Risk Factors for Anal Cancer in Persons Infected With HIV: A Nested Case-Control Study in the Swiss HIV Cohort Study

Bertisch, Barbara; Franceschi, Silvia; Lise, Mauro; Pl, Vernazza; Keiser, Olivia; Schöni‐Affolter, Franziska; Bouchardy, Christine; Dehler, Silvia; Levi, Fabio; Jundt, Gernot; Ess, Silvia; Pawlita, Michael; Kovari, Helen; Wandeler, Gilles; Calmy, Alexandra; Cavassini, Matthias; Stöckle, Marcel; Clifford, Gary M.

doi:10.1093/aje/kwt153

Cited by 116 publications

(127 citation statements)

References 31 publications

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“…This question requires data from large prospective studies with multiple visits, because detectable L1 antibodies are also a marker of exposure and are positively associated with HPV-related cancer [10,11,[13][14][15][16]. Indeed, in the present study, all anal cancers occurred in MSM who were HPV16-L1-seropositive post-HAART.…”

Section: Pos At Haart Initiation Pos At 24-month Follow-up Prevalencementioning

confidence: 71%

“…Antibodies against HPV E6 protein, on the other hand, have been shown to be highly specific markers for HPVrelated cancer [10][11][12][13][14][15][16]. However, although HPV16-E6 is a highly sensitive marker for oropharyngeal cancer and can be consistently detected many years before cancer diagnosis [14,16], the picture is less clear for anal and cervical cancer [11,13,15] and even less so in HIV-positive persons [10,12].…”

Section: Introductionmentioning

confidence: 99%

“…However, although HPV16-E6 is a highly sensitive marker for oropharyngeal cancer and can be consistently detected many years before cancer diagnosis [14,16], the picture is less clear for anal and cervical cancer [11,13,15] and even less so in HIV-positive persons [10,12].…”

Section: Introductionmentioning

confidence: 99%

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Human papillomavirus antibody response following HAART initiation among MSM

Combes

Clifford

Egger

et al. 2017

Aids

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Objective: To describe effects of HAART on high-risk human papillomavirus (HPV) antibody response in HIV-positive MSM and the meaning of this response for subsequent HPV-related cancer risk. Methods: For each individual, two serum samples, one at HAART initiation (pre-HAART) and another 24 months later (post-HAART), were tested for L1 antibodies to HPV6,11,16,18,31,33,35, 45, 52 and 58, as well as HPV16-E6 antibodies, using a multiplex serology assay. Identification of HPV-related cancer included data linkage with Swiss cancer registries.Results: Pre-HAART, 45.2% were seropositive for any high-risk HPV-L1 and 32.4% for HPV16-L1. Sexual intercourse during the last 6 months was the only evaluated factor associated with L1 seropositivity pre-HAART. Seropositivity increased post-HAART to 60.5% for any high-risk HPV-L1 [prevalence ratio versus pre-HAART ¼ 1.34, 95% confidence interval (CI) 1.14-1.57] and 48.0% for HPV16-L1 (prevalence ratio versus pre-HAART ¼ 1.48, 95% CI 1.20-1.83), and seroconversion was significantly associated with both lower CD4 þ cell count and CD4 þ /CD8 þ ratio (P < 0.01). Only one individual was HPV16-E6-seropositive pre-HAART, but two more seroconverted post-HAART. Anal cancer incidence among the three HPV16-E6-positives post-HAART was significantly increased compared with HPV16-E6-negatives (incidence rate ratio ¼ 63.1, 95% CI 1.1-1211).

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Section: Pos At Haart Initiation Pos At 24-month Follow-up Prevalencementioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Human papillomavirus antibody response following HAART initiation among MSM

Combes

Clifford

Egger

et al. 2017

Aids

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“…15 Likewise, in the HIV population, immunosuppression appears to influence risk of developing anal cancer over a 6-7-year period. 16 Incidence of all immune-related cancers was higher during transplant intervals. Lung cancer, melanoma, and nonepithelial skin cancer risks changed distinctly across intervals.…”

Section: Discussionmentioning

confidence: 97%

Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Nonfunction Intervals

Yanik

Clarke

Snyder

et al. 2015

JASN

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Among patients with ESRD, cancer risk is affected by kidney dysfunction and by immunosuppression after transplant. Assessing patterns across periods of dialysis and kidney transplantation may inform cancer etiology. We evaluated 202,195 kidney transplant candidates and recipients from a linkage between the Scientific Registry of Transplant Recipients and cancer registries, and compared incidence in kidney function intervals (time with a transplant) with incidence in nonfunction intervals (waitlist or time after transplant failure), adjusting for demographic factors. Incidence of infection-related and immune-related cancer was higher during kidney function intervals than during nonfunction intervals. Incidence was most elevated for Kaposi sarcoma (hazard ratio [HR], 9.1; 95% confidence interval (95% CI), 4.7 to 18), nonHodgkin's lymphoma (HR, 3.2; 95% CI, 2.8 to 3.7), Hodgkin's lymphoma (HR, 3.0; 95% CI, 1.7 to 5.3), lip cancer (HR, 3.4; 95% CI, 2.0 to 6.0), and nonepithelial skin cancers (HR, 3.8; 95% CI, 2.5 to 5.8). Conversely, ESRD-related cancer incidence was lower during kidney function intervals (kidney cancer: HR, 0.8; 95% CI, 0.7 to 0.8 and thyroid cancer: HR, 0.7; 95% CI, 0.6 to 0.8). With each successive interval, incidence changed in alternating directions for non-Hodgkin's lymphoma, melanoma, and lung, pancreatic, and nonepithelial skin cancers (higher during function intervals), and kidney and thyroid cancers (higher during nonfunction intervals). For many cancers, incidence remained higher than in the general population across all intervals. These data indicate strong short-term effects of kidney dysfunction and immunosuppression on cancer incidence in patients with ESRD, suggesting a need for persistent cancer screening and prevention.

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“…Of note, low frequency of anal cancer in comparison to high‐income settings is not expected to be due to misclassification with colorectal cancer (which were almost entirely adenocarcinoma), but may reflect differences due to younger average age and different homosexual/heterosexual transmission of HIV/HPV in sub‐Saharan Africa. Although we could not control for sexual behaviors that favor acquisition of both HIV and HPV, we expect associations to reflect an independent effect of HIV‐related immunosuppression on cancer risk, beyond that of increased HPV exposure, as has been clearly proven for both cervical,28, 29 and anal cancer,30 as measured by CD4 counts.…”

Section: Discussionmentioning

confidence: 99%

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

Mpunga

Znaor

Uwizeye³

et al. 2018

Intl Journal of Cancer

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The aim of this study was to assess the association between HIV infection and cancer risk in Rwanda approximately a decade after the introduction of antiretroviral therapy (cART). All persons seeking cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda from 2012 to 2016 were routinely screened for HIV, prior to being confirmed with or without cancer (cases and controls, respectively). Cases were coded according to ICD‐O‐3 and converted to ICD10. Associations between individual cancer types and HIV were estimated using adjusted unconditional logistic regression. 2,656 cases and 1,196 controls differed by gender (80.3% vs. 70.8% female), age (mean 45.5 vs. 37.7 years), place of residence and proportion of diagnoses made by histopathology (87.5% vs. 67.4%). After adjustment for these variables, HIV was significantly associated with Kaposi Sarcoma (n = 60; OR = 110.3, 95%CI 46.8–259.6), non‐Hodgkin lymphoma (NHL) (n = 265; OR = 2.5, 1.4–4.6), Hodgkin lymphoma (HL) (n = 76; OR = 5.2, 2.3–11.6) and cancers of the cervix (n = 560; OR = 5.9, 3.8–9.2), vulva (n = 23; OR = 17.8, 6.3–50.1), penis (n = 29; OR = 8.3, 2.5–27.4) and eye (n = 17; OR = 4.7, 1.0–25.0). Associations varied by NHL/HL subtype, with that for NHL being limited to DLBCL (n = 56; OR = 6.6, 3.1–14.1), particularly plasmablastic lymphoma (n = 6, OR = 106, 12.1–921). No significant associations were seen with other commonly diagnosed cancers, including female breast cancer (n = 559), head and neck (n = 116) and colorectal cancer (n = 106). In conclusion, in the era of cART in Rwanda, HIV is associated with increased risk of a range of infection‐related cancers, and accounts for an important fraction of cancers presenting to a referral hospital.

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Risk Factors for Anal Cancer in Persons Infected With HIV: A Nested Case-Control Study in the Swiss HIV Cohort Study

Cited by 116 publications

References 31 publications

Human papillomavirus antibody response following HAART initiation among MSM

Human papillomavirus antibody response following HAART initiation among MSM

Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Nonfunction Intervals

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

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