Spectrum of AIDS-associated malignant disorders

Goedert, James J.; Coté, Timothy R.; Virgo, Phillip; Scoppa, Steven M.; Kingma, Douglas W.; Gail, Mitchell H.; Jaffe, Elaine S.; Biggar, Robert J.

doi:10.1016/s0140-6736(97)09028-4

Cited by 662 publications

(457 citation statements)

References 25 publications

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“…In addition, the prevalence of human immunodeficiency virus (HIV) infection among South African adults aged years is approximately 18k, and there are an estimated 5.4 million HIV-positive adults, the highest number anywhere in the world [3]. HIV-positive women are about three times more likely to have an HPV infection, 4.5 times more likely to develop cervical intraepithelial neoplasia (CIN), [4] and three to five times more likely to develop invasive cervical cancer compared to HIV-negative women [5,6]. Therefore, the high prevalence of HIV in South Africa is likely a contributing factor to the high rates of both HPV and cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

Cost effectiveness of high-risk HPV DNA testing for cervical cancer screening in South Africa

Vijayaraghavan

Efrusy

Lindeque

et al. 2009

Gynecologic Oncology

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a b s t r a c t a r t i c l e i n f oObjective. To determine the cost effectiveness of several cervical cancer screening strategies utilizing HPV testing in South Africa.Methods. We developed a lifetime Markov model of the costs, quality of life, and survival associated with screening and treating cervical cancer and its precursors. Screening strategies evaluated included: 1) conventional cytology, 2) cytology followed by HPV testing for triage of equivocal cytology, 3) HPV testing, 4) HPV testing followed by cytology for triage of HPV-positive women, and 5) co-screening with cytology and HPV testing. Primary outcome measures included quality-adjusted life-years saved (QALYs), incremental cost-effectiveness ratios, and lifetime risk of cervical cancer. Costs are in 2006 South African Rand (R).Results. In a cohort of 100,000 women, starting at age 30 and screening once every 10 years reduced the lifetime risk of cervical cancer by 13-52k depending on the screening strategy used, at an incremental cost of R13,000-R42,000 per QALY. When strategies were compared incrementally, cytology with HPV triage was less expensive and more effective than screening using cytology alone. HPV testing with the use of cytology triage was a more effective strategy and costs an additional R42,121 per QALY. HPV testing with colposcopy for HPV-positive women was the next most effective option at an incremental cost of R1541 per QALY. Simultaneous HPV testing and cytology co-screening was the most effective strategy and had an incremental cost of R25,414 per QALY.Conclusions. In our model, HPV testing to screen for cervical cancer and its precursors is a cost-effective strategy in South Africa.

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Section: Introductionmentioning

confidence: 99%

Cost effectiveness of high-risk HPV DNA testing for cervical cancer screening in South Africa

Vijayaraghavan

Efrusy

Lindeque

et al. 2009

Gynecologic Oncology

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“…[3][4][5] Many non-AIDS defining malignancies have been found at a higher incidence in HIV patients than in the general population. 6,7 The incidences of Hodgkin lymphoma (HL) and malignancy of liver, lung, anus, and oral cavity/pharynx have all been found to be higher among the HIV-infected population than the general population, 8,9 as well as melanoma, leukemia, and vaginal, colon, rectal, and kidney cancer in some studies. 8 Several oncogenic viruses are thought to cause AIDS-defining malignancies; human herpesvirus 8 is associated with KS, Epstein-Barr virus (EBV) is associated with the 2 most common NHL subtypes, and the human papillomavirus (HPV) is associated with cervical cancer.…”

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confidence: 99%

Relationship between current level of immunodeficiency and non‐acquired immunodeficiency syndrome‐defining malignancies

Reekie

Kósa

Engsig

et al. 2010

Cancer

129

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BACKGROUND:In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency syndrome (AIDS)-defining malignancies account for more morbidity and mortality in human immunodeficiency virus-infected patients than AIDS-defining malignancies. However, conflicting data have been reported on the relationship between immunodeficiency and the development of some non-AIDS-defining malignancies. METHODS: A total of 14,453 patients from the prospective, multinational EuroSIDA cohort were included. Malignancies were classified as virusrelated, non-virus-related epithelial, and other. The incidence of non-AIDS-defining malignancies was calculated stratified by current CD4 count. Poisson regression was used to investigate factors associated with the development of non-AIDS-defining malignancies. RESULTS: A total of 356 non-AIDS-defining malignancies occurred, with an incidence rate of 4.3 per 1000 person years of follow-up (95% confidence interval [CI], 3.8-4.7); 172 (48.3%) were virusrelated, 135 (37.9%) were non-virus-related epithelial, and 49 (13.7%) were classified as other. Anal (69 cases), lung (31 cases), and melanoma (13 cases), respectively, were the most common non-AIDS-defining malignancies within each group. After adjustment, current CD4 was associated with virus-related non-AIDS-defining malignancies (incidence rate ratio [IRR], 0.81 per doubling; 95% CI, 0.75-0.88; P < .0001) and non-virus-related epithelial non-AIDSdefining malignancies (IRR, 0.84; 95% CI, 0.75-0.95; P ¼ .004), but not with other non-AIDS-defining malignancies (IRR, 1.04; 95% CI, 0.83-1.31; P ¼ .73). Current CD4 count was also associated with anal cancer (IRR, 0.86; 95% CI, 0.75-0.99; P ¼ .03), Hodgkin lymphoma (n ¼ 52; IRR, 0.83; 95% CI, 0.73-0.95; P ¼ .005), and lung cancer (IRR, 0.76; 95% CI, 0.64-0.90; P ¼ .0002). CONCLUSIONS: A low current CD4 count was associated with an increased incidence of certain non-AIDS-defining malignancies. Starting cART earlier to reduce the proportion of patients with a low CD4 count may decrease the rate of developing many common non-AIDS-related malignancies. A randomized trial to explore this strategy is urgently needed. Cancer 2010;116:5306-15.

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“…Although non-Hodgkin's lymphoma (NHL) and Kaposi's sarcoma account for the vast majority of HIV-1-associated malignancies, other tumours, such as germ cell tumours (GCT), also occur more frequently in HIV-1 infection (Logothetis et al, 1985;Gabutti et al, 1995;Goedert et al, 1998;Lyter et al, 1995;Dal Maso et al, 2001;Frisch et al, 2001). These non-AIDS-defining tumours are relatively rare, and published series have been small.…”

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confidence: 99%

Outcome of patients with HIV-related germ cell tumours: a case–control study

et al. 2004

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Testicular germ cell tumour (GCT) is not an AIDS-defining illness despite an increased incidence in men with HIV infection. We performed a matched case-control study comparing outcomes in HIV-positive men and the general population with GCT, using three age and stage matched controls for each case. There was no difference in the 5-year GCT-free survival between cases and controls. However, overall survival was significantly decreased in the cases (log rank P ¼ 0.03). HIV was responsible for 70% of this mortality. The relapse-free survival for stage I patients treated with orchidectomy and surveillance was not affected by HIV status (log rank P ¼ 0.68). There was no difference in disease free survival in patients with metastatic disease (log rank P ¼ 0.78). The overall survival has not improved since the introduction of highly active antiretroviral therapy (log rank P ¼ 0.4). Thus, HIV-related GCT is not more aggressive than GCT in the general population.

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Spectrum of AIDS-associated malignant disorders

Cited by 662 publications

References 25 publications

Cost effectiveness of high-risk HPV DNA testing for cervical cancer screening in South Africa

Cost effectiveness of high-risk HPV DNA testing for cervical cancer screening in South Africa

Relationship between current level of immunodeficiency and non‐acquired immunodeficiency syndrome‐defining malignancies

Outcome of patients with HIV-related germ cell tumours: a case–control study

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