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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
Daksha: On Alert for High Energy Transients
We present Daksha, a proposed high energy transients mission for the study of
electromagnetic counterparts of gravitational wave sources, and gamma ray
bursts. Daksha will comprise of two satellites in low earth equatorial orbits,
on opposite sides of earth. Each satellite will carry three types of detectors
to cover the entire sky in an energy range from 1 keV to >1 MeV. Any transients
detected on-board will be announced publicly within minutes of discovery. All
photon data will be downloaded in ground station passes to obtain source
positions, spectra, and light curves. In addition, Daksha will address a wide
range of science cases including monitoring X-ray pulsars, studies of
magnetars, solar flares, searches for fast radio burst counterparts, routine
monitoring of bright persistent high energy sources, terrestrial gamma-ray
flashes, and probing primordial black hole abundances through lensing. In this
paper, we discuss the technical capabilities of Daksha, while the detailed
science case is discussed in a separate paper.Comment: 9 pages, 3 figures, 1 table. Additional information about the mission
is available at https://www.dakshasat.in
Science with the Daksha High Energy Transients Mission
We present the science case for the proposed Daksha high energy transients
mission. Daksha will comprise of two satellites covering the entire sky from
1~keV to ~MeV. The primary objectives of the mission are to discover and
characterize electromagnetic counterparts to gravitational wave source; and to
study Gamma Ray Bursts (GRBs). Daksha is a versatile all-sky monitor that can
address a wide variety of science cases. With its broadband spectral response,
high sensitivity, and continuous all-sky coverage, it will discover fainter and
rarer sources than any other existing or proposed mission. Daksha can make key
strides in GRB research with polarization studies, prompt soft spectroscopy,
and fine time-resolved spectral studies. Daksha will provide continuous
monitoring of X-ray pulsars. It will detect magnetar outbursts and high energy
counterparts to Fast Radio Bursts. Using Earth occultation to measure source
fluxes, the two satellites together will obtain daily flux measurements of
bright hard X-ray sources including active galactic nuclei, X-ray binaries, and
slow transients like Novae. Correlation studies between the two satellites can
be used to probe primordial black holes through lensing. Daksha will have a set
of detectors continuously pointing towards the Sun, providing excellent hard
X-ray monitoring data. Closer to home, the high sensitivity and time resolution
of Daksha can be leveraged for the characterization of Terrestrial Gamma-ray
Flashes.Comment: 19 pages, 7 figures. Submitted to ApJ. More details about the mission
at https://www.dakshasat.in