AIDS-defining neoplasm prevalence in a cohort of HIV-infected patients, before and after highly active antiretroviral therapy.

Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, Puerto Rico, USA.
Ethnicity & disease (Impact Factor: 0.92). 01/2008; 18(2 Suppl 2):S2-189-94.
Source: PubMed

ABSTRACT Malignant disorders have been linked to the HIV epidemic from its onset. Implementation of highly active antiretroviral therapy (HAART) has resulted in a dramatic reduction in the HIV/AIDS morbidity and mortality. The present study evaluates the neoplasm prevalence before and after the implementation of HAART.
A cross-sectional study was conducted in 171 HIV-infected adults who were followed in Puerto Rico from May 1992 through December 2005. Neoplasm prevalence was measured, and the difference in AIDS- and non-AIDS-defining neoplasms was analyzed before and after the HAART era. Between-group differences were explored by using chi2, Fisher exact test, analysis of variance, and student t test.
Malignant neoplasms were detected in 171 patients (4.8%). Of these, 51.5% were AIDS-defining neoplasms, and 68% were established before HAART. AIDS-defining neoplasms accounted for 62.4% of those detected before the availability of HAART and 25.9% of those detected after HAART. Except for cervical carcinoma, the prevalence of AIDS-defining neoplasms decreased after HAART. Non-AIDS lymphomas and prostate neoplasms were more frequent after HAART.
Our study found a significant reduction of Kaposi sarcoma and AIDS-related lymphoma in the HAART era of the AIDS epidemic. A higher prevalence of non-AIDS-defining lymphomas, prostate carcinoma, and cervical carcinoma was seen in the HAART era. These findings suggest that factors other than severe immunosuppression are involved in the neoplasms' pathogenesis. Preventive strategies that include screening tests, vaccination, and lifestyle modification should be routinely applied in HIV-infected patients.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background This study provides an estimate of the proportion of HIV-positive patients in Italian clinics showing an ‘adverse prognosis’ (defined as a CD4 count ≤200 cells/L or an HIV RNA >50 HIV-1 RNA copies/mL) over time, and investigates whether this proportion varied according to patients' characteristics. Methods We estimated the annual proportion of patients with a CD4 count ≤200 cells/L or HIV RNA >50 copies/mL out of the total number of patients in the Icona Foundation cohort seen in any given year, both overall and after stratifying by demographical and treatment status groups. Generalized estimating equation models for Poisson regression were applied. Results In 1998–2008, the prevalence of patients with a CD4 count ≤200 cells/L decreased from 14 to 6% [adjusted relative risk (RR) 0.86/year; 95% confidence interval (CI) 0.84–0.88; P50 copies/mL decreased from 66 to 40% (adjusted RR 0.95/year; 95% CI 0.95–0.96; PPThere was a substantial increase in the success rate of ART in Italy in 1998–2008, resulting in a lower percentage of patients with adverse prognosis in recent years. The use of ART seemed to be the most important determinant of viral load outcome, regardless of mode of transmission. Although injecting drug users showed a less marked improvement in CD4 cell count over time than other risk groups, they showed a similar improvement in detectable viral load.
    HIV Medicine 03/2011; 12(3). DOI:10.1111/j.1468-1293.2010.00866.x · 3.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The intersection and syndemic interaction between the human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have global prevalence with devastating morbidity and massive mortality. Using FDG-PET imaging it was shown that in HIV-infected individuals, involvement of the head and neck precedes that of the chest and of the abdomen. The sequence of lymph node involvement observed suggests the existence of a diffusible activation mediator that may be targeted via therapeutic intervention strategies. Furthermore, the degree of FDG uptake proved directly related to viral load and inversely related to CD4 cell count. Available data in acquired immune deficiency syndrome (AIDS)-defining cancers further suggest that FDG-PET/CT imaging may be useful for prognostication of cervical cancer and for identifying appropriate sites for biopsy, staging, and monitoring lymphoproliferative activity owing to HIV-associated Kaposi sarcoma and multicentric Castleman disease. Inversely, in HIV-associated lymphoma, FDG uptake in HIV-involved lymphoid tissue was shown to reduce the specificity of FDG-PET imaging findings, the effect of which in clinical practice warrants further investigation. In the latter setting, knowledge of viremia appears to be essential for FDG-PET image interpretation. Early HIV-associated neurocognitive disorder, formerly known as AIDS dementia complex, proved to be characterized by striatal hypermetabolism and progressive HIV-associated neurocognitive disorder or AIDS dementia complex by a decrease in subcortical and cortical metabolism. In lipodystrophic HIV-infected individuals, lipodystrophy proved associated with increased glucose uptake by adipose tissue, likely resulting from the metabolic stress of adipose tissue in response to highly active antiretroviral therapy. Furthermore, ongoing chronic low-grade infection in arteries of HIV-infected individuals could be depicted by FDG-PET/CT imaging. And there is promising data that FDG-PET/CT in HIV may serve as a new marker for the evaluation of thymic function in HIV-infected patients. In the setting of TB, FDG-PET has proven unable to differentiate malignancy from TB in patients presenting with solitary pulmonary nodules, including those suffering from HIV, and thus cannot be used as a tool to reduce futile biopsy or thoracotomy in these patients. In patients presenting with extrapulmonary TB, FDG-PET imaging was found to be significantly more efficient when compared with CT for the identification of more sites of involvement. Thus supporting that FDG-PET/CT can demonstrate lesion extent, serve as guide for biopsy with aspiration for culture, assist surgery planning and contribute to follow-up. Limited available data suggest that quantitative FDG-PET findings may allow for prediction or rapid assessment, at 4 months following treatment instigation, of response to antituberculostatics in TB-infected HIV patients. These results and more recent findings suggest a role for FDG-PET/CT imaging in the evaluation of therapeutic response in TB patients.
    Seminars in nuclear medicine 09/2013; 43(5):349-66. DOI:10.1053/j.semnuclmed.2013.04.008 · 3.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Non-AIDS defining malignancies (NADM) are a very heterogeneous group of cancers with increasing importance in subjects with HIV infection. They develop in patients that are younger than general population and their clinical manifestations are usually atypical, with higher tumour grades, more aggressive clinical behaviour and metastatic disease. The outcome is poor, with rapid progression, a high rate of relapse, and a poor response to treatment. There are several factors that influence their development: HIV infection, chronic immunosuppression, and co-infection with some oncogenic viruses. The most frequent NADM are those associated with human papillomavirus infection, lung cancer, hepatic cancer, and Hodgkin lymphoma. Their management is based on three essential points: the treatment of the specific malignancy, the use of antiretroviral therapy, and the prophylaxis and treatment of opportunistic infections. The two factors significantly associated with prevention of NADM are a CD4+ lymphocyte count more than 500/mm3, and an undetectable viral load.
    Enfermedades Infecciosas y Microbiología Clínica 05/2013; 31(5):319–327. DOI:10.1016/j.eimc.2012.03.015 · 1.88 Impact Factor


Available from