Routine HIV Measurement and Surveillance Consortium
Cancer and HIV: Global Syndemics Lymphoma trends in Southern Africa, Europe and the Americas Matthias Egger Institute of Social & Preventive Medicine (ISPM) University of Bern, Switzerland Lymphoma Grulich et al. Lancet 2007 200 400 600 800 1000 HIV cohort 0 Cancer incidence rate per 100,000 pys Underascertainment of
cancers in HIV positive people in South Africa All cancers KS Sengayi et al, Int J Cancer 2016 Sengayi et al, CROI 2016 NHL ICC NADCs 3 Record linkage HIV cohorts Cancer registries Deterministic record linkage: folder numbers Probabilistic record linkage: names, date of birth, gender, other data
HIV cohort & linkage identified cancers 200 400 600 800 1000 HIV cohort 0 Cancer incidence rate per 100,000 pys Underascertainment of cancers in HIV positive people in South Africa All cancers KS Sengayi et al, Int J Cancer 2016 Sengayi et al, CROI 2016 NHL
ICC NADCs 5 International consortium of ART programmes >500 sites in 7 regions Harmonized data collection > 1 million adults and children Funded by NIH www.iedea.org Collaboration of Observational HIV Epidemiology and Research Europe 33 cohorts from 30 countries Harmonized data collection >300,000 adults Funded by EU as part of EuroCoord www.cohere.org Cohort profiles in International Journal of Epidemiology 6 Methods
We included HIV-positive adults (16 years) who initiated ART from 1996 onwards We estimated incidence rates and compared the risk of developing NHL between continents using flexible parametric survival models with continent-specific baseline hazards We adjusted for age, current CD4 cell count, ART regimen, ART start year, and either sex or transmission risk group Study population Adults (N) Follow-up time [years] ART start year Age at ART start* [years] Men (%) MSM in men (%) CD4 count at ART start* [cells/l] Southern Africa Latin America North
America Europe 22,136 8,677 17,001 162,229 1.9 4.6 4.3 4.5 2008 2007 2001 2005
Medians are shown ART, combination antiretroviral therapy; MSM, men who have sex with men; NR, not reported. NHL incidence after start of ART Results 1,598 patients developed NHL over 1.1 million person-years NHL incidence rate per 100,000 person-years was 287 (95% CI 270-305) in all regions combined In adjusted analysis, the risk of developing NHL was slightly higher in North America than in Europe and South Africa In Latin America NHL risk was lower than in Europe (adjusted HR 0.46, 95% CI 0.27-0.76), which was mainly explained by a lower NHL risk in women from Latin America. NHL incidence after start of ART NHL incidence in general population Incidence and mortality of HL in HIV infected patients:
A: Cumulative incidence by ART B: Cumulative mortality by ART Conclusions Despite ART the risk of developing cancer remains high in HIV-positive people Regional variation in lymphoma trends might be explained by differences in Completeness of cancer ascertainment Prevalence of oncogenic viruses (EBV-2) Access to health care Ascertainment of both AIDS defining and non AIDS defining cancers needs to be improved in sub-Saharan Africa Probabilistic record linkages with cancer registries may help to reduce underrecording of cancer cases I MI T AMA CS ECS- Mo thers & E CS - I nf an ts NSHPC- Mo thers & NHP S- I n fan ts PI SCI S KOMP NE T C ASC ADE A NR S CO2 SER OCO F r ankfu r t HI V Co ho r t St ud y Sa n Raffael e ANRS CO1/ CO10 EPF UK CHI C Athena I TLR-Mothers & I TLR-I nfants Swiss HI V Cohort Study I CC ANRS CO6 PRI MO Co-RI S MOCHI V-Mothers & MoCHI V-I nfants The I talian MASTER Cohort CHI PS ANRS CO4 French Hospitals Database on HI V HI V-MI P- Mothers & HI V-MI P-I nfants GE ME S- H aemo A NR S CO3 AQ UI TAI NE E u roSI DA Mad ri d Co ho r t HI V Child ren V ACH Mo de n a C o h o rt Stu dy D an i s h H I V Stu d y A N R S CO 8 C O PI L OT E I CON A St. P i er r e Collaboration of Observational HI V Epidemiological Research Europe Coordination: Copenhagen HI V Programme (CHI P) & I nstitut de Sant Publique,d'Epidmiologie et de Dveloppement (I SPED)
Acknowledgements Project leaders and statistical analysis: Juan Berenguer, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, Franois Dabis, Antonella dArminio Monforte, Mary-Anne Davies, Julia del Amo, Maria Dorrucci, David Dunn, Matthias Egger, Hansjakob Furrer, Marguerite Guiguet, Sophie Grabar, Ali Judd, Ole Kirk, Olivier Lambotte, Valriane Leroy, Sara Lodi, Sophie Matheron, Laurence Meyer, Jose M Mir, Amanda Mocroft, Susana Monge, Fumiyo Nakagawa, Roger Paredes, Andrew Phillips, Massimo Puoti, Michael Schomaker, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, , Marc van der Valk, Linda Wittkop, Natascha Wyss Project working group: Gary Clifford, Jonathan Sterne, Julia Bohlius,
Eliane Rohner, Marcel Zwahlen, Margaret May, Maria Campbell, Matthias Egger, Natascha Wyss, Rana Chakraborty, Sylvia Franceschi, Kurt Schmidlin, Annelies Verbon, Diana Gibb, Antoni Noguera-Julian, Claudia Fortuny, Toni Soriano, Niels Obel, Sophie Grabar, Norbert Brockmeyer, Genevive Chne Regional Coordinating Centres: Bordeaux RCC: Diana Barger, Christine Schwimmer, Monique Termote, Linda Wittkop; Copenhagen RCC: Maria Campbell, Casper M. Frederiksen, Nina Friis-Mller, Jesper Kjaer, Dorthe Raben, Rikke Salbl Brandt Sources of funding: The COHERE study group has received unrestricted
funding from: Agence Nationale de Recherches sur le SIDA et les Hpatites Virales (ANRS), France; HIV Monitoring Foundation, the Netherlands; and the Augustinus Foundation, Denmark. The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under EuroCoord grant agreement n 260694. A list of the funders of the participating cohorts can be found on the Regional Coordinating Centre websites at http://www.cphiv.dk/COHERE/tabid/295/Default.aspx and http://etudes.isped.ubordeaux2.fr/cohere." Steering committee: Executive Committee: Stphane de Wit (Chair, St. Pierre University Hospital), Jose M Mir (PISCIS), Dominique Costagliola (FHDH), Antonella dArminio-Monforte (ICONA), Antonella Castagna (San Raffaele), Julia del Amo (CoRIS), Amanda Mocroft (EuroSida), Dorthe Raben (Head, Copenhagen Regional Coordinating Centre), Genevive Chne (Head, Bordeaux Regional Coordinating Centre) Steering Committee - Contributing Cohorts: Ali Judd (AALPHI) Robert Zangerle (AHIVCOS),Giota Touloumi (AMACS), Josiane Warszawski (ANRS CO1 EPF/ANRS CO11 OBSERVATOIRE EPF), Laurence Meyer (ANRS CO2 SEROCO), Franois Dabis (ANRS CO3 AQUITAINE), Murielle Mary Krause (ANRS CO4 FHDH), Jade Ghosn (ANRS CO6 PRIMO), Catherine Leport (ANRS CO8 COPILOTE), Linda Wittkop (ANRS CO13 HEPAVIH), Peter Reiss
(ATHENA), Ferdinand Wit (ATHENA), Maria Prins (CASCADE), Heiner Bucher (CASCADE), Diana Gibb (CHIPS), Gerd Ftkenheuer (Cologne-Bonn), Julia Del Amo (CoRIS), Niels Obel (Danish HIV Cohort), Claire Thorne (ECS), Amanda Mocroft (EuroSIDA), Ole Kirk (EuroSIDA), Christoph Stephan (Frankfurt), Santiago Prez-Hoyos (GEMES-Haemo), Osamah Hamouda (German ClinSurv), Barbara Bartmeyer (German ClinSurv), Nikoloz Chkhartishvili (Georgian National HIV/AIDS), Antoni Noguera-Julian (CORISPE-cat), Andrea Antinori (ICC), Antonella dArminio Monforte (ICONA), Norbert Brockmeyer (KOMPNET), Luis Prieto (Madrid PMTCT Cohort), Pablo Rojo Conejo (CORISPES-Madrid), Antoni Soriano-Arandes (NENEXP), Manuel Battegay (SHCS), Roger Kouyos (SHCS), Cristina Mussini (Modena Cohort), Pat Tookey (NSHPC), Jordi Casabona (PISCIS), Jose M. Mir (PISCIS), Antonella Castagna (San Raffaele), Deborah Konopnick (St. Pierre Cohort), Tessa Goetghebuer (St Pierre Paediatric Cohort), Anders Snnerborg (Swedish InfCare), Carlo Torti (The Italian Master Cohort), Caroline Sabin (UK CHIC), Ramon Teira (VACH), Myriam Garrido (VACH). David Haerry (European AIDS Treatment Group) Paediatric cohort representatives: Ali Judd, Pablo Rojo Conejo European AIDS Treatment Group: David Haerry 15 Acknowledgements Sponsoring Institutions National Institutes of Health
(NIH) National Institute of Allergy and Infectious Diseases (NIAID): Carolyn F.M. Williams, Rosemary McKaig, Melanie Bacon, Lori Zimand, Robin Huebner, Gerald Sharp National Institute for Child Health Development (NICHD): Rohan Hazra National Cancer Institute (NCI): Geraldina Dominguez, Kishor Bhatia Coordinating Center: IeDEA Network Coordinating Center (INCC) at Vanderbilt: Mary Lou Lindegren & C. William Wester, Dana Walker, Kristin Centers, Toni Hill Regions and site PIs Working Groups Chairs NA ACCORD: (Region 1) Richard Moore (Johns Hopkins University) Michael Saag (University of Alabama)
CCASAnet: (Region 2) Cathy McGowan (Vanderbilt University) Pedro Cahn (Fundacin Husped, Argentina) Asia-Pacific: (Region 5) David Cooper, Matthew Law (University of New South Wales), Annette Sohn (amfAR TREAT Asia) Southern Africa: (Region 11) Matthias Egger (University of Bern) Mary-Ann Davies (University of Cape Town) Executive Committee Matthias Egger (University of Bern; Bern, Switzerland) Cancer Julia Bohlius (University of Bern; Bern, Switzerland), Jeff Martin (University of California, San Francisco; CA, USA) Pediatrics Rachel Vreeman (AMPATH / Kenya; Indiana University School of Medicine; Bloomington, IN, USA ) Tuberculosis Marie Ballif (University of Bern; Bern, Switzerland), April Pettit (Vanderbuilt University; Nashville, TN, USA) Clinical Outcomes / Pharmacovigilance Kathy Anastos (Albert Einstein/Montefiore; USA)
Site Assessment Denis Nash (Hunter College; New York, NY, USA); C. William Wester (Vanderbilt University; Nashville, TN, USA) Data Harmonization Beverly Musick (Indiana University; Bloomington, IN, USA) Project working group: Michael Vinikoor, Kathryn Stinson, Cleophas Chimbetete, Hans Prozesky, Brian Eley, Karl Technau, Helena Rabie, Shobna Sawry, Daniela Garone, Roalind Wainwright, Alan Davidson, D Crisitna Stefan, Mhairi Maskew, Mary-Ann Davies, Janet Giddy, Annette Sohn, Arthur Chen, Awachana Jiamsakul, Nicolas Durier, Chuenkamol Sethaputra, Kathy Petoumenos, Valeria Fink, Cathrine McGowan, Pedro Cahn, Beatriz Grinsztein, Gina Perez, Karu Jayathilake, Gypsyamber DSouza, Richard Moore, Michael Silverberg, M John Gill, Sonia Napravnik, Chad Achenbach, James Goedert, Mari Kitahata, Pragna Patel, Rob Dubrow. Funding: Supported by the National Institute Of Allergy and Infectious Diseases (NIAID), National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), of the U.S. National Institutes of Health (NIH) under Award Number Southern Africa: U01AI069924, AsiaPacific: U01AI069907, Central Africa: U01A096299, East Africa: U01AI069911, Caribbean, Central, and South America: U01AI069923, West Africa: 16 U01AI069919, NA-ACCORD: U01-AI069918 and the IeDEA Network Coordinating Center at Vanderbilt: U01A1096186.
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