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

Applicant Bohlius Julia
Number 160407
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 01.12.2014 - 31.05.2016
Approved amount 181'837.00
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All Disciplines (2)

Discipline
Cancer
Methods of Epidemiology and Preventive Medicine

Keywords (8)

low and middle income countries; cancer epidemiology; HIV/AIDS; antiretroviral therapy; sub-Saharan Africa; health services research; record linkage studies; cohort studies

Lay Summary (German)

Lead
Tumorerkrankungen bei HIV-infizierten Patienten im südlichen Afrika Afrika südlich der Sahara ist die weltweit am schwersten von der HIV-Epidemie getroffene Region. Tumorerkrankungen bei HIV-infizierten in dieser Region sind bisher nicht ausreichend untersucht worden. Dieses Projekt leistet dazu einen Beitrag.
Lay summary

Inhalt und Ziel des Forschungsprojekts

Eine HIV-Infektion erhöht das Risiko an einem bösartigen Tumor zu erkranken. Seit Einführung der hochpotenten antiretroviralen Therapie im Jahre 1996 ist das Risiko für die Gruppe der sogenannten AIDS-definierenden Tumorerkrankungen in Europa stark zurückgegangenen. Seit 2004 ist die hochpotente antiretrovirale Therapie in den Ländern des südlichen Afrika erhältlich. Es ist bisher nur unzureichend untersucht worden, wie der Zugang zur hochpotenten antiretrovirale Therapie das Risiko für Tumorerkrankungen bei HIV-infizierten im südlichen Afrika beeinflusst.

Im ersten Teil des Projektes werden wir das Risiko für die AIDS-definierenden Tumorerkrankungen bei HIV-infizierten Personen, die eine hochpotenten antiretrovirale Therapie erhalten, bestimmen. Für diese Analyse werden wir Patientendaten aus dem südlichen Afrika, Nord- und Südamerika, Asien, Australien und Europa auswerten und vergleichen. Im zweiten Teil des Projektes werden wir das Risiko für die Gruppe der nicht AIDS-definierenden Tumorerkrankungen für HIV-infizierte Patienten in Südafrika bestimmen. Die Daten zu dieser Gruppe von Tumorerkrankungen werden mit Hilfe des Südafrikanischen Krebsregisters erhoben.  Im dritten Teil des Projektes werden wir exemplarisch untersuchen, welche spezifischen Tumorbehandlungen für betroffene HIV-infizierte Patienten in Malawi, Sambia und Südafrika angeboten werden.

Wissenschaftlicher und gesellschaftlichere Kontext des Forschungsprojektes

In vielen Ländern des südlichen Afrikas ist der Zugang zur medizinischen Versorgung, insbesondere zu Krebsfrüherkennungsmaßnahmen, Diagnose und Therapie, stark eingeschränkt. Der frühe Zugang zur antiretroviralen Therapie kann das Risiko für bestimmte Tumorerkrankungen signifikant reduzieren. Ein besseres Verständnis der Krebsepidemiologie bei HIV-infizierten im südlichen Afrika kann einen Beitrag zur Planung des Gesundheitswesens in den betroffenen Ländern leisten.

Direct link to Lay Summary Last update: 22.12.2014

Responsible applicant and co-applicants

Employees

Publications

Publication
An Insight Into Cervical Cancer Screening and Treatment Capacity in Sub Saharan Africa
Coleman J. S., Cespedes M. S., Cu-Uvin S., Kosgei R. J., Maloba M., Anderson J., Wilkin T., Jaquet A., Bohlius J., Anastos K., Wools-Kaloustian K. (2016), An Insight Into Cervical Cancer Screening and Treatment Capacity in Sub Saharan Africa, in J Low Genit Tract Dis, 20, 31-7.
HIV and human herpesvirus 8 co-infection across the globe: Systematic review and meta-analysis
Rohner E., Wyss N., Heg Z., Faralli Z., Mbulaiteye S. M., Novak U., Zwahlen M., Egger M., Bohlius J. (2016), HIV and human herpesvirus 8 co-infection across the globe: Systematic review and meta-analysis, in Int J Cancer, 138, 45-54.
Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa: Record Linkage Study
Bohlius J., Maxwell N., Spoerri A., Wainwright R., Sawry S., Poole J., Eley B., Prozesky H., Rabie H., Garone D., Technau K. G., Maskew M., Davies M. A., Davidson A., Stefan D. C., Egger M. (2016), Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa: Record Linkage Study, in Pediatr Infect Dis J, 35, 164-70.
Is human herpesvirus 8 infection more common in men than in women? Systematic review and meta-analysis
Begre L., Rohner E., Mbulaiteye S. M., Egger M., Bohlius J. (2016), Is human herpesvirus 8 infection more common in men than in women? Systematic review and meta-analysis, in Int J Cancer, 139, 776-83.
Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi's sarcoma in five countries across sub-Saharan Africa
Freeman E., Semeere A., Wenger M., Bwana M., Asirwa F. C., Busakhala N., Oga E., Jedy-Agba E., Kwaghe V., Iregbu K., Jaquet A., Dabis F., Yumo H. A., Dusingize J. C., Bangsberg D., Anastos K., Phiri S., Bohlius J., Egger M., Yiannoutsos C., Wools-Kaloustian K., Martin J. (2016), Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi's sarcoma in five countries across sub-Saharan Africa, in BMC Cancer, 16, 65-65.
Record linkage to correct under-ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project
Sengayi M., Spoerri A., Egger M., Kielkowski D., Crankshaw T., Cloete C., Giddy J., Bohlius J. (2016), Record linkage to correct under-ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project, in Int J Cancer, 139, 1209-16.
Health-Related Quality of Life of Young Adults Treated with Recombinant Human Growth Hormone during Childhood
Sommer G., Gianinazzi M. E., Kuonen R., Bohlius J., l'Allemand D., Hauschild M., Mullis P. E., Kuehni C. E. (2015), Health-Related Quality of Life of Young Adults Treated with Recombinant Human Growth Hormone during Childhood, in PLoS One, 10, 0140944-0140944.
HHV-8 seroprevalence in HIV-positive and HIV-negative populations
Bohlius J., Maskew M., Davies M. A., Egger M. (2015), HHV-8 seroprevalence in HIV-positive and HIV-negative populations, in Int J Cancer, 136, 1243-1243.

Collaboration

Group / person Country
Types of collaboration
Groote Schuur Hospital, University of Cape Town South Africa (Africa)
- in-depth/constructive exchanges on approaches, methods or results
Kaohsiung Medical University, Kaohsiung City Taiwan (Asia)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
National Cancer Registry South Africa (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
National Cancer Institute United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Lighthouse Trust Kamuzu Central Hospital, Lilongwe Malawi (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine South Africa (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Cancer Diseases Hospital, Lusaka Zambia (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
ASCO Annual Meeting Poster NHL risk in HIV+ Adults on Antiretroviral Therapy in Four Continents 03.06.2016 Chicago, United States of America Bohlius Julia;
20th International Workshop on HIV Observational Databases (IWHOD) Poster CD4 cell trajectories in HIV-positive adults developing Kaposi Sarcoma after starting cART: a multiregional comparison based on nested case control studies 07.04.2016 Budapest, Hungary Bohlius Julia;
Conference on Retroviruses and Opportunistic Infections (CROI) Poster Global Burden of Cervical Cancer in HIV-Positive Women on Antiretroviral Therapy 22.02.2016 Boston, United States of America Bohlius Julia;
Conference on Retroviruses and Opportunistic Infections (CROI) Poster Kaposi Sarcoma Risk in Children on Antiretroviral Therapy from Africa, Europe and Asia 22.02.2016 Boston, United States of America Bohlius Julia;
Conference on Retroviruses and Opportunistic Infections (CROI) Poster Risk of Kaposi Sarcoma in HIV-Positive Adults on ART: a Global Analysis 22.02.2016 Boston, United States of America Bohlius Julia;
Conference on Retroviruses and Opportunistic Infections (CROI) Poster Kaposi Sarcoma Survival in Adults: The South African Antiretroviral Treatment Era 22.02.2016 Boston, United States of America Bohlius Julia;
Conference on Retroviruses and Opportunistic Infections (CROI) Poster Risk of Cancer in HIV-Positive Adults on ART in South Africa: A Record Linkage Study 22.02.2016 Boston, United States of America Bohlius Julia;
10th International African Organisation for Research and Training in Cancer Conference (AORTIC) Talk given at a conference Kaposi sarcoma incidence rate in HIV-infected children on antiretroviral therapy from Southern Africa, Europe and Asia/Pacific 18.11.2015 Marakesh, Morocco Bohlius Julia;
15th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI) Individual talk Record linkage for cancer ascertainment in HIV cohorts in South Africa 26.10.2015 Washington, United States of America Bohlius Julia;
International Workshop on KSHV and Related Agents Poster Human Herpesvirus 8 and sex: a meta-analysis 30.06.2015 Miami, United States of America Bohlius Julia;
International Workshop on KSHV and Related Agents Poster HIV and human herpesvirus 8 in children and adults across the globe: systematic review and meta-analysis 30.06.2015 Miami, United States of America Bohlius Julia;


Awards

Title Year
Teacher of the year, MPH program of the Universities of Basel, Bern and Zurich 2015
Teacher of the year, MPH program of the Universities of Basel, Bern and Zurich 2014

Associated projects

Number Title Start Funding scheme
136620 AIDS-defining and non AIDS-defining cancers in patients starting ART in Southern Africa: cohort and linkage studies 01.12.2011 Ambizione
169967 The South African HIV Cancer Match Study 01.08.2017 Project funding (Div. I-III)
169967 The South African HIV Cancer Match Study 01.08.2017 Project funding (Div. I-III)

Abstract

Background: There is little data on the effect of HIV and antiretroviral therapy (ART) on the cancer epidemiology in Sub-Saharan Africa, where most people with HIV/AIDS life. In many African countries access to cancer screening, treatment or palliative care is limited. With the scale-up of combination 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 clinical, epidemiological and health services research to inform the prevention and care of HIV-related cancers in Southern Africa. I will address the three following three objectives:1.To compare incidence rates, survival and the impact of ART in HIV-infected children and adults developing AIDS-defining cancer in Southern Africa, Europe, Southern, Central and Northern America, Asia/Pacific and Australia.2.To examine the provision of health care to patients with Kaposi Sarcoma in Southern Africa3.To evaluate the incidence and survival of AIDS-defining cancer and non AIDS-defining cancer in patients attending ART programs 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 (IeDEA) and its European partner, the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). In the past years I have retrieved data for 68 participating cohorts from 38 countries in five continents (Southern Africa, Europe, North America, Central and South America, Asia/Pacific and Australia). The data set includes 913,041 HIV-infected children and adults, 25,674 AIDS-defining cancers (Kaposi Sarcoma (KS), Non Hodgkin Lymphoma (NHL), invasive cervical cancer (ICC)) have been diagnosed in these patients. 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 analyse the time to a cancer diagnosis, loss to follow-up or death. I will collaborate with physicians at HIV and oncology departments in Malawi, Zambia and South Africa to evaluate the provision of care for patients diagnosed with KS. I will extract and analyse data for exact diagnosis and stage, treatment received and treatment outcomes. Deterministic and probabilistic linkages of two South African HIV cohorts with the data from the National Cancer Registry will be performed. Non AIDS-defining cancers, which are not routinely recorded in HIV cohorts, will thus be identified. The study will be done in close cooperation with collaborators in Southern Africa, Europe, North and South America, Asia/Pacific and Australia as well as the HIV/AIDS and cancer research groups at ISPM Bern. Significance: This project was designed to respond to the operational and clinical research priorities identified by the World Health Organization and other national and international agencies. This research will be a build on international research networks and provides a unique opportunity to advance cancer epidemiology in HIV-infected patients in Southern Africa.
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