Concurrent chemoradiotherapy with 5-fluorouracil and mitomycin C for anal carcinoma: Are there differences between HIV-positive and HIV-negative patients in the era of highly active antiretroviral therapy?

PurposeTo define clinical outcome after definitive chemoradiotherapy (CRT) of anal carcinoma in HIV-infected patients treated with highly active antiretroviral therapy (HAART).Patients and MethodsA multicentric cohort comparison of 40 HIV-positive patients with HAART and 81 HIV-negative patients treated with radiotherapy (RT) or CRT was retrospectively performed. Local disease control (LC), relapse-free survival (RFS), overall survival (OS), cancer-specific survival (CSS), toxicity, and prognostic factors were investigated.ResultsHIV-positive patients were younger (mean age, 48 v 62 years; P < .0005), predominantly male (93% v 25%; P < .0005), and with early-stage (P = .06) and large-cell histology (90% v 67%; P = .005) disease. RT or CRT resulted in complete response in 92% (HIV positive) and 96% (HIV negative) of cases. Five-year OS was 61% (95% CI, 44% to 78%) in HIV-positive and 65% (95% CI, 53% to 77%) in HIV-negative patients (median follow-up, 36 months). Five-year LC was 38% (95% CI, 5% to 71%) in HIV-positive and 87% (95% CI, 79% to 95%) in HIV-negative patients (P = .008) compromising CSS and sphincter preservation. Grade 3/4 acute skin (35% v 17% [HIV negative]; P = .04) and hematologic (33% v 12% [HIV negative]; P = .08) toxicity together approximated 50% in HIV-positive patients. RFS in HIV-positive patients was associated with RT dose (P = .08) and severe acute skin toxicity (P = .04).ConclusionLong-term LC and acute toxicity represent major clinical challenges in HIV-positive patients with anal carcinoma. Even if fluoropyrimidine-based CRT is feasible and may result in similar response rates and OS as in HIV-negative patients, improved treatment strategies with better long-term outcome are warranted.

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Human Immunodeficiency Virus–Associated Squamous Cell Cancer of the Anus: Epidemiology and Outcomes in the Highly Active Antiretroviral Therapy Era

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.2810 ◽

2008 ◽

Vol 26 (3) ◽

pp. 474-479 ◽

Cited By ~ 83

Author(s):

Elizabeth Y. Chiao ◽

Thomas P. Giordano ◽

Peter Richardson ◽

Hashem B. El-Serag

Keyword(s):

Antiretroviral Therapy ◽

Hiv Infection ◽

Squamous Cell ◽

Highly Active Antiretroviral Therapy ◽

Cell Cancer ◽

Cox Proportional Hazards ◽

Administrative Databases ◽

Hiv Positive ◽

Highly Active ◽

Hiv Negative

Purpose To evaluate and determine predictors of squamous cell carcinoma of the anus (SCCA) outcomes in the highly active antiretroviral therapy (HAART) era for HIV-positive and -negative individuals using large national Veterans Affairs (VA) Administration databases. Patients and Methods We used the VA administrative databases to perform a retrospective cohort study in 1,184 veterans diagnosed with SCCA between 1998 and 2004. We calculated HIV infection rates and used logistic regression to identify epidemiologic factors that were associated with HIV infection. Kaplan-Meier curves and Cox proportional hazards models were calculated to compare survival between HIV-positive and HIV-negative veterans. Results In our cohort, 175 patients (15%) were HIV positive. The median age of the HIV-negative and -positive patients was 63 and 49 years, respectively (P < .001). Individuals with HIV were eight times more likely to be male (P = .01) and three times more likely to be African American (P < .001). There were no differences between HIV-positive and HIV-negative individuals in the receipt of treatment. The 2-year observed survival rates were 77% and 75% among HIV-positive and HIV-negative individuals, respectively. In multivariate Cox analysis, significant predictors of survival were age, sex, metastasis at diagnosis, and comorbidity score. HIV infection did not affect survival. Conclusion A noteworthy proportion of individuals with SCCA in the VA system are HIV positive. HIV-associated SCCA seems mainly to be a disease among younger men. Survival of SCCA is equivalent between HIV-positive and HIV-negative individuals in the HAART era. Treatment should not be withheld or deintensified based on HIV status.

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Highly active antiretroviral therapy increases fibrinolytic and protein activity in pregnant women

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2018.v37.181-187 ◽

2018 ◽

Vol 37 (3) ◽

pp. 181

Author(s):

Evarista Odaburhine Osime ◽

Catherine Obar

Keyword(s):

Antiretroviral Therapy ◽

Pregnant Women ◽

Highly Active Antiretroviral Therapy ◽

Protein C ◽

Protein S ◽

Enzyme Linked Immunosorbent Assay ◽

Hiv Positive ◽

Highly Active ◽

The Impact ◽

Hiv Negative

BACKGROUNDVarious studies have examined optimal methods for Prevention of Mother to Child Transmission (PMTCT) of human immunodeficiency virus (HIV) and subsequent outcome of response to highly active antiretroviral therapy (HAART) as well as the impact of pregnancy on outcomes of HIV in the Pre-HAART era. Little is known of the impact of pregnancy in response to HAART in Africa. This study is aimed to evaluate euglobulin lysis time (ELT), protein C and protein S in HIV-positive pregnant women on HAART. METHODSThis was a cross-sectional study comprised of 150 participants attending Ante-Natal Clinic (ANC) in Central Hospital, Benin City. Pregnant women on HAART (Test subjects) (n=50, mean age 34 years), 50 pregnant newly diagnosed HIV-positive women that had not yet commenced HAART (n=50, mean age 31 years) and 50 pregnant HIV-negative women (n=50, mean age 30 years) which served as controls. The ELT was determined by methods described by Bain, protein C and protein S were determined using Enzyme Linked Immunosorbent Assay (ELISA). RESULTSThere was a significant increase in ELT in both pregnant women on HAART and not on HAART) when compared to HIV-negative pregnant women (p<0.05). There was a significant decrease in protein C in test subjects when compared with controls (p<0.05) and protein S increased significantly in HIV-positive pregnant women on HAART when compared to those not on HAART and HIV-negative pregnant women (p<0.05). CONCLUSIONThere are changes in ELT, protein C and protein S parameters with the introduction of HAART in pregnancy.

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HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era

Journal of Clinical Oncology ◽

10.1200/jco.2011.41.4193 ◽

2012 ◽

Vol 30 (33) ◽

pp. 4111-4116 ◽

Cited By ~ 93

Author(s):

Silvia Montoto ◽

Kate Shaw ◽

Jessica Okosun ◽

Shreyans Gandhi ◽

Paul Fields ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hodgkin Lymphoma ◽

Highly Active Antiretroviral Therapy ◽

Prognostic Score ◽

Complete Response ◽

Hiv Positive ◽

Hiv Status ◽

Non Hodgkin Lymphoma ◽

Highly Active ◽

Hiv Negative

Purpose The prognosis of HIV-infected patients with non-Hodgkin lymphoma in the highly active antiretroviral therapy (HAART) era approaches that of the general population when they are treated with the same protocols. We analyzed the outcome of patients with Hodgkin lymphoma (HL) treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in the HAART era according to HIV serostatus to establish whether this also holds true for HL. Patients and Methods From 1997 to 2010, 224 patients newly diagnosed with HL, of whom 93 were HIV positive, were consecutively treated with ABVD chemotherapy. HIV-positive patients had more high-risk disease according to the International Prognostic Score (IPS) than HIV-negative patients (IPS ≥ 3: 68% v 26%, respectively; P < .001). Forty-seven HIV-positive patients had a CD4 count less than 200/μL, and 92 patients received HAART during chemotherapy. Results The complete response rate was 74% for HIV-positive patients and 79% for HIV-negative patients (P = not significant). After a median follow-up of 60 months (range, 8 to 174 months), 23 patients (16 HIV-negative and seven HIV-positive patients) have experienced relapse at a median time of 6 months (range, 1 to 106 months). Five-year event-free survival (EFS) was 59% (95% CI, 47% to 70%) for HIV-positive patients and 66% (95% CI, 57% to 74%) for HIV-negative patients (P = not significant). Five-year overall survival (OS) was 81% (95% CI, 69% to 89%) and 88% (95% CI, 80% to 93%) for HIV-positive and HIV-negative patients, respectively (P = not significant). HIV status did not predict OS or EFS on multivariate analysis including IPS and HIV status. Conclusion This mature study demonstrates that HIV-positive patients with HL have more extensive disease with more adverse prognostic factors than HIV-negative patients, but when treated with ABVD, HIV infection does not adversely affect OS or EFS.

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Evaluation of HIV and Highly Active Antiretroviral Therapy on the Natural History of Human Papillomavirus Infection and Cervical Cytopathologic Findings in HIV-Positive and High-Risk HIV-Negative Women

The Journal of Infectious Diseases ◽

10.1093/infdis/jit181 ◽

2013 ◽

Vol 208 (3) ◽

pp. 454-462 ◽

Cited By ~ 63

Author(s):

Sandra Blitz ◽

Joanna Baxter ◽

Janet Raboud ◽

Sharon Walmsley ◽

Anita Rachlis ◽

...

Keyword(s):

Human Papillomavirus ◽

Antiretroviral Therapy ◽

High Risk ◽

Highly Active Antiretroviral Therapy ◽

Hiv Positive ◽

Highly Active ◽

Human Papillomavirus Infection ◽

Papillomavirus Infection ◽

History Of ◽

Hiv Negative

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Long-term effect of highly active antiretroviral therapy on cervical lesions in HIV-positive women

AIDS ◽

10.1097/00002030-200309260-00021 ◽

2003 ◽

Vol 17 (14) ◽

pp. 2136-2138 ◽

Cited By ~ 16

Author(s):

Caterina Uberti-Foppa ◽

Davide Ferrari ◽

Sara Lodini ◽

Salvatore Reina ◽

Franco Ameglio ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Term Effect ◽

Hiv Positive ◽

Cervical Lesions ◽

Highly Active ◽

Hiv Positive Women ◽

Long Term Effect

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A cross-sectional study on caregivers’ perspective of the quality of life and adherence of paediatric HIV patients to Highly Active Antiretroviral Therapy

10.21203/rs.2.21579/v2 ◽

2020 ◽

Author(s):

Michael Lahai ◽

Peter Bai. James ◽

Noel N. Wannang ◽

Haja R. Wurie ◽

Sorie Conteh ◽

...

Keyword(s):

Quality Of Life ◽

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Nuclear Family ◽

Strong Association ◽

Hiv Positive ◽

Cross Sectional ◽

Highly Active ◽

Health Domains

Abstract Background: Poor compliance to highly active antiretroviral therapy (HAART) can result in the poor quality of life in children living with HIV/AIDS because of low plasma drug concentration and the possibility of drug resistance. This study evaluates the response of caregivers for determination of adherence and the four quality of life domains in children (aged 14 years and under) on HAART.Methods: We conducted a cross-sectional study of 188 children, each accompanied by their caregivers at Ola During Children's Hospital and Makeni Government Hospital between September and November 2016. Adherence to HAART and Quality of life was assessed using the WHO Quality of life summary questionnaire (WHOQOL-BREF). We obtained ethical approval from the Sierra Leone Ethics and Scientific Review Committee. Results: The study revealed 5.9% adherence amongst paediatric patients, and a strong association of adherent patients(p=0.019*) to the physical health domain (mean=64.61 SD=8.1).Caregiver HIV status showed a strong association with the physical (mean=58.3, SD=11.7 and p=0.024*), and psychological health domains (mean=68.2, SD=14.7 and p=0.001). Caregiver type (mother/father/sibling) accompanying child to hospital also showed strong associated with the physical (mean=58.0, SD=10.6, p <0.001), psychological (mean 68.2 SD=14.81 p <0.001) and environmental health domains (mean=59.7, SD=13.47, p <0.001). Further regression analysis showed a strong association with physical health domain for HIV positive caregivers (p=0.014) and adherent paediatric patients (p=0.005). Nuclear family also showed a strong association with psychological (p<0.001) and environmental (p=0.001) health domains. Conclusion: This study showed a strong association between the quality of life domains and the involvement of nuclear family caregiver, HIV-positive caregiver and adherence to HAART. Our study suggests that the involvement of any member of the nuclear family, HIV positive parents and patient adherence to therapy can improve the quality of life of paediatric HIV/AIDS patients on highly active antiretroviral therapy in the two hospitals.

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