326. Is Antiretroviral Treatment Averting AIDS and non-AIDS Defining Malignancies in Colombia?

Abstract Background The use of effective antiretroviral therapy (ART) has shown to modify the trend of AIDS-defining malignancies (ADM) toward non-AIDS defining malignancies (NADM); however, Latin America is a region with a known late presentation of HIV/AIDS and late initiation of ART, which could not result in averting the incidence of ADM. The epidemiology of cancers that define or not AIDS in people living with HIV in Colombia is not known. Methods The purpose of our study was to identify the trend of ADM and NADM and the effect of ART in a collective cohort of 15 centers of 8 cities in Colombia. After the institutional review board approval, the study was conducted as a retrospective chart review of patients with any diagnosis of cancer presented after the diagnosis of HIV and a year before. Demographic and clinical data related to the HIV infection, ART treatment, and cancer diagnosis were analyzed with Stata 12 software, and associations between different variables were made using univariate and bivariate analyses. Results A total of 415 patients with malignancies were included since 1986 (table). Most common cancers were Kaposi sarcoma (n = 227; 54.7%), and non-Hodgkin lymphoma (n = 80, 19,3%). Median CD4+ cell count was very low in this population (median 115.5, P25-75 39.5–243) at the time of HIV diagnosis. Most common NADM were skin cancer (n = 22; 5.3%) and Hodgkin lymphoma (15; 3.6%). The ratio of ADM:NADM was 0.5 before 1995 and increased progressively up to 3.0 after 2010 (P = 0.001) (figure). By bivariate analysis, we found a correlation of ADM with older age (P < 0.001), male gender (P = 0.03), recent years (P < 0.001), lower CD4 and higher VL at the time of cancer (P < 0.0001 for both), and mortality (P = 0.027). Cancer-associated mortality was 3.9%. Conclusion The trend for diagnosis of ADM in Colombia is increasing despite antiretroviral treatment and exceeds NADM diagnosis. Potential explaining factors are the late presentation and initiation of ART, and poor treatment success in this population. Special efforts are required to diagnose and treat HIV patients in Colombia to avert this worrying trend. Disclosures All authors: No reported disclosures.

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Malignancy Trends in HIV-Infected Patients Over the Past 10 Years in a Single-Center Retrospective Observational Study in the United States

Cancer Control ◽

10.1177/1073274818797955 ◽

2018 ◽

Vol 25 (1) ◽

pp. 107327481879795 ◽

Cited By ~ 1

Author(s):

Nancy Rihana ◽

Sowmya Nanjappa ◽

Cara Sullivan ◽

Ana Paula Velez ◽

Narach Tienchai ◽

...

Keyword(s):

Breast Cancer ◽

Hodgkin Lymphoma ◽

Anal Cancer ◽

Invasive Cervical Cancer ◽

Human Herpesvirus ◽

Kaposi Sarcoma ◽

Retrospective Chart Review ◽

The United States ◽

Cancer Center ◽

Non Hodgkin Lymphoma

The introduction of antiretroviral therapy (ART) in 1995 had a dramatic impact on the morbidity and mortality of the HIV population, and subsequently, the natural history of cancer has changed. The purpose of our study was to review the prevalence of AIDS-defining malignancies and non-AIDS defining cancers (NADC), taking into consideration racial and gender variations. After the institutional review board approval, the study was conducted as a retrospective chart review of 279 HIV-infected patients who were treated at the Moffitt Cancer Center between January 1, 2000 and December 31, 2010. The demographic characteristics included gender, ethnicity, race, presence or absence of ART, and the type of malignancy reviewed. Of 233 men, 78 (33.5%) had AIDS-defining malignancies. AIDS-related non-Hodgkin lymphoma (NHL) was detected in 49 (21%) patients and Kaposi sarcoma (KS) in 29 (12%) patients. Two-thirds of male patients had NADC, with anal cancer being the most prevalent (8.5%), followed by Hodgkin lymphoma (6%). AIDS-related NHL was also the predominant malignancy for women with a prevalence of 19.5% followed by invasive cervical cancer (ICC) and breast cancer, both with a similar prevalence of 11%. Kaposi sarcoma and anal cancer were equally detected in 2% of women. The prevalence rates of AIDS-defining malignancies among those of white race were 34%, ranging from 21% for NHL to 13% for KS and 1.5% for ICC. Twenty-one (7.7%) patients had anal cancer. AIDS-defining malignancies were found in 36% of patients of black race and 60% had NHL. Non-AIDS-related NHL was the second most common malignancy, followed by breast cancer and anal cancer with a similar prevalence of 6.5%. Of 279 patients, 53% were taking ART; 39.4% were not taking ART; and in 7.5% of the patients, it was unknown if they were taking ART. In the ART era, our study found NADC to be more prevalent than AIDS-defining malignancies with 60% versus 40%, respectively. Non-Hodgkin lymphoma remained the most common AIDS-related malignancy in both genders. Among the patients with NADC, anal cancer was the predominant malignancy. The increasing incidence of some of the NADC is expected as this population is living longer with chronic exposure of viral replication of virus with oncogenic potential such as Human papillomavirus (HPV), Hepatitis B virus (HBV), Epstein-Barr virus (EBV), and Human herpesvirus 8 (HHV-8). Early ART initiation, aggressive vaccination, and judicious cancer screening are the cornerstone of cancer prevention of this growing population.

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Etiology, clinical, and epidemiological characteristics of severe respiratory infection in people living with HIV

International Journal of STD & AIDS ◽

10.1177/0956462419882587 ◽

2020 ◽

Vol 31 (2) ◽

pp. 100-108 ◽

Cited By ~ 1

Author(s):

AC Pecego ◽

RT Amâncio ◽

DM Costa ◽

FA Bozza ◽

MM Siqueira ◽

...

Keyword(s):

Respiratory Infection ◽

Acute Respiratory Infection ◽

Influenza A ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Cd4 Cell Count ◽

Risk Of Death ◽

Severe Acute Respiratory Infection ◽

Living With Hiv ◽

Epidemiological Characteristics

People living with HIV (PLWH) are more prone to severe respiratory infections. We used the severe acute respiratory infection (SARI) definition to describe the etiology, clinical, and epidemiological characteristics in this population. This was a prospective observational study including PLWH hospitalized with fever and cough. Those with symptom onset up to 10 days were classified as severe acute respiratory infection and 11–30 days as non-severe acute respiratory infection. Blood, urine samples and nasopharyngeal swabs were collected. Data were extracted from patient charts during their hospital stay. Forty-nine patients were included, median CD4 cell count: 80 cells/mm3, median time since HIV diagnosis and hospital admission: 84 months and 80% were antiretroviral therapy exposed. Twenty-seven patients were classified as SARI. Etiology was identified in 69%, 47% were polymicrobial. Respiratory virus (9 SARI vs. 13 non-SARI), bacteria (5 SARI vs. 4 non-SARI), Mycobacterium tuberculosis (6 SARI group vs. 7 non-SARI group), Pneumocystis jirovecii (4 SARI vs. 1 non-SARI), Cryptococcus neoformans (1 SARI vs. 3 non-SARI), and influenza A (1 SARI vs. 2 non-SARI). Dyspnea was statistically more prevalent in SARI (78% vs. 36%, p = 0.011) but the risk of death was higher in the non-SARI (4% vs. 36%, p = 0.0067). In the severely immunocompromised PLWH, severe acute respiratory infection can be caused by multiple pathogens and codetection is a common feature.

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Late presentation for HIV remains a major health issue in Spain: Results from a multicenter cohort study, 2004–2018

PLoS ONE ◽

10.1371/journal.pone.0249864 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249864

Author(s):

Marta Rava ◽

Lourdes Domínguez-Domínguez ◽

Otilia Bisbal ◽

Luis Fernando López-Cortés ◽

Carmen Busca ◽

...

Keyword(s):

Risk Factors ◽

Negative Impact ◽

Composite Endpoint ◽

Late Presentation ◽

Research Network ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

Increased Risk

Objectives With the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004–2018. Methods CoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality). Results 14,876 individuals were included. Overall, LP prevalence in 2004–2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08). Conclusions LP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.

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Tracking missed opportunities for an early HIV diagnosis in a population of people living with HIV with known time of infection

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054697 ◽

2021 ◽

pp. sextrans-2020-054697

Author(s):

Dimitrios Basoulis ◽

Evangelia Georgia Kostaki ◽

Dimitrios Paraskevis ◽

Angelos Hatzakis ◽

Mina Psichogiou

Keyword(s):

Late Presentation ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Missed Opportunities ◽

Delay In Diagnosis ◽

Group 4 ◽

Targeted Testing ◽

Hiv Acquisition ◽

Living With Hiv ◽

Low Coverage

PurposeThe goal of 90-90-90 first requires the expansion of access to HIV testing. Our aim was to record frequencies of HIV indicator conditions (ICs) and identify missed opportunities for an early HIV diagnosis.MethodsWe retrospectively identified ICs in a population of 231 people living with HIV with known infection dates who attended our clinic. The study population was divided into four groups: (1) those self-tested pre-emptively (47/231, 20.3%), (2) those offered targeted testing based on risk factors (67/231, 29%), (3) those tested after an IC (73/231, 31.6%) and (4) those who were not offered testing after an IC (44/231, 19%). HIV acquisition dates were estimated by molecular clock analysis.ResultsA total of 169 healthcare contacts (HCCs) were recorded. The most frequent HCC was mononucleosis-like syndrome (20.1%), unexplained weight loss (10.7%) and STIs (10.1%). AIDS-defining conditions were detected in 11.8%. Only 62.4% (73/117) of those with an IC were offered testing after their first HCC. Patients in group 4 had statistically significant delay in diagnosis compared with group 3 (109.1 weeks (IQR 56.4–238.6) vs 71.6 weeks (IQR 32.3–124.6)). The proportion of patients diagnosed as late presenters in each group was: (1) 16/47 (34%), (2) 37/67 (55.2%), (3) 43/73 (58.9%) and (4) 27/44 (61.4%) (p=0.027).ConclusionsOur study uses a combination of molecular and clinical data and shows evidence that late presentation occurs in a high proportion of patients even in the presence of an IC. Given that risk-based targeted testing has low coverage, IC-guided testing provides a reasonable alternative to facilitate earlier HIV diagnosis and to improve late diagnosis across Europe and globally.

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Perceptions dynamics about antiretroviral treatment among HIV patients in Bali

International Journal of Public Health Science (IJPHS) ◽

10.11591/ijphs.v10i3.20917 ◽

2021 ◽

Vol 10 (3) ◽

pp. 500

Author(s):

Anak Agung Sagung Sawitri ◽

I Nyoman Sutarsa ◽

Tuti Parwati Merati ◽

Made Bakta ◽

Dewa Nyoman Wirawan

Keyword(s):

Antiretroviral Treatment ◽

Continuous Process ◽

Hiv And Aids ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Chi Square ◽

Art Initiation ◽

Living With Hiv ◽

The Continuum

Perceptions of people living with HIV and AIDS (PLHIV) about antiretroviral treatment (ART) is crucial for improving adherence. This study aims to examine the dynamics of perceptions during the early phase of ART. A longitudinal study involving newly diagnosed PLHIV was conducted. Interviews were carried out at the time of HIV diagnosis and at three months after ART initiation. Data were analyzed by comparing proportion of good perception across the continuum of HIV diagnosis, ART initiation and threemonths follow-up, and were tested using Chi-square. From 170 PLHIV participated in the study, 81.76% had initiated ART and 73.4% remained on ART at three-months of follow-up. Several positive perception items were significantly decreased: ability to take ART at work and ability to continue treatment if experiencing side effects, effectiveness of ART, confidentiality, unwanted disclosure, and level of support from outreach workers. Ability to follow instruction from physician was significantly increased, and negative attitudes toward ART were decreased across the continuum. Adherence to ART is a continuous process, and is influenced by the dynamics perceptions among PLHIV. Understanding these dynamics is crucial to formulate strategies that can promote and maintain positive attitudes toward ART as well as living with HIV more broadly.

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“Is the bright red patch on the roof of my mouth related to the purple splotches on my back?”

HIV ◽

10.1093/med/9780190088316.003.0020 ◽

2020 ◽

pp. 177-188

Author(s):

Juliana Netto ◽

Monica Merçon

Keyword(s):

Herpes Virus ◽

Opportunistic Infections ◽

Adaptive Immune Response ◽

Significant Risk ◽

Kaposi Sarcoma ◽

Skin Lesions ◽

Late Presentation ◽

Hiv Diagnosis ◽

Herpès Virus ◽

Sex With Men

Kaposi’s sarcoma (KS) is an important differential diagnosis for skin lesions in individuals living with HIV/AIDS that may also present systemic manifestations. KS is the most common AIDS-associated cancer (ADC) worldwide. KS was initially described in 1981 among young men wo have sex with men in USA. Since then, we have learned that Kaposi Sarcoma Herpes Virus (KSHV), also called Human Herpes Virus 8 (HHV8) is necessary but not sufficient factor to develop KS. Replication of each virus, HIV and KSHV/HHV8, can be enhanced in the presence of the other while adaptive immune response plays an important role to control KS. KSHV/HHV8 is the causative agent of a spectrum of diseases Kaposi Sarcoma (KS), Multicenter Cattleman's Disease (MCD), Pleural Effusion Lymphoma (PEL). Late presentation to care at the time of HIV diagnosis is still a significant risk for opportunistic infections and ADCs.

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New Onset of Kaposi Sarcoma in a Human Immunodeficiency Virus-1-Infected Homosexual Man, Despite Early Antiretroviral Treatment, Sustained Viral Suppression, and Immune Restoration

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu005 ◽

2014 ◽

Vol 1 (1) ◽

Cited By ~ 4

Author(s):

Amrei von Braun ◽

Dominique L. Braun ◽

Jivko Kamarachev ◽

Huldrych F. Günthard

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Treatment ◽

Kaposi Sarcoma ◽

Immune Deficiency Syndrome ◽

Deficiency Syndrome ◽

Cd4 Cell Count ◽

Sustained Viral Suppression ◽

Immunodeficiency Virus ◽

Cd4 Cell ◽

New Onset

Abstract This is a rare case of new onset Kaposi sarcoma in a man infected with human immunodeficiency virus (HIV) and receiving antiretroviral treatment since primary HIV infection, with normal CD4+ cell count and suppressed viral load. The presentation questions the general understanding of Kaposi sarcoma as an acquired immune deficiency syndrome-defining disease occurring predominantly in severely immunocompromised patients infected with HIV.

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Differences in Virological and Immunological Risk Factors for Non-Hodgkin and Hodgkin Lymphoma

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djx249 ◽

2017 ◽

Vol 110 (6) ◽

pp. 598-607 ◽

Cited By ~ 5

Author(s):

Leah Shepherd ◽

Lene Ryom ◽

Matthew Law ◽

Camilla Ingrid Hatleberg ◽

Stephane de Wit ◽

...

Keyword(s):

Risk Factors ◽

Cell Count ◽

Hodgkin Lymphoma ◽

Incidence Rate ◽

Immune Dysfunction ◽

Study Cohort ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Increased Risk ◽

Cd4 Cell

AbstractBackgroundNon-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) are increased in populations with immune dysfunction, including people living with HIV; however, there is little evidence for to what degree immunological and virological factors differently affect NHL and HL risk.MethodsData from the Data Collection on Adverse events of Anti-HIV Drugs Study cohort were analyzed to identify independent risk factors for NHL and HL using hazard ratios (HRs), focusing on current and cumulative area under the curve (AUC) measures of immunological and virological status. Variables with different associations with NHL and HL were identified using marginal Cox models. All statistical tests were two-sided.ResultsAmong 41 420 people followed for 337 020 person-years, 392 developed NHL (incidence rate = 1.17/1000 person-years of follow-up [PYFU], 95% confidence interval [CI] = 1.06 to 1.30) and 149 developed HL (incidence rate = 0.44/1000 PYFU, 95% CI = 0.38 to 0.52). Higher risk of both NHL and HL was associated with lower current CD4 cell count (adjusted HR [aHR] of NHL for CD4 <100 vs > 599 cells/mm3 = 8.08, 95% CI = 5.63 to 11.61; HL = 4.58, 95% CI = 2.22 to 9.45), whereas higher current HIV viral load (aHR of NHL for HIV-VL >1000 vs < 50 copies/mL = 1.97, 95% CI = 1.50 to 2.59) and higher AUC of HIV-VL (aHR of NHL for highest vs lowest quintile = 2.91, 95% CI = 1.92 to 4.41) were associated with NHL only. Both current and AUC of HIV-VL were factors that had different associations with NHL and HL, where the hazard ratio for NHL was progressively higher than for HL with increasing HIV-VL category. Lower current CD4 cell count had a strong but similar association with both NHL and HL.ConclusionsCD4 depletion increased risk of both types of lymphomas while current and accumulated HIV-VL was associated with NHL only. This suggests that NHL development is related to both CD4 cell depletion and added immune dysfunction derived from ongoing HIV replication. This latter factor was not associated with HL risk.

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Association between changes in body fat distribution, biochemical profile, time of HIV diagnosis, and antiretroviral treatment in adults living with and without virus infection

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.1.67 ◽

2020 ◽

Vol 66 (1) ◽

pp. 67-73

Author(s):

Lismeia Raimundo Soares ◽

Gabriella Coelho Menezes ◽

Ana Paula Menna Barreto ◽

Mônica de Souza Lima Sant’Anna ◽

Nadir Machado Alves Cardoso ◽

...

Keyword(s):

Virus Infection ◽

Body Fat ◽

Antiretroviral Treatment ◽

Treatment Time ◽

Fat Distribution ◽

Body Fat Distribution ◽

People Living With Hiv ◽

Biochemical Profile ◽

Hiv Diagnosis ◽

Living With Hiv

SUMMARY OBJECTIVES Individuals living with HIV seem to be more prone to changes in the redistribution of body fat, characterized as lipodystrophy, which may occur in conjunction with metabolic diseases. In the present study, such impacts were assessed in adults with and without HIV and associated with the time of virus diagnosis and treatment with antiretroviral. METHODS A cross-sectional study with 123 adults, in which 87 had HIV and 36 without HIV, of both sexes, in outpatient follow-up at the Specialized Care Service (SAE) in Macaé-RJ. The following were made: 1) Alteration in body fat distribution, measured by anthropometric parameters and self-reported lipodystrophy; 2) Biochemical profile; 3) Association between HIV diagnosis time and antiretroviral treatment. RESULTS 54.47% (n = 67) males, 45.52% (n = 56) females, mean age 37 years. Of these 87 were people living with HIV, 29% (n = 25) had self-reported lipodystrophy, mean time of virus infection, and antiretroviral treatment (5.80 ± 4.56 and 5.14 ± 3.82 years), respectively. Patients with self-reported lipodystrophy had a greater change in body fat distribution between 3-6 years of HIV diagnosis and a negative cholesterol profile. The antiretroviral treatment time influenced total cholesterol and triglycerides, even for patients without self-reported lipodystrophy, with a further nine years under treatment. CONCLUSION In this study, the negative cholesterol profile was mainly related to antiretroviral treatment time, even for patients without self-reported lipodystrophy, and changes in body fat distribution, measured by anthropometry, was especially associated with time for HIV infection in those with lipodystrophy self-reported.

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Immunodeficiency and cancer in 3.7 million people living with HIV: the South African HIV Cancer Match Study

10.31219/osf.io/926a7 ◽

2020 ◽

Author(s):

Yann Ruffieux ◽

Mazvita Muchengeti ◽

Matthias Egger ◽

Orestis Efthimiou ◽

Lina Bartels ◽

...

Keyword(s):

Cell Count ◽

Kaposi Sarcoma ◽

Incidence Rates ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Non Hodgkin Lymphoma ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Living With Hiv ◽

Cd4 Cell

Background: The mechanisms linking the human immunodeficiency virus (HIV) to cancer are not fully understood. We analysed associations between immunodeficiency and the incidence of various infection-related and infection-unrelated cancers in a large cohort of people living with HIV (PLWH).Methods: We used data from the South African HIV Cancer Match (SAM) study which is the result of probabilistic record linkage between HIV laboratory measurements provided by the National Health Laboratory Services and cancer records from the National Cancer Registry in South Africa. We classified cancers based on type and related infections. For each of these cancer groups, we calculated crude incidence rates and evaluated associations between time-updated CD4 cell count and cancer incidence rates using Cox proportional hazards models. We reported the associations using adjusted hazard ratios (aHR) over a grid of CD4 values for a reference value of 200 cells/µl, and by estimating the aHR per decrease of 100 CD4 cells/µl after assuming a linear relationship between the log hazard and CD4 cell counts. Results: We analysed 3,695,723 PLWH, of which 16,274 developed cancer, for an overall crude cancer incidence rate of 169 per 100,000 person-years (py). The most common cancers were cervical cancer (4,151 cases in women, rate of 59 per 100,000 py), Kaposi Sarcoma (2,311 cases, rate of 24 per 100,000 py), and non-Hodgkin lymphoma (1,101 cases, rate of 11 per 100,000 py). There were 6,482 PLWH diagnosed with cancer not related to infection (rate of 67 per 100,000 py). The association between low CD4 cell count and higher rates of cancer was strongest in conjunctival cancer (aHR per decrease of 100 CD4 cells/µl: 1.47, 95% confidence interval [CI] 1.39-1.55), followed by Kaposi Sarcoma (aHR 1.23, 95% CI 1.20-1.26) and non-Hodgkin lymphoma (aHR 1.16, 95% CI 1.12-1.19). Among the infection-unrelated cancers, we found low CD4 cell count to be associated with higher rates of squamous cell carcinoma of the skin (aHR 1.06, 95% CI 1.02-1.11) and cancer of the oesophagus (aHR 1.06, 95 CI 1.00-1.11). We found no association between CD4 cell count and both breast and prostate cancer incidence.Conclusions: Low time-updated CD4 cell counts were associated with an increased risk of developing various infection-related cancers among PLWH. Reducing HIV-induced immunodeficiency may be a potent cancer prevention strategy among PLWH in South Africa, a region heavily burdened by cancers attributable to infections.

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