Cancer and HIV in Latin America and the Caribbean: experience of seven sites (the Caribbean, Central and South America Network For HIV Research- CCASAnet Cohort)
V. Fink1, B. Shepherd2, F. Wehbe3, C. Cortés4, B. Crabtree5, D. Padgett6, M. Shaffaee7, M. Schechter8, E. Gotuzzo9, C. Cesar1, A. Krolewiecki1, M. Bacon10, C. Mc Gowan11, P. Cahn1, D. Masys12, IeDEA Region 2: Caribbean, Central and South America
1Fundación Huésped, Investigaciones Clínicas, Buenos Aires, Argentina, 2Vanderbilt University, Biostatistics, Nashville, United States, 3Vanderbilt University, Nashville, United States, 4Universidad de Chile- Fundación Arriarán, Santiago, Chile, 5Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico, Mexico, 6Instituto Hondureño de Seguro Social y Hospital Escuela, Tegucigalpa, Honduras, 7GHESKIO/ Weill Medical College of Cornell University, Port au Prince, Haiti, 8Universidade Federal do Rio de Janeiro, Projeto Praça Onze, Rio de Janeiro, Brazil, 9Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru, 10HJF-NIAID/DAIDS, Epidemiology, Bethesda, United States, 11University of Vanderbilt, Infectious Diseases, Nashville, United States, 12University of Vanderbilt, Biomedical Informatics, Nashville, United States
Background: CCASAnet collaboration established a region-wide registry of cancer-related information on HIV+ individuals.
Methods: Cancer cases were retrospectively identified reviewing clinical charts and preexisting databases and data entered via a secure online web interface. Cases were categorized as AIDS-defining and non-AIDS-defining cancers (ADC and NADC). Time relations between HIV diagnosis, ARV start and cancer diagnosis were established. Characteristics of ADC and NADC were compared using chi-square or Wilcoxon rank sum tests.
Results: 464 cancerous (75%ADC) and 65 pre-cancerous lesions were reported. About half of cancers were diagnosed prior to or within one year of HIV diagnosis. 66% of NADC were diagnosed >1 year after HIV diagnosis compared to 44% of ADC. ADC were more likely to occur in patients with no previous ARV. Among patients with prior exposure to ARV, time from first ARV exposure until cancer diagnosis was longer for NADC than ADC (median: 2 vs 0.58 years, p=0.007). Survival probability for ADC was lower than for NADC but risk of death did not differ among groups (p=0.64). Subanalysis of a group followed from ARV start (n=2607) showed 70/157 cancers diagnosed prior to or at ARV initiation. Incidence of ADC and NADC after ARV initiation was 6.9 per 1000 person-years (44.3 during first two months) and 2.8 per 1000 person-years. Patients initiating ARV with lower CD4 were more likely to have cancer: for a 100-cell increase in CD4 at ARV initiation, relative risk of cancer decreased 23%. (Preliminary data)
Conclusions: Our findings are consistent with previously reported cancer series in HIV setting. The high number of ADC and concomitant diagnosis with HIV or ARV start should prompt actions towards early HIV diagnosis and treatment. (Results also submitted to ICMAOI meeting 2010 (NCI/NIH), submitted to AIDS2010 as novel data on cancer and HIV in the region). (Support: NIH Cooperative agreement 1-U01-AI069923 and NCRR/NIH 1-UL1-RR024975).
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