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AIDS-defining and non AIDS-defining cancers in patients starting ART in Southern Africa: cohort and linkage studies

English title AIDS-defining and non AIDS-defining cancers in patients starting ART in Southern Africa: cohort and linkage studies
Applicant Bohlius Julia
Number 136620
Funding scheme Ambizione
Research institution Institut für Sozial- und Präventivmedizin Universität Bern
Institution of higher education University of Berne - BE
Main discipline Cancer
Start/End 01.12.2011 - 30.11.2014
Approved amount 599'998.00
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All Disciplines (2)

Discipline
Cancer
Methods of Epidemiology and Preventive Medicine

Keywords (12)

HIV; cancer; AIDS-related malignancies; observational cohort studies; record linkage; cancer registry; epidemiology; Southern Africa; North America; Europe; resource-limited; antiretroviral therapy

Lay Summary (English)

Lead
Lay summary

In Southern Africa, where HIV-infection is common, AIDS-defining cancers are an important public health problem. With the scale-up of combination antiretroviral therapy in Africa, the prognosis of individuals living with HIV/AIDS has improved substantially. However, the burden of cancer in the HIV-infected population and the implications for treatment and outcomes in the era of combination antiretroviral therapy are unclear.

In the proposed project, I will investigate the epidemiology and care of AIDS-defining cancers (i.e. Kaposi sarcoma, non-Hodgkin’s lymphoma and invasive cervical cancer) and non AIDS-defining cancers. Specifically, I aim to i) define the incidence and prognosis of cancer in HIV-infected patients starting antiretroviral therapy in Southern Africa, ii) identify factors that influence the occurrence of and survival from cancer, iii) examine the provision of health care to HIV-infected persons developing cancer, including prevention, screening, diagnostic procedures and anti-cancer treatment provided. Results will be compared to the current situation for HIV-infected cancer patients in Europe and North America.

This study will build on a large network of HIV cohort studies, the International epidemiological Databases to Evaluate AIDS in Southern Africa (IeDEA-SA), the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) and the National Cancer Registry in Johannesburg, South Africa. The analyses will be based on more than 30 collaborating cohorts contributing data on more than 300,000 HIV-infected persons from Southern Africa; 70,000 HIV-infected persons from Europe and about 100,000 HIV-infected persons from North America.

 The planned research responds to the operational and clinical research priorities identified by the World Health Organization and the United Nations resolution on non-communicable diseases. The project builds on high-profile international research networks and will provide guidance about improving cancer prevention and care in HIV-infected persons in Southern Africa, Europe and North America.

Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
HHV-8 seroprevalence in HIV-positive and HIV-negative populations.
Bohlius Julia (2015), HHV-8 seroprevalence in HIV-positive and HIV-negative populations., Wiley, Hoboken, New Jersey.
HHV-8 seroprevalence: a global view.
Bohlius Julia (2014), HHV-8 seroprevalence: a global view., BioMed Central, BioMed Central.
Incidence rate of Kaposi sarcoma in HIV-infected patients on antiretroviral therapy in Southern Africa: a prospective multicohort study.
Bohlius Julia (2014), Incidence rate of Kaposi sarcoma in HIV-infected patients on antiretroviral therapy in Southern Africa: a prospective multicohort study., in JAIDS, 547-554.
Kaposi's Sarcoma in HIV-infected patients in South Africa: Multicohort study in the antiretroviral therapy era.
Bohlius Julia (2014), Kaposi's Sarcoma in HIV-infected patients in South Africa: Multicohort study in the antiretroviral therapy era., in International Journal of Cancer, 2644-2652.

Collaboration

Group / person Country
Types of collaboration
Prof. Andrew Boulle, School of Public Health, Faculty of Health Sciences, University of Cape Town South Africa (Africa)
- in-depth/constructive exchanges on approaches, methods or results
Prof. Richard Moore, Johns Hopkins University, School of Medicine, Baltimore, Maryland United States of America (North America)
- Research Infrastructure
Dr. Danuta Kielkowski, National Institute of Occupational Health, Johannesburg, RSA South Africa (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Prof. Ian Weller, Research Department of Infection & Population Health UCL Medical School, London Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
AORTIC INTERNATIONAL CANCER CONFERENCE Talk given at a conference Cancer in HIV-infected children: record linkage study in South Africa 21.11.2013 Durban, South Africa Bohlius Julia;
AORTIC INTERNATIONAL CANCER CONFERENCE Talk given at a conference The use of computerized record linkage for cancer ascertainment in a South African HIV cohort. 21.11.2013 Durban, South Africa Bohlius Julia;
14th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI) 2013 Poster ancer in HIV-infected children: record linkage study in South Africa, 12.11.2013 Bethesda, United States of America Bohlius Julia;
14th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI) 2013 Poster he Use Of Computerized Record Linkage For Cancer Ascertainment In A South African HIV Cohort 12.11.2013 Bethesda, United States of America Bohlius Julia;
14th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI) 2013 Poster Is HHV-8 More Common Among HIV Infected People? Systematic Review and Meta-Analysis 12.11.2013 Bethesda, United States of America Bohlius Julia; Wyss Natascha;
20th Conference on Retroviruses and Opportunistic Infections (CROI 2013) Poster Kaposi Sarcoma in South Africa in the ART era: Prospective multi-cohort study 04.03.2013 Atlanta, United States of America Bohlius Julia;
20th Conference on Retroviruses and Opportunistic Infections (CROI 2013) Poster Mortality among HIV infected children with cancer in South Africa: a pilot linkage study 04.03.2013 Bethesda, United States of America Bohlius Julia;
South African HIV Clinicians Society Conference Poster Incidence of epidemic Kaposi Sarcoma in HIV-infected patients in South Africa: a prospective multi-cohort study 25.11.2012 Cape Town, South Africa Bohlius Julia;


Associated projects

Number Title Start Funding scheme
160407 AIDS-defining and non AIDS-defining cancers in patients starting ART in Southern Africa: cohort and linkage studies 01.12.2014 Ambizione
145489 Cancer in HIV-infected populations: studies of incidence, prognosis and oncovirus seroprevalence 01.09.2013 Marie Heim-Voegtlin grants

Abstract

Background: Many Africans have no access to cancer screening, treatment or palliative care. In Southern Africa, where HIV-infection is common, AIDS-defining cancers are an important public health problem. With the scale-up of combination antiretroviral therapy (ART) in Africa the prognosis of individuals living with HIV/AIDS has been improved substantially, however, the burden of cancer in the HIV-infected population and the implications for treatment and outcomes in the era of ART are unclear. Objectives: I propose epidemiological research to inform the prevention and care of AIDS-defining cancers (Kaposi sarcoma (KS), non-Hodgkin’s lymphoma (NHL) and invasive cervical cancer (ICC) and non AIDS-defining cancers. Specifically, I aim: 1.To define incidence and prognosis of KS, NHL and ICC in HIV-infected patients starting ART in Southern Africa.2.To identify individual-level and program-level risk factors associated with incidence, late diagnosis, and survival, with a focus on the impact of ART.3.To examine the provision of health care to patients with KS, NHL and ICC, including diagnostic procedures, chemotherapy and radiotherapy, specialist nursing, oncological and palliative care, referrals and waiting times. 4.To compare incidence rates, survival and the impact of ART in HIV-infected patients developing KS, ICC and NHL in Southern Africa, Europe and North America.5.To evaluate the incidence and survival of non AIDS-defining cancers in patients attending HIV clinics in South Africa, through linkage to the National Cancer Registry. Methods: This study will build on a large NIH-funded network of HIV cohorts, the International epidemiological Databases to Evaluate AIDS in Southern Africa (IeDEA-SA) and, in the Republic of South Africa, on the linkage of the HIV cohort data with the National Cancer Registry in Johannesburg. The current IeDEA-SA database, which is held at the Universities of Bern and Cape Town, includes data on 288,015 adults (251,759 on ART) and 30,470 children (24,277 on ART) in six countries (Botswana, Malawi, Mozambique, South Africa, Zambia and Zimbabwe). The incidence rate for KS, NHL and ICC will be calculated by dividing the number of patients developing the disease by the number of person-years at risk. Survival of patients with KS, NHL or ICC will be assessed in time to event analyses, measuring time from the date of cancer diagnosis until death from any cause or the date the patient was last known to be alive. I will use competing risk models to analyze the time to a cancer diagnosis, loss to follow-up or death. Deterministic and probabilistic linkages of the South African HIV cohort data with the data from the National Cancer Registry will be performed, using the Generalized Iterative Record Linkage System (GIRLS, Statistics Canada). Non AIDS-defining cancers, which are not routinely recorded in IeDEA-SA, will thus be identified. For international comparisons of incidence and survival, I will work with the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). The study will be done in close collaboration with collaborators in Southern Africa, Europe and North America, as well as the HIV/AIDS and cancer research groups at ISPM Bern. Significance: The planned research responds to the operational and clinical research priorities identified by the World Health Organization (WHO) and other national and international agencies. The 2007 London Declaration on Cancer Control in Africa explicitly called for the integration of cancer care in HIV/AIDS treatment programs. Building on high-profile international research networks the proposed project provides a unique opportunity for a productive Ambizione-PROSPER fellowship in cancer epidemiology, and excellent value for money.
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