1. BACKGROUND
Cancer in Latin American and Caribbean HIV+ populations has not been studied comprehensively. CCASAnet includes sites from Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru (McGowan et al, 2008). With support from NIH and NCI, CCASAnet established a region-wide registry of cancer-related information on HIV+ individuals.
METHODS
Retrospective cancer data from HIV+ patients were collected from Cancer cases were identified by review of clinical charts and other preexisting databases. Data were recorded on a standardized case report form and digitized using a secure web interface. Cancers were categorized as AIDS-defining and non-AIDS-defining cancers (ADC and NADC). Time relations between HIV diagnosis, ARV initiation and cancer diagnosis were established. For computing cancer incidence after HAART initiation, we used data from HAART starters in the CCASAnet cohort (Tuboi et al, 2009).
RESULTS
Participating sites reported a total of 463 cancer cases.
Table 1: Distribution of different cancer types.
Cancer in HIV Patients in Latin America and the Caribbean: Characteristics in seven sites from the CCASAnet Cohort (IeDEA Region 2)
Site – Country
Type of Cancer
FH – Argentina
UFRJ – Brazil
FA – Chile
GHESKIO – Haiti*
IHSS – Honduras
INCMNSZ – Mexico
IMTAvH – Peru
Total
AIDS related cancers
Kaposi Sarcoma 81 7 71 18 5 42
242
Non Hodgkin Lymphoma 23 13 32 1 4 14 11 98
Invasive Cervical Cancer 3 8 2 17
Non AIDS related cancers
Hodgkin Lymphoma 6 16
Skin cancer
Breast 15
Anal Cancer
Cervical Carcinoma
in situ
Prostate
Lung
Other
20** 40
Valeria Fink1, Bryan Shepherd2, Firas Wehbe3, Claudia Cortés4, Brenda Crabtree5, 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 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
Acknowledgements: CCASAnet, IeDEA Region 2: Caribbean, Central and South America
Support from NIH Cooperative Agreement 1-U01-AI and 1- UL1-RR from NCRR/NIH)
* Cancer diagnosis unit in Haiti started in July Pathologic histology diagnosis and cancer treatment were not often available. Data in clinical charts were scarce.
** Includes cases reported as suspected cancer but without clear data on cancer type.
Temporal relationship between cancer diagnosis, HIV diagnosis and ARV start#
About 50% of the cancers were diagnosed prior to or within one year of HIV diagnosis.
73% of NADC and 45% of ADC were found >1 year after HIV diagnosis.
ADC occurred more commonly prior to initiation of ARV therapy.
Time from ARV start until cancer diagnosis (in patients previously exposed to ARV) was longer for NADC than ADC (median: 2.48 vs 0.5 years, p=<0.001).
Survival probability for people with ADC was lower than for those with NADC but risk of death did not differ among both groups (p=0.51).
Cancer in a group of HAART recipients#
3372 HAART recipients were included in previous studies of CCASAnet (Tuboi et al, 2009). Of these, 158 (4.7%) were diagnosed with 165 cancers during the follow-up period: 136 ADC and 29 NADC.
85 cases were diagnosed prior to or at HAART initiation (77 ADC and 8 NADC).
Incidence of cancer after HAART initiation in person-years of follow-up (median=1.9, IQR= years) was 7.3 (95%CI= ) for ADC [47.6 (95%CI= ) in the first two months] and 2.6 (95%CI= 1.7-4) for NADC.
For a 100-cell increase in CD4 at HAART initiation, relative risk of cancer decreased 31% (95%CI 13-45%).
#Haiti´s data was not included in this analysis.
CONCLUSIONS
Our findings on incidence and type of cancer in this cohort are consistent with reports from other regions, with variations among sites. Early HIV diagnosis and treatment should be improved considering the high proportion of ADC and the number of ADC and NADC concomitant with HIV diagnosis or around HAART initiation.