Retrospective cohort study of cancer incidence and mortality by HIV status in a Georgia, USA, prisoner cohort during the HAART era

OBJECTIVE:

Non-AIDS-defining cancers (NADCs) have emerged as significant contributors to cancer mortality and morbidity among persons living with HIV (PLWH). Because NADCs are also associated with many social and behavioural risk factors that underlie HIV, determining the extent to which each of these factors contributes to NADC risk is difficult. We examined cancer incidence and mortality among persons with a history of incarceration, because distributions of other cancer risk factors are likely similar between prisoners living with HIV and non-infected prisoners.

DESIGN:

Registry-based retrospective cohort study.

PARTICIPANTS:

Cohort of 22 422 persons incarcerated in Georgia, USA, prisons on 30 June 1991, and still alive in 1998.

OUTCOME MEASURES:

Cancer incidence and mortality were assessed between 1998 and 2009, using cancer and death registry data matched to prison administrative records. Age, race and sex-adjusted standardised mortality and incidence ratios, relative to the general population, were calculated for AIDS-defining cancers, viral-associated NADCs and non-infection-associated NADCs, stratified by HIV status.

RESULTS:

There were no significant differences in cancer mortality relative to the general population in the cohort, regardless of HIV status. In contrast, cancer incidence was elevated among the PLWH. Furthermore, incidence of viral-associated NADCs was significantly higher among PLWH versus those without HIV infection (standardised incidence ratio=6.1, 95% CI 3.0 to 11.7, p<0.001).

CONCLUSIONS:

Among PLWH with a history of incarceration, cancer incidence was elevated relative to the general population, likely related to increased prevalence of oncogenic viral co-infections. Cancer prevention and screening programmes within prisons may help to reduce the cancer burden in this high-risk population.

Full article at:   http://goo.gl/bU7ddc

By:  Zlotorzynska M1, Spaulding AC1, Messina LC1, Coker D1, Ward K1, Easley K1, Baillargeon J2, Mink PJ3, Simard EP1.

• 1Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
• 2University of Texas Medical Branch, Galveston, Texas, USA.
• 3Rollins School of Public Health, Emory University, Atlanta, Georgia, USA Division of Applied Research, Allina Health, Minneapolis, Minnesota, USA.
• BMJ Open. 2016 Apr 11;6(4):e009778. doi: 10.1136/bmjopen-2015-009778. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Incidence of Potentially HPV-Related Neoplasms in the United States, 1978–2007

Population-based studies comprehensively describing incidence patterns of human papillomavirus (HPV)-related preinvasive and invasive neoplasms prior to widespread HPV vaccination are sparse.

We calculated age-adjusted incidence rates (IRs), IR ratios (IRRs), and annual percent changes (APC) in IRs for potentially HPV-related tumors diagnosed in the Surveillance, Epidemiology and End Results Program during 1978–2007.

Overall IRs for preinvasive tumors were significantly higher than for invasive squamous cell tumors of cervix (IRR=3.42), vulva (IRR=1.87), and vagina (IRR=1.19) and significantly lower for adenomatous cervical tumors (IRR=0.43), and squamous cell tumors of penis (IRR=0.64), anus (males, IRR=0.53; females, IRR=0.14), and head and neck (H&N) (males, IRR=0.01; females, IRR=0.02). Incidence of preinvasive squamous tumors of cervix, vagina, and penis rose rapidly over time and decreased for invasive neoplasms. The most rapid increases occurred for preinvasive (males, APC=16.0; females, APC=7.3) and invasive anal tumors (males, APC=3.6; females, APC=2.3). IR patterns were generally similar among evaluable racial/ethnic groups, with the exception of H&N invasive tumor IRs which increased exclusively among white males.

Contrary to the opposing trends of preinvasive and invasive squamous tumors of cervix, vagina, and penis, preinvasive and invasive anal tumor IRs increased significantly over time by gender, age, and racial/ethnic groups. 

Successful HPV vaccination programs are needed to measurably reduce incidence of HPV-related neoplasms in the future, particularly for cancer sites with rising incidence rates for which effective screening modalities are limited.

Read more at:  http://ht.ly/SqNfp

By: George Kurdgelashvili, MD,1,2,* Graça M. Dores, MD, MPH,1,3 Samer A. Srour, MD,1,2 Anil K. Chaturvedi, PhD,3 Mark M. Huycke, MD,1,2 and Susan S. Devesa, PhD3

²University of Oklahoma Health Sciences Center, Oklahoma City, OK

³

1Department of Veterans Affairs Medical Center, Oklahoma City, OK

2University of Oklahoma Health Sciences Center, Oklahoma City, OK

3Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD

1Department of Veterans Affairs Medical Center, Oklahoma City, OK

Cancer Incidence following Expansion of HIV Treatment in Botswana

Below:  Overall cancer age-adjusted incidence among HIV-infected (solid) and HIV-uninfected (dotted) individuals.

Analyses utilized the IPW population.

Below:  Annual number of cancer diagnoses among HIV-infected and HIV-uninfected in Botswana

Below:  Trend in standardized incidence ratio (SIR) of cancer comparing HIV infected and HIV uninfected populations during ART expansion

Below:  Trends in incidence for leading cancers among HIV-infected population.

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

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%).

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.

Read more at:   http://goo.gl/oKyRyJ HT @BrighamWomens