome diversity, taxon abundance, and predicted functional pathways with oral HPV were assessed, adjusting for age, race/ethnicity, education, human immunodeficiency virus, current smoking, and sequencing batch. RESULTS Participants with oral HPV (n = 68) compared with those without HPV had similar oral microbiome alpha-diversity yet different beta-diversity (Bray-Curtis distance for bacterial taxa, P = .009; functional pathways, P = .02). Participants with oral HPV had higher abundance of Actinomycetaceae, Prevotellaceae, Veillonellaceae, Campylobacteraceae, Bacteroidetes, and lower abundance of Gemellaceae (false discovery rate <0.10). We also found differential functional potential of oral microbiome by oral HPV status: xenobiotic biodegradation-related pathways were less abundant among participants with oral HPV, suggesting potential xenobiotic-induced toxic effects with implications for HPV susceptibility. CONCLUSIONS Our findings suggest a shift in oral microbiome community structure, composition, and functional potential between individuals with and without oral HPV.
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Affiliation(s)
- Yuehan Zhang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA,Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carole Fakhry
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA,Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elaine O Bigelow
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mykhaylo Usyk
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA,Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert D Burk
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA,Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ni Zhao
- Correspondence: Ni Zhao, PhD, Johns Hopkins University, 615 N. Wolfe St, #E3622, Baltimore, MD 21205, USA ()
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13
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D’Souza G, Tong W, Gustafson D, Alcaide ML, Lahiri CD, Sharma A, French AL, Palella FJ, Kempf MC, Mimiaga MJ, Ramirez C, Kassaye S, Rinaldo CR, Brown TT, Tien PC, Adimora AA. SARS-CoV-2 Infection Among People Living With HIV Compared With People Without HIV: Survey Results From the MACS-WIHS Combined Cohort Study. J Acquir Immune Defic Syndr 2022; 89:1-8. [PMID: 34878431 PMCID: PMC8667184 DOI: 10.1097/qai.0000000000002822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) symptoms among people living with HIV (PLWH) are not well described. SETTING Longitudinal survey within the MACS/WIHS Combined Cohort Study (MWCCS) of PLWH compared with similar HIV-seronegative (SN) individuals. METHODS Telephone-administered survey of MWCCS participants at 13 clinical research sites across the United States addressing COVID-19 symptoms, SARS-CoV-2 testing, and pandemic impact on social distancing and antiretroviral therapy (ART) use. Primary data collection occurred during May (wave 1), June-July (wave 2), and August-September, 2020 (wave 3). RESULTS One-third of MWCCS participants were tested for SARS-CoV-2 infection; 10% was tested ≥2 times. Similar proportions of PLWH and SN participants were tested, but SARS-CoV-2 positivity was higher among PLWH than among SN individuals (9.4% vs 4.8%, P = 0.003). Odds of SARS-CoV-2 positivity remained higher among PLWH after adjusting for age, sex, race/ethnicity, and study site (adjusted odds ratio = 2.0, 95% confidence interval = 1.2 to 3.2). SARS-CoV-2 positivity was not associated with CD4 cell counts among PLWH. Among SARS-CoV-2 positive participants, 9% had no symptoms, 7% had 1-2 mild symptoms, and 84% had ≥3 symptoms. Most of the (98%) participants reported physical distancing during all survey waves; self-reported ART adherence among PLWH was not adversely affected during the pandemic compared with the previous year (similar adherence in 89% of participants, improved in 9% of participants, and decreased in 2% of participants). CONCLUSIONS Despite similar SARS-CoV-2 testing and physical distancing profiles by HIV serostatus among MWCCS participants, PLWH who reported SARS-CoV-2 testing were more likely to have a positive test result. Additional studies are needed to determine whether and why PLWH are at increased risk of SARS-CoV-2 infection.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Weiqun Tong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Deborah Gustafson
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Maria L. Alcaide
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Fl, USA
| | - Cecile D. Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Audrey L. French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago IL
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew J. Mimiaga
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles 90095-1772
| | - Catalina Ramirez
- Department of Medicine, UNC School Division of Medicine, The Infectious Diseases, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seble Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University, Washington DC, USA
| | - Charles R. Rinaldo
- Department of Infectious Diseases and Microbiology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco and Department of Veterans Affairs, San Francisco, CA, USA
| | - Adaora A. Adimora
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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14
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Massad LS, Xie X, Minkoff HL, Michel KG, D’Souza G, Wang CC, Konkle-Parker D, Ofotokun I, Fischl MA, Rahangdale L, Strickler HD. Frequency of high-grade squamous cervical lesions among women over age 65 years living with HIV. Am J Obstet Gynecol 2021; 225:411.e1-411.e7. [PMID: 33957115 DOI: 10.1016/j.ajog.2021.04.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Current US cervical cancer screening guidelines recommend screening cessation at the age of 65 years provided women have adequate previous screening and no history of precancer. Women living with HIV are at higher risk of cervical cancer than women living without HIV. Furthermore, limited data exists to quantify the risk of cervical cancer among women who otherwise would qualify for screening cessation. OBJECTIVE This study aimed to determine whether guidelines recommending women to discontinue cervical cancer screening at the age of 65 years are appropriate for women living with HIV. STUDY DESIGN Semiannual Papanicolaou testing was performed as part of surveillance visits in the Women's Interagency HIV Study. Launched in October 1994, the Women's Interagency HIV Study is a federally funded US multisite cohort study that has enrolled 3678 women living with HIV and 1304 women living without HIV; we included data throughout September 2019 onward. Conventional Papanicolaou tests were collected at scheduled 6-month visits and read centrally according to the 1991 Bethesda System criteria. Results were analyzed among women at least 65 years of age. The primary endpoint was high-grade cytology, including high-grade squamous intraepithelial lesions; atypical glandular cells; atypical squamous cells, cannot exclude high-grade lesions; and malignant cytology. Wilcoxon rank-sum tests were used to compare the continuous variables, and Chi-square tests or the Fisher exact tests were used to compare the categorical variables. The Kaplan-Meier method was used to calculate the cumulative incidence. Poisson regression was used to compare 2 incidence rates. RESULTS Of 169 eligible women (121 women living with HIV and 48 women living without HIV) who contributed 678.4 person-years of observation after reaching the age of 65 years, 2.2% had high-grade cytologic abnormalities. However, no cancer was found. Furthermore, 20 women had previous precancer results, and 74 women had abnormal Papanicolaou test results in the previous decade. Among 50 women (38 women living with HIV and 12 women living without HIV) with a previous hysterectomy and no history of cervical precancer, the cumulative incidence rates of high-grade squamous intraepithelial lesions were 0.6 (95% confidence interval, 0.0-3.2) per 100 person-years for women living with HIV and 0.0 (95% confidence interval, 0.0-8.1) per 100 person-years for women living without HIV (P=.61). Only 48 women (27 women living with HIV and 21 women living without HIV) had cervices and met the current guidelines to discontinue screening; their risk of experiencing high-grade squamous intraepithelial lesions was 2.2 (95% confidence interval, 0.6-5.5) per 100 person-years overall and did not vary by HIV status (2.3 [95% confidence interval, 0.5-6.8] per 100 person-years for women living with HIV and 1.8 [95% confidence interval, 0.0-9.8] per 100 person-years for women living without HIV; P=.81). CONCLUSION Most women living with HIV do not meet the criteria for cervical cancer screening cessation and will need to continue screening over the age of 65 years; however, women who meet the criteria for screening cessation have risks of high-grade squamous lesions similar to women living without HIV and may choose to discontinue.
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15
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D’Souza G, Benning L, Stosor V, Witt MD, Johnson J, Friedman M, Abraham AG. The shifting picture of HIV treatment, comorbidity and substance use among US MSM living with HIV. HIV Med 2021; 22:538-546. [PMID: 33751813 PMCID: PMC8295172 DOI: 10.1111/hiv.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) have increased risk of chronic disease and poor mental health. We aimed to explore HIV disease indicators, comorbidity, and risk behavior of recent antiretroviral therapy (ART) initiators to inform current needs of PLWH. METHODS Men who have sex with men (MSM) in the Multicenter AIDS Cohort Study (MACS) who initiated ART between 2010 and 2018 (recent initiators) were compared with age-, race- and geographic location-matched men who initiated ART during 2000-2009 (early initiators). Measures of HIV disease, behavior, comorbidity and mental health were collected prospectively every 6 months using standardized forms. RESULTS Recent initiators had higher current CD4 (median CD4 451 vs. 307 cells/μL, P < 0.0001) and nadir CD4 (451 vs. 300 cells/μL, P < 0.0001) than earlier initiators. The proportion achieving viral suppression within a year of starting ART was significantly higher in recent compared with earlier initiators (92% vs. 74%, P < 0.0001). Median [interquartile range (IQR)] time from HIV diagnosis to ART initiation was 5.4 (1.7-23.1) months in recent initiators. Comorbidity prevalence was high in recent initiators, including obesity (24%), hypertension (25%) and kidney disease (15%). Substance use continues to be common, including cigarette use (40%), daily alcohol use (88%) and marijuana use (46%). CONCLUSIONS Improvements in getting individuals onto ART at an early stage have led to substantially higher CD4 cell counts at initiation. However, the high burden of comorbidity, substance use and poor mental health affecting MSM living with HIV in the US underscore ongoing challenges and our need to adapt and coordinate care.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Valentina Stosor
- Department of Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Mallory D. Witt
- Department of Medicine, The Lundquist Institute at Harbor-UCLA, USA
| | - Jacquett Johnson
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Mackey Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, USA
| | - Alison G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
- Department of Ophthalmology, Johns Hopkins School of Medicine
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16
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Silverberg MJ, Leyden W, Hernández-Ramírez RU, Qin L, Lin H, Justice AC, Hessol NA, Achenbach CJ, D’Souza G, Engels EA, Althoff KN, Mayor AM, Sterling TR, Kitahata MM, Bosch RJ, Saag MS, Rabkin CS, Horberg MA, Gill MJ, Grover S, Mathews WC, Li J, Crane HM, Gange SJ, Lau B, Moore RD, Dubrow R, Neugebauer RS. Timing of Antiretroviral Therapy Initiation and Risk of Cancer Among Persons Living With Human Immunodeficiency Virus. Clin Infect Dis 2021; 72:1900-1909. [PMID: 32785640 PMCID: PMC8315132 DOI: 10.1093/cid/ciaa1046] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Persons living with human immunodeficiency virus (HIV; PLWH) experience a high burden of cancer. It remains unknown which cancer types are reduced in PLWH with earlier initiation of antiretroviral therapy (ART). METHODS We evaluated AIDS-free, ART-naive PLWH during 1996-2014 from 22 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. PLWH were followed from first observed CD4 of 350-500 cells/µL (baseline) until incident cancer, death, lost-to-follow-up, or December 2014. Outcomes included 6 cancer groups and 5 individual cancers that were confirmed by chart review or cancer registry linkage. We evaluated the effect of earlier (in the first 6 months after baseline) versus deferred ART initiation on cancer risk. Marginal structural models were used with inverse probability weighting to account for time-dependent confounding and informative right-censoring, with weights informed by subject's age, sex, cohort, baseline year, race/ethnicity, HIV transmission risk, smoking, viral hepatitis, CD4, and AIDS diagnoses. RESULTS Protective results for earlier ART were found for any cancer (adjusted hazard ratio [HR] 0.57; 95% confidence interval [CI], .37-.86), AIDS-defining cancers (HR 0.23; 95% CI, .11-.49), any virus-related cancer (HR 0.30; 95% CI, .16-.54), Kaposi sarcoma (HR 0.25; 95% CI, .10-.61), and non-Hodgkin lymphoma (HR 0.22; 95% CI, .06-.73). By 15 years, there was also an observed reduced risk with earlier ART for virus-related NADCs (0.6% vs 2.3%; adjusted risk difference -1.6; 95% CI, -2.8, -.5). CONCLUSIONS Earlier ART initiation has potential to reduce the burden of virus-related cancers in PLWH but not non-AIDS-defining cancers (NADCs) without known or suspected viral etiology.
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Affiliation(s)
- Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Raúl U Hernández-Ramírez
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Li Qin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Haiqun Lin
- Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- School of Nursing, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, USA
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- Research Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA
| | - Chad J Achenbach
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angel M Mayor
- Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico
| | - Timothy R Sterling
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ronald J Bosch
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles S Rabkin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - W Christopher Mathews
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Romain S Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Wherry EJ, Jaffee EM, Warren N, D’Souza G, Ribas A. How Did We Get a COVID-19 Vaccine in Less Than 1 Year? Clin Cancer Res 2021; 27:2136-2138. [PMID: 33542081 PMCID: PMC8052930 DOI: 10.1158/1078-0432.ccr-21-0079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
The successful development of COVID-19 vaccines within an unprecedented short time needs to be followed by rapid vaccine uptake, in particular, in high-risk populations such as patients with cancer. It is important for the scientific research community and cancer physicians to convey the knowledge behind the COVID-19 vaccine development and contribute to build the required trust on their use.
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Affiliation(s)
- E. John Wherry
- Department of Systems Pharmacology and Translational Therapeutics, Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth M. Jaffee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Nicholas Warren
- American Association for Cancer Research, Philadelphia, Pennsylvania
| | - Gypsyamber D’Souza
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Antoni Ribas
- Department of Medicine and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California
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18
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Feinstein MJ, Haberlen SA, Ashikaga H, Palella FJ, Magnani JW, Budoff M, Berlacher K, D’Souza G, Brown T, Post WS, Wu KC. Ventricular ectopy and arrhythmia by HIV serostatus, viremia, and CD4+ cell count. AIDS 2021; 35:846-849. [PMID: 33724260 PMCID: PMC7970630 DOI: 10.1097/qad.0000000000002820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Matthew J. Feinstein
- Division of Cardiology and Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Sabina A. Haberlen
- Division of Cardiology, Division of Endocrinology and Metabolism, Department of Medicine and Department of Epidemiology, Johns Hopkins University
| | - Hiroshi Ashikaga
- Division of Cardiology, Division of Endocrinology and Metabolism, Department of Medicine and Department of Epidemiology, Johns Hopkins University
| | - Frank J. Palella
- Division of Cardiology and Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Jared W. Magnani
- Division of Cardiology, Department of Medicine, University of Pittsburgh
| | | | - Kathryn Berlacher
- Division of Cardiology, Department of Medicine, University of Pittsburgh
| | - Gypsyamber D’Souza
- Division of Cardiology, Division of Endocrinology and Metabolism, Department of Medicine and Department of Epidemiology, Johns Hopkins University
| | - Todd Brown
- Division of Cardiology, Division of Endocrinology and Metabolism, Department of Medicine and Department of Epidemiology, Johns Hopkins University
| | - Wendy S. Post
- Division of Cardiology, Division of Endocrinology and Metabolism, Department of Medicine and Department of Epidemiology, Johns Hopkins University
| | - Katherine C. Wu
- Division of Cardiology, Division of Endocrinology and Metabolism, Department of Medicine and Department of Epidemiology, Johns Hopkins University
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19
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Noor SW, Hart TA, Okafor CN, Ware D, Chew KW, D’Souza G, Ho K, Friedman MR, Plankey M. Staying or moving: Results of a latent transition analysis examining intra-individual stability of recreational substance use among MSM in the Multicenter AIDS Cohort Study from 2004 to 2016. Drug Alcohol Depend 2021; 220:108516. [PMID: 33485009 PMCID: PMC7901540 DOI: 10.1016/j.drugalcdep.2021.108516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Studies have examined patterns of substance use among Men who have Sex with Men (MSM), but few have examined factors predicting transitioning from one substance use pattern to another. We investigated transitioning from one substance use pattern to another over a 12-year period (2004-2016) among the Multicenter AIDS Cohort Study participants. METHOD Alcohol, marijuana, heroin, cocaine, poppers, uppers (e.g., methamphetamines) and erectile dysfunction(ED) medications use in the last 6 months from 3568 US MSM was dichotomized (no/yes) to classify participants into substance use classes at each follow up visit. We fit latent transition models to calculate transition probabilities of moving from one substance use class to another over a 3, 4 and 6-year time period. Then fit regression models to identify factors associated with the probability of each participant staying in or moving from the same substance use class. RESULTS Overall, cocaine and ED medication use declined but marijuana and heroin use increased over 2004-2016. We observed most participants (84.6 %-100 %) stayed in the same class. Increased age was associated with transition from the Minimal-use class to the Alcohol-only class (aOR = 1.06,95 %CI:1.01-1.13;p < 0.01) and non-White MSM reported lower odds of moving from the Alcohol-only class to the Alcohol-Popper class (aOR = 0.50,95 %CI:0.30-0.82;p <0.01). There were no difference in the transition probabilities by HIV-status. CONCLUSION Despite decline in substance use in general, participants are highly stable in their choice of substances. However, treating MSM as a homogeneous group can lead to an under-appreciation of the diversity of prevention needs and treatment of substance using MSM.
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Affiliation(s)
- Syed W. Noor
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada,Department of Kinesiology and Health Science, Louisiana State University Shreveport, One University Place, Shreveport, LA 71115, USA
| | - Trevor A. Hart
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Chukwuemeka N. Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, 1311 S 5th St, Waco, TX 76706, USA
| | - Deanna Ware
- Georgetown University Medical Center, 4000 Reservoir Road, NW, Suite 120 Washington, D.C. 20057, USA
| | - Kara W. Chew
- David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd, Suite 100, Los Angeles, CA 90025, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Ken Ho
- Division of Infectious Diseases, University of Pittsburgh, 3520 Fifth Avenue, Suite 533, Pittsburgh, PA 15213, USA
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA 15261, USA
| | - Michael Plankey
- Georgetown University Medical Center, 4000 Reservoir Road, NW, Suite 120 Washington, D.C. 20057, USA
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20
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Rooper LM, Windon MJ, Hernandez T, Miles B, Ha PK, Ryan WR, Van Zante A, Eisele DW, D’Souza G, Fakhry C, Westra WH. HPV-positive Squamous Cell Carcinoma of the Larynx, Oral Cavity, and Hypopharynx: Clinicopathologic Characterization With Recognition of a Novel Warty Variant. Am J Surg Pathol 2020; 44:691-702. [PMID: 31934915 PMCID: PMC7885126 DOI: 10.1097/pas.0000000000001433] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Human papillomavirus (HPV) is a principal driver for most oropharyngeal squamous cell carcinomas (OPSCCs), where it is strongly associated with improved survival. HPV is much less frequently detected in squamous cell carcinomas arising in nonoropharyngeal sites (non-OPSCCs), and its pathogenic role and prognostic value in these tumors is unclear. We evaluated the clinicopathologic features of 52 non-OPSCCs considered HPV-positive based upon p16 immunohistochemistry and direct HPV detection using RNA in situ hybridization (ISH), DNA ISH, or real-time DNA polymerase chain reaction. The HPV-positive non-OPSCCs were from the larynx (n=27), oral cavity (n=21), and hypopharynx (n=4). While most cases (n=34, 65%) showed classic histologic features of HPV-positive OPSCC, including endophytic growth, minimal keratinization, and hyperchromatic nuclei without koilocytic changes, a subset (n=13, 25%) were characterized by exophytic growth, exuberant surface hyperkeratosis and parakeratosis, marked nuclear pleomorphism, and prominent koilocytic atypia. These antithetical features were highly reminiscent of the warty variant of HPV-positive squamous cell carcinoma described in anogenital sites. Compared with tumors without warty features, the warty tumors presented at lower stage and were not associated with lymph node metastasis, local recurrence, or distant spread (4 y disease-free survival of 100% vs. 66%, P=0.069). The presence of transcriptionally active HPV as detected by RNA ISH suggests a pathogenic role for HPV in these nonoropharyngeal sites. While most HPV-positive non-OPSCCs are morphologically similar to their tonsillar counterparts, this study highlights a previously unrecognized warty variant that may be associated with a highly favorable clinical outcome.
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Affiliation(s)
- Lisa M. Rooper
- Department of Pathology, The Johns Hopkins University School of Medicine
- Department of Oncology, The Johns Hopkins University School of Medicine
| | - Melina J. Windon
- Department of Otolaryngology, The Johns Hopkins University School of Medicine
| | - Tahyna Hernandez
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brett Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick K. Ha
- Department of Otolaryngology, University of California at San Francisco, San Francisco, CA
| | - William R. Ryan
- Department of Otolaryngology, University of California at San Francisco, San Francisco, CA
| | - Annemieke Van Zante
- Department of Pathology, University of California at San Francisco, San Francisco, CA
| | - David W. Eisele
- Department of Oncology, The Johns Hopkins University School of Medicine
- Department of Otolaryngology, The Johns Hopkins University School of Medicine
| | - Gypsyamber D’Souza
- Department of Otolaryngology, The Johns Hopkins University School of Medicine
- Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, MD
| | - Carole Fakhry
- Department of Oncology, The Johns Hopkins University School of Medicine
- Department of Otolaryngology, The Johns Hopkins University School of Medicine
| | - William H. Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
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21
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Rohner E, Bütikofer L, Schmidlin K, Sengayi M, Maskew M, Giddy J, Taghavi K, Moore RD, Goedert JJ, Gill MJ, Silverberg MJ, D’Souza G, Patel P, Castilho JL, Ross J, Sohn A, Bani-Sadr F, Taylor N, Paparizos V, Bonnet F, Verbon A, Vehreschild JJ, Post FA, Sabin C, Mocroft A, Dronda F, Obel N, Grabar S, Spagnuolo V, Quiros-Roldan E, Mussini C, Miro JM, Meyer L, Hasse B, Konopnicki D, Roca B, Barger D, Clifford GM, Franceschi S, Egger M, Bohlius J. Cervical cancer risk in women living with HIV across four continents: A multicohort study. Int J Cancer 2020; 146:601-609. [PMID: 31215037 PMCID: PMC6898726 DOI: 10.1002/ijc.32260] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 01/02/2023]
Abstract
We compared invasive cervical cancer (ICC) incidence rates in Europe, South Africa, Latin and North America among women living with HIV who initiated antiretroviral therapy (ART) between 1996 and 2014. We analyzed cohort data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) and the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord. We used flexible parametric survival models to determine regional ICC rates and risk factors for incident ICC. We included 64,231 women from 45 countries. During 320,141 person-years (pys), 356 incident ICC cases were diagnosed (Europe 164, South Africa 156, North America 19 and Latin America 17). Raw ICC incidence rates per 100,000 pys were 447 in South Africa (95% confidence interval [CI]: 382-523), 136 in Latin America (95% CI: 85-219), 76 in North America (95% CI: 48-119) and 66 in Europe (95% CI: 57-77). Compared to European women ICC rates at 5 years after ART initiation were more than double in Latin America (adjusted hazard ratio [aHR]: 2.43, 95% CI: 1.27-4.68) and 11 times higher in South Africa (aHR: 10.66, 95% CI: 6.73-16.88), but similar in North America (aHR: 0.79, 95% CI: 0.37-1.71). Overall, ICC rates increased with age (>50 years vs. 16-30 years, aHR: 1.57, 95% CI: 1.03-2.40) and lower CD4 cell counts at ART initiation (per 100 cell/μl decrease, aHR: 1.25, 95% CI: 1.15-1.36). Improving access to early ART initiation and effective cervical cancer screening in women living with HIV should be key parts of global efforts to reduce cancer-related health inequities.
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Affiliation(s)
- Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | | | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Mazvita Sengayi
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janet Giddy
- Department of Medicine, McCord Hospital, Durban, South Africa
| | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Richard D. Moore
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - James J. Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | | | | | | | - Pragna Patel
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica L. Castilho
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, USA
| | - Jeremy Ross
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Annette Sohn
- TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - Firouze Bani-Sadr
- Reims Champagne-Ardenne University, Faculté de médecine, CHU Reims, Hôpital Robert Debré, Tropical and Infectious Diseases, Reims, France
| | - Ninon Taylor
- IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectious Diseases and Rheumathology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria, Present address: Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Vassilios Paparizos
- AIDS Unit, Clinic of Venereologic and Dermatologic Diseases, Athens Medical School, “Syngros” Hospital, Athens, Greece
| | - Fabrice Bonnet
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France
| | - Annelies Verbon
- Department Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
| | - Frank A. Post
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Caroline Sabin
- Institute for Global Health, UCL, London, United Kingdom
| | - Amanda Mocroft
- Institute for Global Health, UCL, London, United Kingdom
| | - Fernando Dronda
- Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sophie Grabar
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France
- INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France
- Université Paris Descartes et Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Cochin Hôtel-Dieu, Paris, France
| | - Vincenzo Spagnuolo
- Vita-Salute San Raffaele University, Faculty of Medicine and Surgery, Milan, Italy
| | | | | | - José M. Miro
- Infectious Diseases Service, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Laurence Meyer
- INSERM, U1018, Epidemiology of HIV, Reproduction, Paediatrics, CESP, University Paris-Sud, Paris, France
- Department of Public Health and Epidemiology, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, Paris, France
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Deborah Konopnicki
- Department of Infectious Diseases, St Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Diana Barger
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France
| | | | - Silvia Franceschi
- Centro di Riferimento Oncologico di Aviano (CRO)-IRCCS, Aviano, Italy
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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22
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D’Souza G, Golub ET, Gange SJ. The Changing Science of HIV Epidemiology in the United States. Am J Epidemiol 2019; 188:2061-2068. [PMID: 31595945 PMCID: PMC7036648 DOI: 10.1093/aje/kwz211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022] Open
Abstract
In 1984, a large prospective study of the natural history of human immunodeficiency virus (HIV) infection, the Multicenter AIDS Cohort Study (MACS), was established; 10 years later, the Women's Interagency HIV Study (WIHS) was launched. Motivated by the merger and redesign of these long-standing HIV cohort studies in 2019, we review ways in which HIV epidemiology in the United States has transformed over the lives of these studies and how this evolution has influenced planning for enrollment and follow-up. We highlight changes that have occurred in the 3 major domains that are central to epidemiologic science: changes to key populations at highest risk for HIV, refinements in measurement and shifts in the outcomes of interest, and a new era in the tools and approaches that epidemiologists use to synthesize evidence from measurements made on populations. By embracing foundational principles with modern methods, the epidemiologic approach of analyzing the causes and distributions of diseases in contemporaneous populations will continue to advance HIV science over the next decade.
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Affiliation(s)
- Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD
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Windle M, Lee HD, Cherng ST, Lesko CR, Hanrahan C, Jackson JW, McAdams-DeMarco M, Ehrhardt S, Baral SD, D’Souza G, Dowdy DW. From Epidemiologic Knowledge to Improved Health: A Vision for Translational Epidemiology. Am J Epidemiol 2019; 188:2049-2060. [PMID: 30927354 DOI: 10.1093/aje/kwz085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/18/2022] Open
Abstract
Epidemiology should aim to improve population health; however, no consensus exists regarding the activities and skills that should be prioritized to achieve this goal. We performed a scoping review of articles addressing the translation of epidemiologic knowledge into improved population health outcomes. We identified 5 themes in the translational epidemiology literature: foundations of epidemiologic thinking, evidence-based public health or medicine, epidemiologic education, implementation science, and community-engaged research (including literature on community-based participatory research). We then identified 5 priority areas for advancing translational epidemiology: 1) scientific engagement with public health; 2) public health communication; 3) epidemiologic education; 4) epidemiology and implementation; and 5) community involvement. Using these priority areas as a starting point, we developed a conceptual framework of translational epidemiology that emphasizes interconnectedness and feedback among epidemiology, foundational science, and public health stakeholders. We also identified 2-5 representative principles in each priority area that could serve as the basis for advancing a vision of translational epidemiology. We believe an emphasis on translational epidemiology can help the broader field to increase the efficiency of translating epidemiologic knowledge into improved health outcomes and to achieve its goal of improving population health.
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Affiliation(s)
- Michael Windle
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Hojoon D Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Sarah T Cherng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Colleen Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
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Rositch AF, Atnafou R, Krakow M, D’Souza G. A Community-Based Qualitative Assessment of Knowledge, Barriers, and Promoters of Communicating about Family Cancer History among African-Americans. Health Commun 2019; 34:1192-1201. [PMID: 29757007 PMCID: PMC7303890 DOI: 10.1080/10410236.2018.1471335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Family cancer history (FCH) can shape prevention and early detection behaviors to decrease cancer risk. However, many individuals are unaware of increased risk for cancers based on family patterns. For some African-American communities, communication about FCH is rare and barriers have not been well studied. To optimize the use of FCH, it is crucial to understand how patients gather and share FCH with relatives and healthcare providers. We conducted four focus groups (n = 40) and seven key informant interviews (n = 9) to investigate knowledge, experiences, and barriers/promoters of FCH in the East Baltimore African-American community. Thematic analysis identified 14 distinct themes across six communication domains: participants' understanding of FCH, past FCH communication with family and providers, barriers to FCH communication, promoters of FCH communication, suggestions for future communication, and community health priorities. FCH was most often defined by narratives of family cancer experiences, and the majority of participants had shared little FCH with family members. Five psychosocial domains were commonly reported as barriers to sharing FCH: fear/denial, pride/dignity, selflessness/self-sacrifice, cancer fatalism, and distrust/skepticism of medical care. Diagnosis/death and caregiving/social support promoted FCH communication and encouraged cancer prevention behaviors such as screening. Although most participants had experienced cancer in their families, communication about FCH was low and psychosocial barriers were common. Understanding these communication domains in minority populations is crucial to developing interventions to address disparities in cancer prevention and control, particularly where effective screening and care recommendations exist for those with positive family histories.
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Affiliation(s)
- Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | | | - Melinda Krakow
- Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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25
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Hernández-Ramírez RU, Qin L, Lin H, Leyden W, Neugebauer RS, Althoff KN, Achenbach CJ, Hessol NA, D’Souza G, Gebo KA, Gill MJ, Grover S, Horberg MA, Li J, Mathews WC, Mayor AM, Park LS, Rabkin CS, Salters K, Justice AC, Moore RD, Engels EA, Silverberg MJ, Dubrow R. Association of immunosuppression and HIV viraemia with non-Hodgkin lymphoma risk overall and by subtype in people living with HIV in Canada and the USA: a multicentre cohort study. Lancet HIV 2019; 6:e240-e249. [PMID: 30826282 PMCID: PMC6531288 DOI: 10.1016/s2352-3018(18)30360-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Research is needed to better understand relations between immunosuppression and HIV viraemia and risk for non-Hodgkin lymphoma, a common cancer in people living with HIV. We aimed to identify key CD4 count and HIV RNA (viral load) predictors of risk for non-Hodgkin lymphoma, overall and by subtype. METHODS We studied people living with HIV during 1996-2014 from 21 Canadian and US cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. To determine key independent predictors of risk for non-Hodgkin lymphoma, we assessed associations with time-updated recent, past, cumulative, and nadir or peak measures of CD4 count and viral load, using demographics-adjusted, cohort-stratified Cox models, and we compared models using Akaike's information criterion. FINDINGS Of 102 131 people living with HIV during the study period, 712 people developed non-Hodgkin lymphoma. The key independent predictors of risk for overall non-Hodgkin lymphoma were recent CD4 count (ie, lagged by 6 months; <50 cells per μL vs ≥500 cells per μL, hazard ratio [HR] 3·2, 95% CI 2·2-4·7) and average viral load during a 3-year window lagged by 6 months (a cumulative measure; ≥100 000 copies per mL vs ≤500 copies per mL, HR 9·6, 95% CI 6·5-14·0). These measures were also the key predictors of risk for diffuse large B-cell lymphoma (recent CD4 count <50 cells per μL vs ≥500 cells per μL, HR 2·4, 95% CI 1·4-4·2; average viral load ≥100 000 copies per mL vs ≤500 copies per mL, HR 7·5, 95% CI 4·5-12·7). However, recent CD4 count was the sole key predictor of risk for CNS non-Hodgkin lymphoma (<50 cells per μL vs ≥500 cells per μL, HR 426·3, 95% CI 58·1-3126·4), and proportion of time viral load was greater than 500 copies per mL during the 3-year window (a cumulative measure) was the sole key predictor for Burkitt lymphoma (100% vs 0%, HR 41·1, 95% CI 9·1-186·6). INTERPRETATION Both recent immunosuppression and prolonged HIV viraemia have important independent roles in the development of non-Hodgkin lymphoma, with likely subtype heterogeneity. Early and sustained antiretroviral therapy to decrease HIV replication, dampen B-cell activation, and restore overall immune function is crucial for preventing non-Hodgkin lymphoma. FUNDING National Institutes of Health, Centers for Disease Control and Prevention, US Agency for Healthcare Research and Quality, US Health Resources and Services Administration, Canadian Institutes of Health Research, Ontario Ministry of Health and Long Term Care, and the Government of Alberta.
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Affiliation(s)
- Raúl U. Hernández-Ramírez
- Corresponding author: Raúl U.
Hernández-Ramírez, Department of Biostatistics, Yale School of
Public Health, New Haven, CT 06520-8034, USA
| | - Li Qin
- Department of Internal Medicine, Yale School of Medicine, New
Haven, CT, USA
| | - Haiqun Lin
- Department of Biostatistics, Yale School of Public Health, Yale
School of Medicine, New Haven, CT, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California,
Oakland, CA, USA
| | | | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg
School of Public Health, Baltimore, MD, USA
| | - Chad J. Achenbach
- Division of Infectious Diseases, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA
| | - Nancy A. Hessol
- Department of Clinical Pharmacy, University of California, San
Francisco, San Francisco, CA, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins University Bloomberg
School of Public Health, Baltimore, MD, USA
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta,
Canada
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente
Mid-Atlantic States, Rockville, MD, USA
| | - Jun Li
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | | | - Angel M. Mayor
- Retrovirus Research Center, Universidad Central del Caribe School
of Medicine, Bayamon, Puerto Rico
| | - Lesley S. Park
- Stanford Center for Population Health Sciences, Stanford
University School of Medicine, Palo Alto, CA, USA
| | - Charles S. Rabkin
- Infections and Immunoepidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, Rockville, MD,
USA
| | - Kate Salters
- Epidemiology and Population Health, British Columbia Centre for
Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Amy C. Justice
- Department of Internal Medicine, Yale School of Medicine, New
Haven, CT, USA,Department of Health Policy and Management, Yale School of Public
Health, Yale School of Medicine, New Haven, CT, USA,Research Service, Veterans Affairs Connecticut Healthcare System,
West Haven, CT, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, Rockville, MD,
USA
| | | | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public
Health, Yale School of Medicine, New Haven, CT, USA
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Halec G, Waterboer T, Brenner N, Butt J, Hardy DW, D’Souza G, Wolinsky S, Macatangay BJ, Pawlita M, Detels R, Martínez-Maza O, Hussain SK. Serological Assessment of 18 Pathogens and Risk of AIDS-Associated Non-Hodgkin Lymphoma. J Acquir Immune Defic Syndr 2019; 80:e53-e63. [PMID: 30531297 PMCID: PMC6375787 DOI: 10.1097/qai.0000000000001916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND HIV infection is associated with increased susceptibility to common pathogens, which may trigger chronic antigenic stimulation and hyperactivation of B cells, events known to precede the development of AIDS-associated non-Hodgkin lymphoma (AIDS-NHL). METHODS To explore whether cumulative exposure to infectious agents contributes to AIDS-NHL risk, we tested sera from 199 AIDS-NHL patients (pre-NHL, average lead time 3.9 years) and 199 matched HIV-infected controls from the Multicenter AIDS Cohort Study, for anti-IgG responses to 18 pathogens using multiplex serology. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression models. RESULTS We found no association between cumulative exposure to infectious agents and AIDS-NHL risk (OR 1.01, 95% CI: 0.91 to 1.12). However, seropositivity for trichodysplasia spinulosa polyomavirus (TSPyV), defined as presence of antibodies to TSPyV capsid protein VP1, was significantly associated with a 1.6-fold increase in AIDS-NHL risk (OR 1.62, 95% CI: 1.02 to 2.57). High Epstein-Barr virus (EBV) anti-VCA p18 antibody levels closer to the time of AIDS-NHL diagnosis (<4 years) were associated with a 2.6-fold increase in AIDS-NHL risk (OR 2.59, 95% CI: 1.17 to 5.74). In addition, high EBV anti-EBNA-1 and anti-ZEBRA antibody levels were associated with 2.1-fold (OR 0.47, 95% CI: 0.26 to 0.85) and 1.6-fold (OR 0.57, 95% CI: 0.35 to 0.93) decreased risk of AIDS-NHL, respectively. CONCLUSIONS Our results do not support the hypothesis that cumulative exposure to infectious agents contributes to AIDS-NHL development. However, the observed associations with respect to TSPyV seropositivity and EBV antigen antibody levels offer additional insights into the pathogenesis of AIDS-NHL.
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Affiliation(s)
- Gordana Halec
- University of California Los Angeles (UCLA) AIDS Institute and Department of Obstetrics and Gynecology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Tim Waterboer
- Infections and Cancer Epidemiology, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicole Brenner
- Infections and Cancer Epidemiology, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julia Butt
- Infections and Cancer Epidemiology, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David W. Hardy
- Clinical Investigations, Whitman-Walker Health, Washington, DC
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steven Wolinsky
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bernard J. Macatangay
- Division of Infectious Diseases, Department of Medicine, University of Pittsburg School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael Pawlita
- Infections and Cancer Epidemiology, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roger Detels
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Otoniel Martínez-Maza
- University of California Los Angeles (UCLA) AIDS Institute and Department of Obstetrics and Gynecology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Shehnaz K. Hussain
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Samuel Oschin Comprehensive Cancer Institute and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Ware D, Palella FJ, Chew KW, Friedman MR, D’Souza G, Ho K, Plankey M. Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016. PLoS One 2018; 13:e0203890. [PMID: 30204807 PMCID: PMC6133387 DOI: 10.1371/journal.pone.0203890] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/29/2018] [Indexed: 01/21/2023] Open
Abstract
Rates of aging-related comorbidities, which require targeted medications to treat, have been shown to be increased among persons living with HIV compared with uninfected counterparts. Polypharmacy is generally defined as the concurrent use of 5 or more medications. We investigated polypharmacy prevalence for non-HIV medications over a 12-year period among HIV-positive and -negative participants in the Multicenter AIDS Cohort Study. Information regarding non-HIV medication use, HIV status, age, race/ethnicity, enrollment period, and medication insurance was obtained on 3,160 participants from semiannual visits between 2004 and 2016. Polypharmacy was defined as taking 5 or more non-HIV medications since the last health care visit. Generalized estimating equation models with repeated measures were produced overall and by HIV status to examine polypharmacy. The unadjusted prevalence of polypharmacy across all study visits was 18.6% and was higher among HIV-positive participants (24.4%) compared with HIV-negative participants (11.6%) (P < .0001). Among the 50 years and older age group, HIV-positive and HIV-negative participants had increases in polypharmacy over the observation period, from 38.4% to 46.8% (P = .0081) and from 16.7% to 46.0% (P < .0001), respectively. Among participants younger than 50, polypharmacy among HIV-positive participants remained stable (18.9% in 2004 to 17.3% in 2016; P = .5374) but increased among HIV-negative men (5.6% to 20.4%; P < .0001). After adjusting for age, race/ethnicity, and medication insurance, HIV-positive participants had a higher prevalence of polypharmacy than HIV-negative participants (25.3% vs 18.7%; P < .0001). Older age, white race, and having medication insurance coverage were also associated with greater polypharmacy. A convergence of polypharmacy prevalence was observed between HIV-positive and -negative participants at the end of observation. HIV-positive status was associated with an increased likelihood of polypharmacy, after adjusting for age, race/ethnicity, enrollment period, medication insurance, and study visit. Over time, polypharmacy prevalence increased among all participants, with converging rates between HIV-positive and -negative participants by the end of the observation period.
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Affiliation(s)
- Deanna Ware
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
- * E-mail:
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Kara W. Chew
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - M. Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Gypsyamber D’Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael Plankey
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
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Peprah S, Curreiro FC, Hayes JH, Stern K, Parekh S, D’Souza G. A spatiotemporal analysis of invasive cervical cancer incidence in the state of Maryland between 2003 and 2012. Cancer Causes Control 2018. [DOI: 10.1007/s10552-018-1019-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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29
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Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
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Anantharaman D, Abedi-Ardekani B, Beachler DC, Gheit T, Olshan AF, Wisniewski K, Wunsch-Filho V, Toporcov TN, Tajara EH, Levi JE, Moyses RA, Boccia S, Cadoni G, Rindi G, Ahrens W, Merletti F, Conway DI, Wright S, Carreira C, Renard H, Chopard P, McKay-Chopin S, Scelo G, Tommasino M, Brennan P, D’Souza G. Geographic heterogeneity in the prevalence of human papillomavirus in head and neck cancer. Int J Cancer 2017; 140:1968-1975. [PMID: 28108990 PMCID: PMC8969079 DOI: 10.1002/ijc.30608] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/11/2016] [Accepted: 12/05/2016] [Indexed: 12/22/2022]
Abstract
Human papillomavirus (HPV) causes oropharyngeal squamous cell carcinoma (OPSCC), although strongly divergent results have been reported regarding the prevalence of HPV16 in different countries, whether this represents important differences in etiology remains unclear. Applying rigorous protocols for sample processing, we centrally evaluated 1,420 head and neck tumors (533 oropharynx, 395 oral cavity and 482 larynx) from studies conducted in the US, Europe and Brazil for mucosal HPV DNA and p16INK4a expression to evaluate regional heterogeneity in the proportion of HPV16-associated OPSCC and other head and neck cancer, and to assess covariates associated with the risk of HPV16-positive OPSCC. While majority of OPSCC in the US (60%) were HPV16-positive, this proportion was 31% in Europe and only 4% in Brazil (p < 0.01). Similar differences were observed for other head and neck tumors, ranging from 7% in the US and 5% in Europe, to 0% in South America. The odds of HPV16-positive OPSCC declined with increasing pack years of smoking (OR: 0.75; 95% CI: 0.64-0.87) and drink years of alcohol use (OR: 0.64; 95% CI: 0.54-0.76). These results suggest that while the contribution of HPV16 is substantial for the oropharynx, it remains limited for oral cavity and laryngeal cancers.
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Affiliation(s)
| | | | - Daniel C. Beachler
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Tarik Gheit
- International Agency for Research on Cancer, Lyon, France
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Kathy Wisniewski
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Victor Wunsch-Filho
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Tatiana N. Toporcov
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Eloiza H. Tajara
- Department of Genetics and Evolutionary Biology, Institute of Bioscience, University of São Paulo, São Paulo, Brazil
- Department of Molecular Biology, School of Medicine of São José do Rio Preto, São José do Rio Preto, Brasil
| | - José Eduardo Levi
- Virology Laboratory, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil
| | - Raquel A. Moyses
- Division of Head and Neck, Department of Surgery, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Stefania Boccia
- Section of Hygiene-Institute of Public Health, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella Cadoni
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Rindi
- Institute of Anatomic Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
- Institute for Statistics, University Bremen, Bremen, Germany
| | - Franco Merletti
- Department of Medical Sciences, CeRMS and University of Turin, Turin, Italy
| | - David I. Conway
- Dental School, University of Glasgow, Glasgow, United Kingdom
| | - Sylvia Wright
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Helene Renard
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | | | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
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Chaturvedi AK, D’Souza G, Gillison ML, Katki HA. Burden of HPV-positive oropharynx cancers among ever and never smokers in the U.S. population. Oral Oncol 2016; 60:61-7. [DOI: 10.1016/j.oraloncology.2016.06.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/07/2016] [Accepted: 06/08/2016] [Indexed: 12/11/2022]
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Robbins HA, Massad LS, Pierce CB, Flowers L, Darragh TM, Minkoff H, Rahangdale L, Keller MJ, Milam J, Fischl M, Shrestha S, Colie C, Strickler H, D’Souza G. Abstract 2580: Optimizing cervical cancer screening for HIV-infected women: A risk-based approach. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Women living with HIV (WLHIV) have increased cervical cancer risk. Guidelines suggest screening WLHIV with negative cervical cytology annually, and managing WLHIV with ASC-US cytology by general population (GP) guidelines (1 year return if HPV testing unavailable).
Methods: We used risk benchmarking to compare cervical precancer risk in WLHIV to the GP. For WLHIV ages 21-65 years in the Women's Interagency HIV Study (WIHS), we evaluated the first cytology result from 2000 or later. We used parametric survival models to calculate HSIL risks after negative or ASC-US cytology, overall and by CD4 cell count. Separately, we synthesized HSIL risk estimates among GP women in 13 published studies using mixed-effects models. We then benchmarked risks in WLHIV to the 3-year GP risks, which for negative cytology represent the threshold for re-screening.
Results: Among 2,653 WLHIV, 1,982 (75%) had negative cytology and 377 (14%) had ASC-US cytology. Most WLHIV with negative (72%) and ASC-US (52%) cytology had CD4≥350 cells/μL. We observed 95 cases of HSIL (CIN2+; 44 were CIN3+ including 1 cancer) within 5 years of cytology. After negative cytology, 3-year GP risk “benchmarks” were 0.83% (CIN2+) and 0.60% (CIN3+). WLHIV with CD4≥350 met both benchmarks by 2 years (1.1% and 0.68% respectively), while WLHIV with CD4<350 exceeded the CIN2+ benchmark at only 1 year (1.1%). After ASC-US cytology, 3-year GP benchmarks were 8.7% (CIN2+) and 4.4% (CIN3+). For WLHIV with CD4≥350, 3-year risks were similar to the benchmarks (9.4% and 4.0%), but WLHIV with CD4<350 approximated these risks at only 1 year (8.8% and 3.9%).
Conclusions: For WLHIV with CD4≥350, these data suggest that the interval for re-screening after negative cervical cytology can be lengthened from 1 to 2 years, and that inclusion in GP guidelines for managing ASC-US cytology is appropriate. In contrast, WLHIV with CD4<350 remain at increased risk and should be screened annually after negative cervical cytology and referred to colposcopy after ASC-US. Cervical precancer risk after normal or ASC-US cytology in WLHIV compared to the general populationHSIL (CIN2+) risk,%HSIL (CIN2+) risk,%HSIL (CIN2+) risk,%HSIL (CIN3+) risk,%HSIL (CIN3+) risk,%HSIL (CIN3+) risk,%1 year2 years3 years1 year2 years3 yearsNEGATIVE CYTOLOGY:General population benchmark0.830.60HIV+, overall (N = 1,982)0.621.32.00.330.681.0HIV+, CD4≥350 (N = 1,393)0.471.11.70.380.680.96HIV+, CD4<350 (N = 542)1.12.02.80.240.651.1ASC-US CYTOLOGY:General population benchmark8.74.4HIV+, overall (N = 377)7.310.112.23.24.35.2HIV+, CD4≥350 (N = 191)5.57.89.42.53.34.0HIV+, CD4<350 (N = 175)8.812.815.93.95.56.8
Citation Format: Hilary A. Robbins, L. Stewart Massad, Christopher B. Pierce, Lisa Flowers, Teresa M. Darragh, Howard Minkoff, Lisa Rahangdale, Marla J. Keller, Joel Milam, Margaret Fischl, Sadeep Shrestha, Christine Colie, Howard Strickler, Gypsyamber D’Souza. Optimizing cervical cancer screening for HIV-infected women: A risk-based approach. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2580.
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Affiliation(s)
| | | | | | - Lisa Flowers
- 3Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA
| | | | | | - Lisa Rahangdale
- 6University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Joel Milam
- 8University of Southern California, Los Angeles, CA
| | | | - Sadeep Shrestha
- 10University of Alabama at Birmingham School of Public Health, Birmingham, AL
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Lam JO, Lim WY, Chow KY, D’Souza G. Incidence, Trends and Ethnic Differences of Oropharyngeal, Anal and Cervical Cancers: Singapore, 1968-2012. PLoS One 2015; 10:e0146185. [PMID: 26720001 PMCID: PMC4705110 DOI: 10.1371/journal.pone.0146185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/14/2015] [Indexed: 02/07/2023] Open
Abstract
In recent decades, several Western countries have reported an increase in oropharyngeal and anal cancers caused by human papillomavirus (HPV). Trends in HPV-associated cancers in Asia have not been as well described. We describe the epidemiology of potentially HPV-related cancers reported to the Singapore Cancer Registry from 1968-2012. Analysis included 998 oropharyngeal squamous cell carcinoma (OPSCC), 183 anal squamous cell carcinoma (ASCC) and 8,019 invasive cervical cancer (ICC) cases. Additionally, 368 anal non-squamous cell carcinoma (ANSCC) and 2,018 non-oropharyngeal head and neck carcinoma (non-OP HNC) cases were included as comparators. Age-standardized incidence rates (ASR) were determined by gender and ethnicity (Chinese, Malay and Indian). Joinpoint regression was used to evaluate annual percentage change (APC) in incidence. OPSCC incidence increased in both genders (men 1993-2012, APC = 1.9%, p<0.001; women 1968-2012, APC = 2.0%, p = 0.01) and was 5 times higher in men than women. In contrast, non-OP HNC incidence declined between 1968-2012 among men (APC = -1.6%, p<0.001) and women (APC = -0.4%, p = 0.06). ASCC and ANSCC were rare (ASR = 0.2 and 0.7 per 100,000 person-years, respectively) and did not change significantly over time except for increasing ANSCCs in men (APC = 2.8%, p<0.001). ICC was the most common HPV-associated cancer (ASR = 19.9 per 100,000 person-years) but declined significantly between 1968-2012 (APC = -2.4%). Incidence of each cancer varied across ethnicities. Similar to trends in Western countries, OPSCC incidence increased in recent years, while non-OP HNC decreased. ICC remains the most common HPV-related cancer in Singapore, but Pap screening programs have led to consistently decreasing incidence.
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Affiliation(s)
- Jennifer O. Lam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Khuan-Yew Chow
- National Registry of Diseases Office, Singapore, Singapore
| | - Gypsyamber D’Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
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Silverberg MJ, Lau B, Achenbach CJ, Jing Y, Althoff KN, D’Souza G, Engels EA, Hessol N, Brooks JT, Burchell AN, Gill MJ, Goedert JJ, Hogg R, Horberg MA, Kirk GD, Kitahata MM, Korthuis PT, Mathews WC, Mayor A, Modur SP, Napravnik S, Novak RM, Patel P, Rachlis AR, Sterling TR, Willig JH, Justice AC, Moore RD, Dubrow R. Cumulative Incidence of Cancer Among Persons With HIV in North America: A Cohort Study. Ann Intern Med 2015; 163:507-18. [PMID: 26436616 PMCID: PMC4711936 DOI: 10.7326/m14-2768] [Citation(s) in RCA: 226] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cancer is increasingly common among persons with HIV. OBJECTIVE To examine calendar trends in cumulative cancer incidence and hazard rate by HIV status. DESIGN Cohort study. SETTING North American AIDS Cohort Collaboration on Research and Design during 1996 to 2009. PARTICIPANTS 86 620 persons with HIV and 196 987 uninfected adults. MEASUREMENTS Cancer type-specific cumulative incidence by age 75 years and calendar trends in cumulative incidence and hazard rates, each by HIV status. RESULTS Cumulative incidences of cancer by age 75 years for persons with and without HIV, respectively, were as follows: Kaposi sarcoma, 4.4% and 0.01%; non-Hodgkin lymphoma, 4.5% and 0.7%; lung cancer, 3.4% and 2.8%; anal cancer, 1.5% and 0.05%; colorectal cancer, 1.0% and 1.5%; liver cancer, 1.1% and 0.4%; Hodgkin lymphoma, 0.9% and 0.09%; melanoma, 0.5% and 0.6%; and oral cavity/pharyngeal cancer, 0.8% and 0.8%. Among persons with HIV, calendar trends in cumulative incidence and hazard rate decreased for Kaposi sarcoma and non-Hodgkin lymphoma. For anal, colorectal, and liver cancer, increasing cumulative incidence, but not hazard rate trends, were due to the decreasing mortality rate trend (-9% per year), allowing greater opportunity to be diagnosed. Despite decreasing hazard rate trends for lung cancer, Hodgkin lymphoma, and melanoma, cumulative incidence trends were not seen because of the compensating effect of the declining mortality rate. LIMITATION Secular trends in screening, smoking, and viral co-infections were not evaluated. CONCLUSION Cumulative cancer incidence by age 75 years, approximating lifetime risk in persons with HIV, may have clinical utility in this population. The high cumulative incidences by age 75 years for Kaposi sarcoma, non-Hodgkin lymphoma, and lung cancer support early and sustained antiretroviral therapy and smoking cessation.
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Affiliation(s)
| | - Bryan Lau
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chad J. Achenbach
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Center for Global Health and Lurie Cancer Center, Chicago, IL, USA
| | - Yuezhou Jing
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric A. Engels
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nancy Hessol
- Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
| | - John T. Brooks
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann N. Burchell
- Ontario HIV Treatment Network and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - James J. Goedert
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser, Burnaby, Canada
| | - Michael A. Horberg
- HIV/AIDS, Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, MD, USA
| | - Gregory D. Kirk
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mari M. Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Phillip T. Korthuis
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - William C. Mathews
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Angel Mayor
- Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico
| | - Sharada P. Modur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Richard M. Novak
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Pragna Patel
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anita R. Rachlis
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | | | - James H. Willig
- Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA
| | - Amy C. Justice
- VA Connecticut Healthcare System and Yale University Schools of Medicine and Public Health, New Haven, CT, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert Dubrow
- VA Connecticut Healthcare System and Yale University Schools of Medicine and Public Health, New Haven, CT, USA
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Massad LS, Xie X, D’Souza G, Darragh TM, Minkoff H, Wright R, Colie C, Sanchez-Keeland L, Strickler HD. Incidence of cervical precancers among HIV-seropositive women. Am J Obstet Gynecol 2015; 212:606.e1-8. [PMID: 25499260 DOI: 10.1016/j.ajog.2014.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/12/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of the study was to estimate the impact of human immunodeficiency virus (HIV) infection on the incidence of high-grade cervical intraepithelial neoplasia (CIN). STUDY DESIGN HIV-seropositive and comparison seronegative women enrolled in a prospective US cohort study were followed up with semiannual Papanicolaou testing, with colposcopy for any abnormality. Histology results were retrieved to identify CIN3+ (CIN3, adenocarcinoma in situ, and cancer) and CIN2+ (CIN2 and CIN3+). Annual detection rates were calculated and risks compared using a Cox analysis. Median follow-up (interquartile range) was 11.0 (5.4-17.2) years for HIV-seronegative and 9.9 (2.5-16.0) for HIV-seropositive women. RESULTS CIN3+ was diagnosed in 139 HIV-seropositive (5%) and 19 HIV-seronegative women (2%) (P<.0001), with CIN2+ in 316 (12%) and 34 (4%) (P<.0001). The annual CIN3+ detection rate was 0.6 per 100 person-years in HIV-seropositive women and 0.2 per 100 person-years in seronegative women (P<.0001). The CIN3+ detection rate fell after the first 2 years of study, from 0.9 per 100 person-years among HIV-seropositive women to 0.4 per 100 person-years during subsequent follow-up (P<.0001). CIN2+ incidence among these women fell similarly with time, from 2.5 per 100 person-years during the first 2 years after enrollment to 0.9 per 100 person-years subsequently (P<.0001). In Cox analyses controlling for age, the hazard ratio for HIV-seropositive women with CD4 counts less than 200/cmm compared with HIV-seronegative women was 8.1 (95% confidence interval, 4.8-13.8) for CIN3+ and 9.3 (95% confidence interval, 6.3-13.7) for CIN2+ (P<.0001). CONCLUSION Although HIV-seropositive women have more CIN3+ than HIV-seronegative women, CIN3+ is uncommon and becomes even less frequent after the initiation of regular cervical screening.
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Hsu HK, Brown TT, Li X, Young S, Cranston RD, D’Souza G, Jacobson LP, Martínez-Maza O, Seaberg EC, Margolick JB, Jenkins FJ, Moran MG, Chua K, Bolan RK, Detels R, Wiley DJ. Association between free testosterone levels and anal human papillomavirus types 16/18 infections in a cohort of men who have sex with men. PLoS One 2015; 10:e0119447. [PMID: 25794147 PMCID: PMC4368778 DOI: 10.1371/journal.pone.0119447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 01/26/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) types 16 and 18 cause invasive cervical cancer and most invasive anal cancers (IACs). Overall, IAC rates are highest among men who have sex with men (MSM), especially MSM with HIV infection. Testosterone is prescribed for men showing hypogonadism and HIV-related wasting. While there are direct and indirect physiological effects of testosterone in males, its role in anal HPV16/18 infections in men is unknown. METHODS Free testosterone (FT) was measured in serum from 340 Multicenter AIDS Cohort Study (MACS) participants who were tested for anal HPV16/18-DNA approximately 36 months later. The effect of log10-transformed current FT level on anal HPV16/18 prevalence was modeled using Poisson regression with robust error variance. Multivariate models controlled for other HPV types, cumulative years of exogenous testosterone use, race, age, lifetime number of receptive anal intercourse partnerships, body mass index, tobacco smoking, HIV-infection and CD4+ T-cell counts among HIV-infected, and blood draw timing. RESULTS Participants were, on average, 60 (+5.4) years of age, White (86%), and HIV-uninfected (56%); Twenty-four percent tested positive for anal HPV16 and/or 18-DNA (HPV16 prevalence=17.1%, HPV18=9.1%). In adjusted analysis, each half-log10 increase of FT was associated with a 1.9-fold (95% Confidence Interval: 1.11, 3.24) higher HPV16/18 prevalence. Additionally, other Group 1 high-risk HPVs were associated with a 1.56-fold (1.03, 2.37) higher HPV16/18 prevalence. Traditional risk factors for HPV16/18 infection (age, tobacco smoking; lifetime number of sexual partners, including the number of receptive anal intercourse partnerships within 24 months preceding HPV testing) were poorly correlated with one another and not statistically significantly associated with higher prevalence of HPV16/18 infection in unadjusted and adjusted analyses. CONCLUSIONS Higher free testosterone was associated with increased HPV16/18 prevalence measured approximately three years later, independent of sexual behavior and other potential confounders. The mechanisms underlying this association remain unclear and warrant further study.
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Affiliation(s)
- Hilary K. Hsu
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Todd T. Brown
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Xiuhong Li
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stephen Young
- Tricore Reference Laboratories, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Ross D. Cranston
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Gypsyamber D’Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Lisa P. Jacobson
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Otoniel Martínez-Maza
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
- Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Eric C. Seaberg
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joseph B. Margolick
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Frank J. Jenkins
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Matthew G. Moran
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
- Desert AIDS Project, Palm Springs, California, United States of America
| | - Kristofer Chua
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Robert K. Bolan
- Los Angeles LGBT Center, Jeffrey Goodman Clinic, Hollywood, California, United States of America
| | - Roger Detels
- Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Dorothy J. Wiley
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
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Affiliation(s)
- Carole Fakhry
- Johns Hopkins University School of Medicine, Baltimore MD
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Mony P, Rose D, Sreedaran P, D’Souza G, Srinivasan K. Tobacco cessation outcomes in a cohort of patients attending a chest medicine outpatient clinic in Bangalore city, southern India. Indian J Med Res 2014; 139:523-30. [PMID: 24927338 PMCID: PMC4078490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND & OBJECTIVES Nicotine dependence is a widely prevalent and harmful chronic addictive disorder. Quitting tobacco use is however, uncommon in India. We present long-term treatment outcomes of out-patient, tobacco cessation treatments from a specialty clinic setting in southern India. METHODS Patients seen in a tobacco cessation clinic were characterized for tobacco use, nicotine dependence and motivation for quitting and offered pharmacologic/non-pharmacologic treatment. They were subsequently contacted telephonically at a mean (±standard deviation) of 24 (±9.1) months to assess tobacco cessation outcome defined as 'point prevalence of 1-month abstinence' by self-reporting. RESULTS The mean age of participants was 48.0 ±14.0 yr. Tobacco use distribution was: beedis only (22%), cigarettes only (49%), beedis and cigarettes (18%), chewing only (2%), and smoking and chewing (9%). Two-thirds had high level of nicotine dependence. Of the 189 patients enrolled, only 15 per cent attended follow up clinics. Only 106 (56%) patients were successfully contacted telephonically and 83 (44%) were lost to follow up. Self-reported point prevalence abstinence was 5 per cent by 'intent-to-treat' analysis and 10 per cent by 'responder' analysis. Two clinical parameters - high level of nicotine dependence [estimated by the heaviness of smoking index (HSI)] and the absence of vascular or other chronic disease were found to be associated with successful quitting; these were however, not significant on multivariate analysis. INTERPRETATION & CONCLUSIONS Our study has identified low quit-rates in a cohort of patients attending a hospital-based tobacco cessation clinic. In the absence of clear-cut predictors of cessation with low quit-rates, there should be continued efforts to improve cessation outcomes and identify predictors for action.
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Affiliation(s)
- P.K. Mony
- Division of Epidemiology, St John's Research Institute, Bangalore, India,Reprint requests: Dr Prem K. Mony, Associate Professor, Division of Epidemiology, St John's Research Institute, 100 feet road, Koramangala, Bangalore 560 034, India e-mail:
| | - D.P. Rose
- Department of Psychiatry, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India
| | - P. Sreedaran
- Department of Psychiatry, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India
| | - G. D’Souza
- Department of Chest Medicine, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India
| | - K. Srinivasan
- Department of Psychiatry, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India
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Wiley DJ, Li X, Hsu H, Seaberg EC, Cranston RD, Young S, D’Souza G, Martínez-Maza O, DeAzambuja K, Chua K, Hussain SK, Detels R. Factors affecting the prevalence of strongly and weakly carcinogenic and lower-risk human papillomaviruses in anal specimens in a cohort of men who have sex with men (MSM). PLoS One 2013; 8:e79492. [PMID: 24278140 PMCID: PMC3835810 DOI: 10.1371/journal.pone.0079492] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/22/2013] [Indexed: 02/06/2023] Open
Abstract
Background MSM are at higher risk for invasive anal cancer. Twelve human papillomaviruses (HPVs) cause cervical cancer in women (Group 1 high-risk HPVs (hrHPVs)) and 13 HPVs are probable/possible causes (Group 2 hrHPVs) of cervical malignancy. HPVs rarely associated with malignancy are classified as lower-risk HPVs (lrHPVs). Materials and Methods Dacron-swab anal-cytology specimens were collected from and data complete for 97% (1262/1296) of Multicenter AIDS Cohort Study (MACS) men tested for HPVs using the Linear Array assay. Multivariate Poisson regression analyses estimated adjusted prevalence ratios for Group 1/2 hrHPVs and lrHPVs, controlling for the effects of age, race, ethnicity, sexual partnerships, smoking; HIV-infection characteristics, treatment, and immune status among HIV-infected men. Results HIV-infected men showed 35–90% higher prevalence of Group 1/2 hrHPVs and lrHPVs than HIV-uninfected men, and higher prevalence of multi-Type, and multiple risk-group infections. CD4+ T-cell count was inversely associated with HPV Group 2 prevalence (p<0.0001). The number of receptive anal intercourse (RAI) partners reported in the 24 months preceding HPV testing predicted higher prevalence of Group 1/2 hrHPVs. Men reporting ≥30 lifetime male sex partners before their first MACS visit and men reporting ≥1 RAI partners during the 24 months before HPV testing showed 17–24% and 13–17% higher prevalence of lrHPVs (p-values ≤0.05). Men reporting smoking between MACS visit 1 and 24 months before HPV testing showed 1.2-fold higher prevalence of Group 2 hrHPVs (p = 0.03). Both complete adherence to CART (p = 0.02) and HIV load <50 copies/mL (p = 0.04) were protective for Group 1 hrHPVs among HIV-infected men. Conclusions HIV-infected men more often show multi-type and multi-group HPV infections HIV-uninfected men. Long-term mutual monogamy and smoking cessation, generally, and CART-adherence that promotes (HIV) viremia control and prevents immunosuppression, specifically among HIV-infected MSM, are important prevention strategies for HPV infections that are relevant to anal cancer.
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Affiliation(s)
- Dorothy J. Wiley
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Xiuhong Li
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hilary Hsu
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Eric C. Seaberg
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ross D. Cranston
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Stephen Young
- Tricore Diagnostic Laboratories, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Gypsyamber D’Souza
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Otoniel Martínez-Maza
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
- UCLA AIDS Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Katherine DeAzambuja
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kristofer Chua
- School of Nursing, University of California Los Angeles, Los Angeles, California, United States of America
| | - Shehnaz K. Hussain
- Jonathan and Karen Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Roger Detels
- Jonathan and Karen Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
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D’Souza G. Reply to Sourvinos et al. J Infect Dis 2010. [DOI: 10.1086/649915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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