scholarly journals 328. Kaposi Sarcoma in High Population ART Utilization Setting: An Observational Study in Botswana

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S174-S175
Author(s):  
Kristen Hysell ◽  
Zola Musimar ◽  
Shekinah N C Elmore ◽  
Mukendi K A Kayembe ◽  
Gita Suneja ◽  
...  
Keyword(s):  
Cell Count ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
Kaposi Sarcoma ◽  
Cox Proportional Hazards ◽  
Recent Measurement ◽  
Surveillance Period ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Abstract Background Despite population antiretroviral treatment (ART) utilization exceeding UNAIDS 90-90-90 targets, Kaposi sarcoma (KS) remains one of the most prevalent malignancies in Botswana. We sought to examine the characteristics and outcomes of KS in the context of high ART utilization. Methods Consenting patients at one of four oncology centers for KS treatment were enrolled prospectively (October 2010 to March 2019) and followed quarterly for 5 years. Survival was estimated using Kaplan–Meier estimator and predictors assessed with Cox proportional hazards modeling. Results A total of 408 KS patients were enrolled and of those, 396 (97%) were HIV-positive and included in analyses. Median age at diagnosis was 40 years (IQR: 34.1, 46.7) and 247 patients (62%) were male. The median CD4 cell count at the time of KS diagnosis was 253 cells/mL (IQR: 134, 364) and 279 (73%) were receiving ART at the time of KS diagnosis. Among those on ART, the median duration of ART prior to KS diagnosis was 11.9 months (IQR: 2.7, 46.7). The proportion receiving ART prior to KS increased during the surveillance period from 58% to 80% (P < 0.001). Of the 248 (62.6%) patients with recent measurement, 91% had HIV-1 RNA < 1000 copies/mL. Five-year overall survival was 73% (95% CI 68–78%). In multivariable analysis, Female sex and higher income were associated with improved survival, but not age or CD4 cell count. The duration of ART was significantly associated with survival (P = 0.02), with improved survival for individuals on ART < 6 months compared with longer ART (HR 0.54; 95% CI 0.29–0.98). The incidence of KS cases declined by nearly 50%, but has remained relatively stable since 2015. Conclusion Survival rates in this cohort were comparable to other KS cohorts. While KS treatment initially declined with ART expansion, KS remains a significant disease burden in Botswana with 80% of cases occurring among individuals receiving ART. Disclosures All authors: No reported disclosures.

scholarly journals Advanced HIV Infection in Treatment Naïve Individuals: Effectiveness and Persistence of Recommended Three-Drug Regimens

2022 ◽  
Author(s):  
Karam Mounzer ◽  
Laurence Brunet ◽  
Jennifer S Fusco ◽  
Ian R Mcnicholl ◽  
Helena Diaz Cuervo ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cell Count ◽  
Viral Suppression ◽  
Proportional Hazards ◽  
Drug Regimen ◽  
Cox Proportional Hazards ◽  
Cd4 Cell Count ◽  
Significant Difference ◽  
Treatment Naïve ◽  
Cd4 Cell

Abstract Background Approximately 20% of newly diagnosed people with HIV (PWH) in the U.S. have advanced HIV infection, yet literature on current antiretroviral therapy (ART) options is limited. Discontinuation/modification and effectiveness of common regimens were compared among ART-naïve people with advanced HIV infection (CD4 cell count &lt;200 cells/μL). Methods ART-naïve adults with advanced HIV infection initiating bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or a boosted darunavir (bDRV)-, dolutegravir (DTG)- or elvitegravir/cobicistat (EVG/c)-based three-drug regimen between 1JAN2018 and 31JUL2019 in the OPERA cohort were included. The association between regimen and discontinuation or viral suppression (&lt;50 or &lt;200 copies/mL) was assessed using Cox proportional hazards models with inverse probability of treatment weights. Results Overall, 961 PWH were included (416 B/F/TAF, 106 bDRV, 271 DTG, 168 EVG/c); 70% achieved a CD4 cell count ≥200 cells/μL over a 16 months median follow-up. All regimens were associated with a statistically higher likelihood of discontinuation than B/F/TAF (bDRV aHR: 2.65 [95% CI: 1.75, 4.02], DTG: 2.42 [1.75, 3.35], EVG/c: 3.52 [95% CI: 2.44, 5.07]). Compared to B/F/TAF, bDRV initiators were statistically less likely to suppress to &lt;50 copies/mL (0.72 [0.52, 0.99]) and &lt;200 copies/mL (0.55 [0.43, 0.70]); no statistically significant difference was detected with DTG or EVG/c. Conclusions Among people with advanced HIV infection, those initiating B/F/TAF were less likely to discontinue/modify their regimen than those on any other regimen, and more likely to achieve viral suppression compared to those on bDRV but not compared to those on other integrase inhibitors.

scholarly journals Quest for Universal Health Coverage for Pediatric Acute Lymphoblastic Leukemia in Mexico

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 17-17
Author(s):  
Paloma Muñoz-Aguirre ◽  
Rodrigo Huerta ◽  
Martin Lajous
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Hospital Volume ◽  
Proportional Hazards ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
High Volume ◽  
Cox Proportional Hazards ◽  
Health Coverage ◽  
Seguro Popular

PURPOSE Until 2005, most Mexican children did not have coverage for cancer treatment. In that year, Seguro Popular began funding the treatment of children with acute lymphoblastic leukemia (ALL). We aimed to estimate 5-year survival in children with ALL. We also sought to evaluate the relationship of hospital volume, out-of-state treatment, and treatment administered by an adult hematologist to 5-year survival. METHODS We categorized patients according to risk (National Cancer Institute age criteria), hospital volume, out-of-state treatment, and treatment administered by an adult hematologist. We obtained overall 5-year survival using the Kaplan-Meier method and compared survival among groups. We used Cox proportional hazards regression analysis to conduct multivariable analysis and obtained hazard ratios (HRs) and 95% CI. RESULTS Between 2005 and 2015, 9,555 children were treated for ALL under Seguro Popular. Mean age (± standard deviation) was 7.4 (4.7) years. Five-year overall survival was 61% (95% CI, 60% to 62%); survival for high-risk patients was 51% (95% CI, 49% to 52%) and 66% (95% CI, 65% to 67%) for those with standard risk. We observed state heterogeneity (Sinaloa: 75% [95% CI, 69% to 80%] v Campeche: 45% [95% CI, 54% to 62%]). Patients who were treated in low-volume hospitals had lower survival rates compared with those treated in medium- and high-volume hospitals (HR v low, 1.17 [95% CI, 1.08 to 1.26]). Patients treated outside of their residence state had 10% lower mortality compared with those treated in their home state (HR, 0.89 [95% CI, 0.82 to 0.99]). The hazard of death among children who were treated by an adult hematologist was 1.93 times (95% CI, 1.44 times to 2.57 times) higher than the hazard of death among those treated by a pediatric oncologist/hematologist (26% [95% CI, 16% to 37%] v 61% [95% CI, 60% to 62%]). CONCLUSION Our results highlight the disparities in survival for ALL in Mexico. Health reform must consider increasing the patient volume required for hospital accreditation and mandating treatment by pediatric oncologists/hematologists.

scholarly journals Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal

2019 ◽  
Vol 4 (3) ◽  
pp. e001319 ◽  
Author(s):  
Dharma N Bhatta ◽  
Ruchi Adhikari ◽  
Sushil Karki ◽  
Arun K Koirala ◽  
Sharada P Wasti
Keyword(s):  
Antiretroviral Therapy ◽  
Life Expectancy ◽  
Cell Count ◽  
Clinical Stage ◽  
Survival Rates ◽  
Study Cohort ◽  
Cd4 Cell Count ◽  
Infected People ◽  
Cell Counts ◽  
Cd4 Cell

IntroductionThe advent of antiretroviral therapy (ART) has dramatically slowed down the progression of HIV. This study assesses the disparities in survival, life expectancy and determinants of survival among HIV-infected people receiving ART.MethodsUsing data from one of Nepal’s largest population-based retrospective cohort studies (in Kathmandu, Nepal), we followed a total of 3191 HIV-infected people aged 15 years and older who received ART over the period of 2004–2015. We created abridged life tables with age-specific survival rates and life expectancy, stratified by sex, ethnicity, CD4 cell counts and the WHO-classified clinical stage at initiation of ART.ResultsHIV-infected people who initiated ART with a CD4 cell count of >200 cells/cm3 at 15 years had 27.4 (22.3 to 32.6) years of additional life. People at WHO-classified clinical stage I and 15 years of age who initiated ART had 23.1 (16.6 to 29.7) years of additional life. Life expectancy increased alongside the CD4 cell count and decreased as clinical stages progressed upward. The study cohort contributed 8484.8 person years, with an overall survival rate of 3.3 per 100 person years (95% CI 3.0 to 3.7).ConclusionsThere are disparities in survival among HIV-infected people in Nepal. The survival payback of ART is proven; however, late diagnosis or the health system as a whole will affect the control and treatment of the illness. This study offers evidence of the benefits of enrolling early in care in general and ART in particular.

scholarly journals Low CD4/CD8 ratio predicts cancer risk among adults with HIV

2021 ◽  
Author(s):  
Jessica L. Castilho ◽  
Aihua Bian ◽  
Cathy A. Jenkins ◽  
Bryan E. Shepherd ◽  
Keith Sigel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Risk ◽  
Cell Count ◽  
Anal Cancer ◽  
Kaposi Sarcoma ◽  
Cd4 Cell Count ◽  
Non Hodgkin Lymphoma ◽  
Increased Risk ◽  
The Usa ◽  
Cd4 Cell

Background: Independent of CD4 cell count, low CD4/CD8 ratio in people with HIV (PWH) is associated with deleterious immune senescence, activation, and inflammation, which may contribute to carcinogenesis and excess cancer risk. We examined whether low CD4/CD8 ratios predicted cancer among PWH in the USA and Canada. Methods: We examined all cancer-free PWH with one or more CD4/CD8 values from NA-ACCORD observational cohorts with validated cancer diagnoses between 1998-2016. We evaluated the association between time-lagged CD4/CD8 ratio and risk of specific cancers in multivariable, time-updated Cox proportional hazard models using restricted cubic spines. Models were adjusted for age, sex, race/ethnicity, hepatitis C virus, and time-updated CD4 cell count, HIV RNA, and history of AIDS-defining illness. Results: Among 83,893 PWH, there were 5,628 incident cancers, including lung cancer (n=755), Kaposi sarcoma (KS, n=501), non-Hodgkin lymphoma (NHL, n=497), and anal cancer (n=439). Median age at cohort entry was 43 years, 87% were male, and 43% were white. Overall median six-month lagged CD4/CD8 ratio was 0.52 (interquartile range: 0.30-0.82). Compared with six-month lagged CD4/CD8=0.80, CD4/CD8=0.30 was associated with increased risk of any incident cancer (adjusted hazard ratio = 1.24 [95% confidence interval: 1.14-1.35]). CD4/CD8 ratio was also inversely associated with NHL, KS, lung cancer, anal cancer, and colorectal cancer in adjusted analyses (all p<0.05). Results were similar using 12-, 18-, and 24-month lagged CD4/CD8 values. Conclusions: Low CD4/CD8 ratio up to 24 months prior to cancer diagnosis was independently associated with increased cancer risk in PWH and may serve as a clinical biomarker.

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

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.

Epidemiology and treatment of high-grade gastrointestinal neuroendocrine tumors (HG-GI-NETs).

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 421-421
Author(s):  
Olatunji B. Alese ◽  
Renjian Jiang ◽  
Walid Labib Shaib ◽  
Christina Sing-Ying Wu ◽  
Mehmet Akce ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Proportional Hazards ◽  
Management Strategies ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
High Volume ◽  
Cox Proportional Hazards ◽  
High Grade ◽  
Short Treatment ◽  
Academic Center

421 Background: High grade neuroendocrine tumors of the gastrointestinal tract are rare tumors. Management strategies are modeled after small cell lung cancer (SCLC). Treatment patterns and outcomes have not been studied. Methods: Data were obtained from all US hospitals that contributed to the National Cancer Database (NCDB) between 2004 and 2013. Univariate and multivariate testing was done to identify factors associated with patient outcome. Kaplan-Meier analysis and Cox proportional hazards models were used to assess the association between patient characteristics and survival. Results: A total of 1,861 patients were identified for the 10 years of the study. The mean age was 63 years (SD±13), with a male preponderance (53.3%). The vast majority of patients (78.1%) were non-Hispanic Whites. The most common primary sites were pancreas (PNET = 19.4%), large intestine (18.1%), esophagus (17.8%) and rectum (15.5%). About 27.9% of the cases were resectable at the time of diagnosis, and distribution across stages 1-IV was 6.6%, 10.5%, 18% and 64.6% consecutively. Liver was a common site of metastases (50.4%), followed by bone (11.3%) and lungs (10.8%). Only 3.5% of the patients had brain metastases. On univariable analysis, age < 65years (HR 0.72; 0.66-0.8; p < 0.001) and treatment at an academic center (HR 0.88; 0.79-0.99; p < 0.034) were associated with improved survival. Multivariable analysis confirmed prognostic advantage of treatment at an academic center. Patients treated with chemotherapy had a median overall survival (OS) of 11.2 months, compared with 1.7 months for those who did not. The median OS for high grade PNET was 6 months, compared to 9.9 months for other HG-GI-NETs. One year and 5-year survival rates were 27.5% vs. 41% and 4.5% vs. 12.3% respectively. Conclusions: This is the largest series of HG-GI-NET. Almost two-thirds of the cases present with metastatic disease. Pattern of metastasis differs from SCLC. Survival is short. Treatment at high volume academic center, younger age and use of chemotherapy are associated with improved survival.

Kaposi sarcoma among adults enrolling for HIV care in a large HIV clinic in Nigeria: 2006-2017.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18539-e18539
Author(s):  
Maxwell Oluwole Akanbi ◽  
Lucy Bilaver ◽  
Chad Achenbach ◽  
Lisa Hirschhorn ◽  
Oche Agbaji ◽  
...  
Keyword(s):  
Cell Count ◽  
Kaposi Sarcoma ◽  
Hiv Care ◽  
Trend Test ◽  
Hiv Diagnosis ◽  
Cd4 Cell Count ◽  
Logistic Regression Models ◽  
Institutional Review ◽  
Cd4 Cell ◽  
The Impact

e18539 Background: Expanded access to antiretroviral therapy (ART) has led to a dramatic decline in Kaposi sarcoma (KS) among people initiating HIV care globally. In Nigeria, the country with the second-largest global HIV population, ART coverage increased from 11% in 2006 to 57% by 2017. The impact of Nigeria’s ART expansion of KS risk is unclear. We examined trends in KS risk among patients enrolled for HIV care in a large clinic in Nigeria from 2006-2017. Methods: We analyzed data of 16,431 adults (age ≥18 years) enrolled for HIV care from January 1, 2006, to December 31, 2017, in a large clinic in Jos, Nigeria. KS at enrollment was defined as KS recorded in the electronic health record within 30 days of clinic enrollment. Time trends were compared among three periods: 2006-2009, 2010-2013, and 2014-2017 (Mean national ART coverage 16%, 33%, and 50% respectively), using the Chi-test trend test and logistic regression models to identify factors independently associated with KS. The study was approved by the local institutional Institutional Review Board (IRB) and ruled exempt by the IRBs of Northwestern University and Harvard School of Public Health. Results: The study population had a mean age 35.1 (standard deviation, SD 9.5) years, and were 65.7% female (n= 10,788). The median first CD4 cell count was 192 (IQR 84-320), 215 (IQR 98-344), and 222 (IQR 94-353) in 2006-2009, 2010-2013, and 2014-2017, respectively. The overall KS prevalence at entry was 0.59 % (95% CI 0.48-0.72). KS prevalence was lowest for patient entering care during 2006-2009 (0.39%, 95% CI 0.29-0.53), increased to 1.12% (95% CI 0.82-1.52) in 2010-2013 and declined to 0.72% (95% CI 0.42-1.20) from 2014-2017 (Chi2 for trend, 12.14, p<0.01). Adjusting for age, sex, and CD4 T-cell count KS prevalence was significantly higher in 2010-2013 compared to 2006-2009 (Table). Conclusions: Despite ART expansion, KS at enrollment showed no significant decline. The low CD4+ cell count, across all periods, indicates delay in enrollment for HIV care, which increases KS risk. Interventions aimed at early HIV diagnosis and linkage to ART are critical to KS risk reduction in this population. Factors associated with Kaposi sarcoma at HIV care enrollment in Jos, Nigeria (2006-2017).[Table: see text]

scholarly journals The Role of Aerosol Pentamidine Prophylaxis

1993 ◽  
Vol 4 (2) ◽  
pp. 67-69
Author(s):  
E L C Ong
Keyword(s):  
Cell Count ◽  
Pneumocystis Carinii Pneumonia ◽  
Lymphocyte Count ◽  
Pneumocystis Carinii ◽  
Total Lymphocyte Count ◽  
First Episode ◽  
Cd4 Cell Count ◽  
Drug Of Choice ◽  
Cd4 Cell

Pneumocystis carinii pneumonia (PCP) is the most frequent opportunistic infection in patients with AIDS, occurring in 80% and recurring in 50% of patients within 12 months of the first episode. Prophylaxis for PCP is recommended if the CD4+ cell count is <200×106/l or 20% of the total lymphocyte count, or after an episode of PCP. The most effective prophylactic agent currently is trimethoprim-sulphamethoxazole and should be the drug of choice but alternatives such as aerosol pentamidine are being increasingly used for patients who cannot tolerate this combination or other oral preparations. If aerosol pentamidine is used and administered via a Respigard II Marquest nebulizer, the dosage should be higher than the currently recommended monthly dosage of 300 mg.

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