1. AIDS-Defining cancers (n=331) Non-AIDS-Defining cancers (n=75)
Cancer and HIV in Latin America and the Caribbean: experience of seven sites in CCASAnet
BACKGROUND
The CCASAnet collaboration established a region-wide registry of cancer-related information on HIV-positive 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 dates of HIV diagnosis, HAART start and cancer diagnosis were established. Characteristics of ADC and NADC were compared using chi-square or Wilcoxon rank sum tests.
RESULTS
Data have been updated since abstract presentation. 463 cancer cases were reported: 357 ADC (242 Kaposi´s sarcoma and 98 Non-Hodgkin lymphoma). Most common NADC were Hodgkin lymphoma, skin and breast (50% from Haiti) cancer. The characteristics of patients diagnosed with cancer are shown in Table 1. Year of cancer diagnosis and time relationships between dates of cancer diagnosis, HIV diagnosis and HAART start are presented in Figure 1.
Table 1: Characteristics of cancer cases*
Overall (n=406) #
AIDS-Defining cancers (n=331)
Non-AIDS-Defining cancers (n=75)
p-value
Male at birth
350 (86%)
299 (90%)
51 (68%)
<0.001
Age at cancer diagnosis [Median (IQR)]
37 (31, 44)
36 (31, 43)
41 (35, 50)
Probable Transmission Route
0.88
Sexual
370 (91%)
302 (91%)
68 (91%)
Intravenous Drug Users
8 (2%)
6 (2%)
2 (3%)
Other
2 (0%)
2 (1%)
0 (0%)
Unknown
26 (6%)
21 (6%)
5 (7%)
Valeria Fink1, Bryan Shepherd2, Firas Wehbe3, Claudia Cortés4, Brenda Crabtree- Ramírez5, Denis Padgett6, Maryam Shafaee7, Mauro Schechter8, Eduardo Gotuzzo9, Carina Cesar1, Alejandro Krolewiecki1, Melanie Bacon10, Catherine McGowan11, Pedro Cahn1, Daniel Masys12
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 Zubirán, 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
11Vanderbilt University, Infectious Diseases, Nashville, United States
12Vanderbilt University, Biomedical Informatics, Nashville, United States
Acknowledgements: CCASAnet, IeDEA Region 2: Caribbean, Central and South America
Funding for this work was provided by US NIAID (U01-AI069923)
* Cases from the same individual were considered independently.
# Haiti´s data are not included in this analysis. Cancer diagnosis unit in Haiti started in July 2008, and prior to this, histologic diagnosis and cancer treatment often were not available. Data in clinical charts were scarce.
Figure 1: Temporal relationships between cancer diagnosis, HIV diagnosis and HAART start
C. Time between HAART start
and cancer diagnosis*
A. Calendar year of cancer diagnosis*
B. Time between HIV and cancer diagnosis*
￭ ALL CANCERS (n=406) ￭ AIDS-DEFINING CANCERS (n=331) ￭ NON-AIDS-DEFINING CANCERS (n=75)
* Statistically significant differences were found between ADC and NADC for calendar year of cancer diagnosis, time between HIV and cancer diagnosis, and HAART start and cancer diagnosis (p<0.001)
Survival probability for ADC was lower than for NADC.
A subanalysis of 3372 subjects followed from HAART start (Tuboi S, 2009, Cesar C, 2010) identified 165 cancers. Eighty-five cases were diagnosed prior to HAART start. Incidence of cancers after HAART start in 8080 person-years of follow-up (median=1.9, IQR=1-3.2 years) is shown in Table 2.
Although patients starting HAART with lower CD4 lymphocyte count (CD4) were more likely to have cancer, no statistically significant association was found between CD4 and incidence of cancer after 2 months of HAART. Subjects with cancer diagnosed prior to or at HAART start were more likely to die (p <0.0001). A pre-HAART AIDS-defining cancer was a strong predictor of mortality after adjusting for age, sex, and CD4 at HAART initiation [HR: 0.51 (0.43, 0.6)].
Table 2: Incidence of cancer after HAART initiation in a cohort of HAART starters per 1000 person- years
Time from HAART start
< 2 months*
2-12 months
> 12 months
Overall
ALL CANCERS
55.3 ( )
12.4 ( )
4.2 ( )
9.9 ( )
AIDS-
DEFINING CANCERS
All
45.7 ( )
9.8 ( )
2.1 ( )
7.2 ( )
Kaposi´s sarcoma
34.3 ( )
4.7 ( )
1.3 ( )
4.5 ( )
Non-Hodgkin lymphoma
11.4 ( )
5.1 (2.9-9)
0.4 ( )
2.5 ( )
NON-AIDS-DEFINING CANCERS
All
9.5 (4-22.9)
2.6 ( )
2.1 ( )
2.7 ( )
*Incidence (95%CI)
CONCLUSION
Our findings are consistent with previously reported cancer series in the setting of HIV infection. The numerous ADC occurring at the time of HIV diagnosis or at HAART start should prompt actions towards early HIV diagnosis and treatment.