Impact of an enhanced screening program on the detection of non-AIDS neoplasias in patients with human immunodeficiency virus infection

Abstract

Background The incidence of non-AIDS defining cancer (NADC) is higher in people living with HIV (PLWH) than in the general population, and it is already one of the leading causes of death in the HIV-infected population. It is estimated that the situation will be aggravated by the progressive aging of PLWH. Early diagnosis through intensive cancer screening may improve the ability for therapeutic interventions and could be critical in reducing mortality, but it might also increase expenditure and harms associated with adverse events. The aim of this study is to evaluate an enhanced screening program for early diagnosis of cancer in PLWH compared to standard practice. The specific objectives are (1) to compare the frequency of cancer diagnosed at an early stage, (2) to analyze safety of the enhanced program: adverse events and unnecessary interventions, (3) to analyze the cost-utility of the program, and (4) to estimate the overall and site-specific incidence of NADC in PLWH. Methods We will conduct a multicenter, non-blinded, randomized, controlled trial, comparing two parallel arms: conventional vs enhanced screening. Data will be recorded in an electronic data collection notebook. Conventional intervention group will follow the standard of care screening in the participating centers, according to the European AIDS Clinical Society recommendations, and the enhanced intervention group will follow an expanded screening aimed to early detection of lung, liver, anal, cervical, breast, prostate, colorectal, and skin cancer. The trial will be conducted within the framework of the Spanish AIDS Research Network Cohort (CoRIS). Discussion The trial will evaluate the efficacy, safety, and efficiency of an enhanced screening program for the early diagnosis of cancer in HIV patients compared to standard of care practice. The information provided will be relevant since there are currently no studies on expanded cancer screening strategies in patients with HIV, and available data estimating cost effectiveness or cost-utility of such as programs are scarce. An enhanced program for NADC screening in patients with HIV could lead to early diagnosis and improve the prognosis of these patients, with an acceptable rate of unnecessary interventions, but it is critical to demonstrate that the benefits clearly outweigh the harms, before the strategy could be implemented. Trial registration ClinicalTrials.gov NCT04735445. Registered on 25 June 2019

Cancer screening in people living with HIV

“…There is an urgent need to extend the investigation in cancer screening performance to PWH, evaluating whether personalized measures according to individual risk could result in higher efficiency and improve patient outcomes. Randomized intervention studies that assess earlier initiation, more frequent testing, and include the most recent advances in cancer screening are needed to generate high‐level evidence on cancer surveillance tailored to PWH, and to fill existing knowledge gaps 69 . Nevertheless, owing to the challenges in attaining adequate statistical power to demonstrate a reduction in mortality within in this population, alternative approaches, such as modeling studies, should also be taken into consideration for evidence generation.…”

Hematological damage and risk factors prediction in HIV-infected patients with secondary malignancies：A single-center study from China

“…These patients often have unexplained fever or abnormal CBC, while pure PLWH may also have cytopenia [13] with varying degrees. Bone marrow aspiration examination is of great value for the diagnosis of secondary malignant tumors in PLWH [14], which can be used as a quick and de nite diagnostic tool, so that malignant tumors can be diagnosed as early as possible, timely and effective intervention treatment can be obtain, and mortality can be reduced [15][16][17][18]. Therefore, to strengthen the understanding of PLWH with secondary malignant tumors, improve the diagnosis rate, to achieve the early diagnosis and screening of PLWH with secondary malignant tumors, optimize the cancer treatment and management strategy, is conducive to prolong the survival of these patients [2; 19].…”

Competing risk analysis of cardiovascular death in breast cancer: evidence from the SEER database

“…According to the published literature ( 2 ), the 5-year survival rate for BC is as high as 90% and cancer-specific mortality is steadily decreasing, but the proportion of deaths from non-cancer causes among women with BC is increasing ( 3 - 5 ). Therefore, identifying high risk factors for non-cancer deaths such as cardiovascular disease (CVD) ( 3 ), infections ( 6 ), suicide ( 7 ), and diabetes ( 8 ) has become critical for BC patients.…”