HIV and cancer registry linkage identifies a substantial burden of cancers in persons with HIV in India.

We utilized computerized record-linkage methods to link HIV and cancer databases with limited unique identifiers in Pune, India, to determine feasibility of linkage and obtain preliminary estimates of cancer risk in persons living with HIV (PLHIV) as compared with the general population.Records of 32,575 PLHIV were linked to 31,754 Pune Cancer Registry records (1996-2008) using a probabilistic-matching algorithm. Cancer risk was estimated by calculating standardized incidence ratios (SIRs) in the early (4-27 months after HIV registration), late (28-60 months), and overall (4-60 months) incidence periods. Cancers diagnosed prior to or within 3 months of HIV registration were considered prevalent.Of 613 linked cancers to PLHIV, 188 were prevalent, 106 early incident, and 319 late incident. Incident cancers comprised 11.5% AIDS-defining cancers (ADCs), including cervical cancer and non-Hodgkin lymphoma (NHL), but not Kaposi sarcoma (KS), and 88.5% non-AIDS-defining cancers (NADCs). Risk for any incident cancer diagnosis in early, late, and combined periods was significantly elevated among PLHIV (SIRs: 5.6 [95% CI 4.6-6.8], 17.7 [95% CI 15.8-19.8], and 11.5 [95% CI 10-12.6], respectively). Cervical cancer risk was elevated in both incidence periods (SIRs: 9.6 [95% CI 4.8-17.2] and 22.6 [95% CI 14.3-33.9], respectively), while NHL risk was elevated only in the late incidence period (SIR: 18.0 [95% CI 9.8-30.20]). Risks for NADCs were dramatically elevated (SIR > 100) for eye-orbit, substantially (SIR > 20) for all-mouth, esophagus, breast, unspecified-leukemia, colon-rectum-anus, and other/unspecified cancers; moderately elevated (SIR > 10) for salivary gland, penis, nasopharynx, and brain-nervous system, and mildly elevated (SIR > 5) for stomach. Risks for 6 NADCs (small intestine, testis, lymphocytic leukemia, prostate, ovary, and melanoma) were not elevated and 5 cancers, including multiple myeloma not seen.Our study demonstrates the feasibility of using probabilistic record-linkage to study cancer/other comorbidities among PLHIV in India and provides preliminary population-based estimates of cancer risks in PLHIV in India. Our results, suggesting a potentially substantial burden and slightly different spectrum of cancers among PLHIV in India, support efforts to conduct multicenter linkage studies to obtain precise estimates and to monitor cancer risk in PLHIV in India

High Cancer Burden Among Antiretroviral Therapy Users in Malawi: a Record Linkage Study of Observational HIV Cohorts and Cancer Registry Data.

Background With antiretroviral therapy (ART), AIDS-defining cancer incidence has declined and non-AIDS defining cancers are now more frequent among HIV-infected populations in high-income countries. In sub-Saharan Africa, limited epidemiological data describe cancer burden among ART users. Methods We used probabilistic algorithms to link cases from the population-based cancer registry with electronic medical records supporting ART delivery in the Malawi's two largest HIV cohorts, Lighthouse Trust (LT; 2007-2010) and Queen Elizabeth Central Hospital (QECH; 2000-2010). Age-adjusted cancer incidence rates (IR) and 95% confidence intervals were estimated by cancer site, early versus late incidence periods (4 -24 and >24 months after ART start), and WHO stage among naïve ART initiators enrolled for at least 90 days. Results We identified 4,346 cancers among 28,576 persons. Most people initiated ART at advanced WHO stage (LT stage 3/4: 55%; QECH stage 3/4: 66%); 12% of patients had prevalent malignancies at ART initiation, which were predominantly AIDS-defining eligibility criteria for initiating ART. Kaposi sarcoma (KS) had the highest IR (634.7 per 100,000 person-years), followed by cervical cancer (36.6). KS incidence was highest during the early period 4-24 months after ART initiation. Non-AIDS defining cancers (NADC) accounted for 6% of new cancers. Conclusions Under historical ART guidelines, NADC were observed at low rates, and were eclipsed by high KS and cervical cancer burden. Cancer burden among Malawian ART users does not yet mirror high-income countries. Integrated cancer screening and management in HIV clinics, especially for KS and cervical cancer, remain important priorities in the current Malawi context

AIDS

Objective:Recommendations for the age of initiating screening for cervical cancer in women living with HIV (WLHIV) in the United States have not changed since 1995 when all women (regardless of immune status) were screened for cervical cancer from the age of onset of sexual activity, which often occurs in adolescence. By 2009, recognizing the lack of benefit as well as harms in screening young women, guidelines were revised to initiate cervical cancer screening for the general population at age 21. By comparing cervical cancer incidence in young WLHIV to that of the general population, we assessed the potential for increasing the recommended age of initiating cervical cancer screening in WLHIV.Design:We compared age-specific invasive cervical cancer (ICC) rates among WLHIV to the general population in the United States HIV/AIDS Cancer Match Study.Methods:We estimated standardized incidence ratios as the observed number of cervical cancer cases among WLHIV divided by the expected number, standardized to the general population by age, race/ethnicity, registry and calendar year.Results:ICC rates among WLHIV were elevated across all age groups between ages 25\u201354 (SIR=3.80; 95%CI 3.48, 4.15), but there were zero cases among ages <25.Conclusions:The absence of ICC among WLHIV <25 years supports initiating cervical cancer screening at age 21, rather than adolescence, to prevent cancers in WLHIV at ages with higher risk of ICC.U58 DP003931/DP/NCCDPHP CDC HHSUnited States/HHSN261201800009C/CA/NCI NIH HHSUnited States/U58 DP003875/DP/NCCDPHP CDC HHSUnited States/U62 PS003960/PS/NCHHSTP CDC HHSUnited States/HHSN261201300021C/CA/NCI NIH HHSUnited States/U01DP006302/ACL/ACL HHSUnited States/U62 PS004011/PS/NCHHSTP CDC HHSUnited States/U62 PS004001/PS/NCHHSTP CDC HHSUnited States/U01 DP006302/DP/NCCDPHP CDC HHSUnited States/UM1 CA121947/CA/NCI NIH HHSUnited States/U62 PS001005/PS/NCHHSTP CDC HHSUnited States/U01 CA121947/CA/NCI NIH HHSUnited States/HHSN261201800002C/CA/NCI NIH HHSUnited States/HHSN261201800009I/CA/NCI NIH HHSUnited States/HHSN261201800002B/CA/NCI NIH HHSUnited States/HHSN261201800007C/CA/NCI NIH HHSUnited States/2022-09-01T00:00:00Z34049357PMC83737791188

Risk of cancer in persons with AIDS in Italy, 1985–1998

Risk of cancer in persons with AID

Cancer burden among HIV-positive persons in Nigeria: preliminary findings from the Nigerian AIDS-cancer match study

Background: Although Nigeria has a large HIV epidemic, the impact of HIV on cancer in Nigerians is unknown. Methods: We conducted a registry linkage study using a probabilistic matching algorithm among a cohort of HIV positive persons registered at health facilities where the Institute of Human Virology Nigeria (IHVN) provides HIV prevention and treatment services. Their data was linked to data from 2009 to 2012 in the Abuja Cancer Registry. Match compatible files with first name, last name, sex, date of birth and unique HIV cohort identification numbers were provided by each registry and used for the linkage analysis. We describe demographic characteristics of the HIV clients and compute Standardized Incidence Ratios (SIRs) to evaluate the association of various cancers with HIV infection. Results: Between 2005 and 2012, 17,826 persons living with HIV (PLWA) were registered at IHVN. Their median age (Interquartile range (IQR)) was 33 (27–40) years; 41% (7246/17826) were men and 59% (10580/17826) were women. From 2009 to 2012, 2,029 clients with invasive cancers were registered at the Abuja Cancer Registry. The median age (IQR) of the cancer clients was 45 (35–68) years. Among PLWA, 39 cancer cases were identified, 69% (27/39) were incident cancers and 31% (12/39) were prevalent cancers. The SIR (95% CI) for the AIDS Defining Cancers were 5.7 (4.1, 7.2) and 2.0 (0.4, 3.5), for Kaposi Sarcoma and Cervical Cancer respectively. Conclusion: The risk of Kaposi Sarcoma but not Cervical Cancer or Non-Hodgkin’s Lymphoma, was significantly increased among HIV positive persons, compared to the general population in Nigeria

AIDS

Objective(s):HIV-infected people have increased cancer risk. Lymphoma survivors have an increased risk of certain second primary cancers in the general population, but second cancer risk among HIV-infected people is poorly understood. Herein, we characterized the risk of cancers following lymphoid malignancies among HIV-infected people.Design:Population-based linkage of HIV and cancer registries.Methods:We used data from the US HIV/AIDS Cancer Match Study (1996\u20132015) and evaluated the risk of first nonlymphoid malignancy in Cox regression models, with first lymphoid malignancy diagnosis as a time-dependent variable.Results:Among 531 460 HIV-infected people included in our study, 6513 first lymphoid and 18 944 first nonlymphoid malignancies were diagnosed. Risk of nonlymphoid cancer following a lymphoid malignancy was increased overall [adjusted hazard ratio (aHR) = 2.7; 95% confidence interval (CI) = 2.3\u20133.2], and specifically for cancers of the oral cavity (aHR = 2.6; 95% CI = 1.2\u20135.5), colon (2.4; 1.1\u20135.0), rectum (3.6; 1.9\u20136.7), anus (3.6; 2.5\u20135.1), liver (2.0; 1.2\u20133.5), lung (1.6; 1.1\u20132.4), vagina/vulva (6.1; 2.3\u201316.3), and central nervous system (5.0; 1.6\u201315.6), Kaposi sarcoma (4.6; 3.4\u20136.2), and myeloid malignancies (9.7; 6.1\u201315.4). After additional adjustment for prior AIDS diagnosis and time since HIV diagnosis, aHRs were attenuated overall (aHR = 1.7; 95% CI = 1.5\u20132.0) and remained significant for cancers of the rectum, anus, and vagina/vulva, Kaposi sarcoma, and myeloid malignancies.Conclusion:HIV-infected people with lymphoid malignancies have an increased risk of subsequent non-lymphoid cancers. As risks remained significant after adjustment for time since HIV diagnosis and prior AIDS diagnosis, it suggests that immunosuppression may explain some, but not all, of these risks.U58 DP003931/DP/NCCDPHP CDC HHS/United StatesU62 PS004011/PS/NCHHSTP CDC HHS/United StatesHHSN261201300019C/CA/NCI NIH HHS/United StatesU58 DP003919/DP/NCCDPHP CDC HHS/United StatesU58 DP003875/DP/NCCDPHP CDC HHS/United StatesHHSN261201300021C/CA/NCI NIH HHS/United StatesU58 DP003921/DP/NCCDPHP CDC HHS/United StatesF31 CA246855/CA/NCI NIH HHS/United StatesU62 PS001005/PS/NCHHSTP CDC HHS/United StatesU62 PS004001/PS/NCHHSTP CDC HHS/United StatesU58 DP000824/DP/NCCDPHP CDC HHS/United StatesT32 CA009314/CA/NCI NIH HHS/United StatesU58 DP003879/DP/NCCDPHP CDC HHS/United StatesU62 PS003960/PS/NCHHSTP CDC HHS/United States2021-07-01T00:00:00Z32287068PMC73820238066vault:3577

Pattern of cancer risk in persons with AIDS in Italy in the HAART era

A record-linkage study was carried out between the Italian AIDS Registry and 24 Italian cancer registries to compare cancer excess among persons with HIV/AIDS (PWHA) before and after the introduction of highly active antiretroviral therapy (HAART) in 1996. Standardised incidence ratios (SIR) were computed in 21951 AIDS cases aged 16–69 years reported between 1986 and 2005. Of 101 669 person-years available, 45 026 were after 1996. SIR for Kaposi sarcoma (KS) and non-Hodgkin lymphoma greatly decreased in 1997–2004 compared with 1986–1996, but high SIRs for KS persisted in the increasingly large fraction of PWHA who had an interval of <1 year between first HIV-positive test and AIDS diagnosis. A significant excess of liver cancer (SIR=6.4) emerged in 1997–2004, whereas the SIRs for cancer of the cervix (41.5), anus (44.0), lung (4.1), brain (3.2), skin (non-melanoma, 1.8), Hodgkin lymphoma (20.7), myeloma (3.9), and non-AIDS-defining cancers (2.2) were similarly elevated in the two periods. The excess of some potentially preventable cancers in PWHA suggests that HAART use must be accompanied by cancer-prevention strategies, notably antismoking and cervical cancer screening programmes. Improvements in the timely identification of HIV-positive individuals are also a priority in Italy to avoid the adverse consequences of delayed HAART use

Trends in the incidence of AIDS-defining and non-AIDS-defining cancers in people living with AIDS: a population-based study from Sao Paulo, Brazil

People living with AIDS are at increased risk of developing certain cancers. Since the introduction of the highly active antiretroviral therapy (HAART), the incidence of AIDS-defining cancers (ADCs) has decreased in high-income countries. The objective of this study was to analyse trends in ADCs and non-AIDS-defining cancers (NADCs) in HIV-positive people with a diagnosis of AIDS, in comparison to the general population, in Sao Paulo, Brazil. A probabilistic record linkage between the 'Population-based Cancer Registry of Sao Paulo' and the AIDS notification database (SINAN) was conducted. Cancer trends were assessed by annual per cent change (APC). In people with AIDS, 2074 cancers were diagnosed. Among men with AIDS, the most frequent cancer was Kaposi's sarcoma (469;31.1%), followed by non-Hodgkin lymphoma (NHL;304;20.1%). A decline was seen for ADCs (APC = -14.1%). All NADCs have increased (APC = -7.4%/year) significantly since the mid-2000s driven by the significant upward trends of anal (APC = -24.6%/year) and lung cancers (APC = -15.9%/year). In contrast, in men from the general population, decreasing trends were observed for these cancers. For women with AIDS, the most frequent cancer was cervical (114;20.2%), followed by NHL (96;17.0%). Significant declining trends were seen for both ADCs (APC = -15.6%/ year) and all NADCs (APC = -15.8%/ year), a comparable pattern to that found for the general female population. Trends in cancers among people with AIDS in Sao Paulo showed similar patterns to those found in developed countries. Although ADCs have significantly decreased, probably due to the introduction of HAART, NADCs in men have shown an opposite upward trend

Trends in AIDS-defining and non-AIDS-defining cancers among patients with AIDS in the city of São Paulo: 1997 - 2012

Background: People with AIDS (PWA) are at increased risk for certain types of cancer. The objective of the present study was to describe three aspects of the cancer epidemiology among PWA: time trends, risk and survival. Methods: To identify PWA who had cancer, a probabilistic record linkage between the databases “Information System on Disease Notification (SINAN)” (87,109 records) and the “Population-based Cancer Registry of São Paulo” (628,161 cancer cases) was conducted. The trend analyses were based on the annual percent change (APC) and corresponding 95% confidence intervals (95% CI). To assess the risk for cancer the standardized incidence ratio (SIR) and 95% CI were calculated. The survival analyses were conducted by means of Kaplan Meier methods and Cox models. Results: The database comprised 2,074 cancer cases, diagnosed in 2,000 PWA (seventy-four people had two primary site tumors). The majority were male (1,461; 73.0%), white (1,111; 55.6%) and aged 30-49 years old at cancer diagnosis (1,257; 62.9%). Most cancers (1,057; 51.0%) were non-AIDS defining (NADC). A statistically significant decline in the incidence of AIDS-defining cancers (ADC) was found in males and females (APCM = -14.1%/year; APCF = -15.6%/year). Conversely the incidence of NADC has increased since the mid 2000’s (APCM = 7.4%/year) among men. The risks for both ADC (SIRM = 27.74; SIRF = 8.71) and NADC (SIRM = 1.87; SIRF = 1.44) were significantly elevated. The overall five-year survival in PWA after cancer diagnosis was 49.4% (versus 72.7% in matched non-PWA). The hazard ratios were 2.93 and 2.51 for ADC and NADC, respectively. Conclusion: Cancer burden among PWA in São Paulo was similar to that described in high-income countries following the introduction of the highly active antiretroviral therapy. Despite the significant reductions in the incidence of ADC, PWA remain at higher risk of developing cancer

The risk of cancer in HIV-infected people in southeast England: a cohort study

This study used data from the Communicable Disease Surveillance Centre's national HIV database and the Thames Cancer Registry to assess the risk of cancer in HIV-infected people in southeast England. Among 26 080 HIV-infected men with 158 660 person-years follow-up, 1851 cancers, and among 7110 HIV-infected women (31 098 person-years), 171 cancers were identified. The standardised incidence ratio (SIR) for all non-AIDS-defining cancers was significantly increased in HIV-infected men (2.8, 95% confidence interval (CI) 2.6–3.1) but was nonsignificant in HIV-infected women (1.1, 95% CI 0.8–1.6). Most of the cancers observed were in men (n=1559) and women (n=127) with AIDS, and among them, the SIR for all non-AIDS-defining cancers was significantly increased in men (8.2, 95% CI 7.2–9.2) and women (2.8, 95% CI 1.6–4.6). The SIR for all non-AIDS-defining cancers was only just significantly increased in men with HIV-infection but not AIDS (1.2, 95% CI 1.0–1.5) and was nonsignificant in such women (0.8, 95% CI 0.5–1.2)