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Cancer Incidence following Expansion of HIV Treatment in Botswana
Background: The expansion of combination antiretroviral treatment (ART) in southern Africa has dramatically reduced mortality due to AIDS-related infections, but the impact of ART on cancer incidence in the region is unknown. We sought to describe trends in cancer incidence in Botswana during implementation of the first public ART program in Africa. Methods: We included 8479 incident cases from the Botswana National Cancer Registry during a period of significant ART expansion in Botswana, 2003–2008, when ART coverage increased from 7.3% to 82.3%. We fit Poisson models of age-adjusted cancer incidence and counts in the total population, and in an inverse probability weighted population with known HIV status, over time and estimated ART coverage. Findings: During this period 61.6% of cancers were diagnosed in HIV-infected individuals and 45.4% of all cancers in men and 36.4% of all cancers in women were attributable to HIV. Age-adjusted cancer incidence decreased in the HIV infected population by 8.3% per year (95% CI -14.1 to -2.1%). However, with a progressively larger and older HIV population the annual number of cancers diagnosed remained constant (0.0% annually, 95% CI -4.3 to +4.6%). In the overall population, incidence of Kaposi’s sarcoma decreased (4.6% annually, 95% CI -6.9 to -2.2), but incidence of non-Hodgkin lymphoma (+11.5% annually, 95% CI +6.3 to +17.0%) and HPV-associated cancers increased (+3.9% annually, 95% CI +1.4 to +6.5%). Age-adjusted cancer incidence among individuals without HIV increased 7.5% per year (95% CI +1.4 to +15.2%). Interpretation Expansion of ART in Botswana was associated with decreased age-specific cancer risk. However, an expanding and aging population contributed to continued high numbers of incident cancers in the HIV population. Increased capacity for early detection and treatment of HIV-associated cancer needs to be a new priority for programs in Africa
Seizures associated with fever and psychomotor development in primary health care in Kinshasa
peer reviewedUne étude prospective menée pendant 3 mois dans 2
centres des soins de santé primaires à Kinshasa, a permis
de décrire les caractéristiques sémiologiques des
Convulsions Fébriles (CF) présentées par 148 patients,
âgés de 5 à 71 mois. Les CF ont été décrites en fonction
de leur distribution, leur durée et leur répétition
éventuelle. Les caractères latéralisés, prolongés et
répétitifs étaient considérés comme des facteurs de
gravité. Le Quotient de Développement psychomoteur
(QDP) des patients a été évalué sur base de l’échelle de
Gensini et Gavito, reprenant les domaines de la
motricité, de la communication, et de l’adaptation.
Le QDP Ă©tait bas chez 6,7% des patients. 5% avaient un
retard dans le domaine de la motricité, 3,4% dans le
domaine de la communication, et 2,7% dans celui de
l’adaptation. Nous n’avons pas noté de lien significatif
entre le QDP global, et les facteurs de gravité des CF.
Toutefois, tous les enfants ayant un retard dans le
domaine de la motricité, avaient présenté des
convulsions répétées avant leur admission: (p=0,02
[OR=1,096 (IC 95%) : 1,060 -1,128)].
La motricité était l’élément le plus significativement
atteint chez les malades ayant présenté les CF. Cette
observation mérite d’être validée par des études castémoins,
incluant un plus grand nombre de sujets.Summary
A prospective and descriptive study including 148
children (age: 5-71 months) presenting with febrile
seizures (FS) at two Primary Health Care centres in
Kinshasa, was conducted over a period of 3 months.
Type of seizure (genaralized or focal), its duration, and
its characteristic (recurrent or not), were documented,
to assess the severity of the disorder. The Psychomotor
Development (PMD) of each patient was evaluated,
using the Gensini and Gavito scale and then the
Psychomotor Development Quotient (PDQ) calculated,
according to the motor, communication, and social
domains.
Main results were: a reduction in PDQ (6.7%), motor
delay (5%), communication delay (3.4%), and social
delay (2.7%), based on this scale. No significant link
was found between global PDQ reduction and markers
of FS severity. However, recurrent seizures seemed
strongly associated to delayed motor development
(p=0.02 [OR=1.096, CI: 1.060-1.128]).
These findings suggest that the motor domain could be
more affected in children presenting FS, especially
those with recurrent seizures. This link needs to be
clearly established through larger case-control studies
HIV prevalence and change in incidence for leading cancers.
<p>Note: IP, inverse probability; 95%CI, 95% confidence interval</p><p><sup>a</sup> Quadratic term was significant for non-Hodgkin’s lymphoma among HIV-infected individuals—4.5% (95%CI -10.1 to 23.9%) per year and -9.45% (95%CI -19.5 to -1.2%) per year<sup>2</sup>.</p><p>HIV prevalence and change in incidence for leading cancers.</p
Trends in incidence for leading cancers among HIV-infected population.
<p>Estimates from IPW population accounting for changes in overall and age-specific HIV prevalence. Shaded 95% confidence bands from 1000 bootstrap samples. Note: NHL, non-Hodgkin’s lymphoma</p
Annual number of cancer diagnoses among HIV-infected and HIV-uninfected in Botswana.
<p>Analyses used the IPW population.</p
Overall cancer age-adjusted incidence among HIV-infected (solid) and HIV-uninfected (dotted) individuals.
<p>Analyses utilized the IPW population.</p