A prospective ascertainment of cancer incidence in sub‐Saharan Africa: The case of Kaposi sarcoma

Semeere, Aggrey; Wenger, Megan; Busakhala, Naftali; Buziba, Nathan; Bwana, Mwebesa; Muyindike, Winnie; Amerson, Erin; Maurer, Toby; McCalmont, Timothy H.; LeBoit, Philip E.; Musick, Beverly; Yiannoutsos, Constantin T.; Lukande, Robert; Castelnuovo, Barbara; Laker‐Oketta, Miriam; Kambugu, Andrew; Glidden, David V.; Wools‐Kaloustian, Kara; Martin, Jeffrey N.

doi:10.1002/cam4.618

Cited by 48 publications

(44 citation statements)

References 17 publications

(28 reference statements)

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“…Record linkage is one way of ascertaining cancers in HIV‐positive people. Other potential strategies which may be explored for creating robust cancer data in the HIV population include routine collection of cancer data in HIV cohorts, strengthening of HIV testing in cancer patients and HIV clinician and patient education on current knowledge on HIV‐related cancers.…”

Section: Discussionmentioning

confidence: 99%

Record linkage to correct under‐ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project

Sengayi

Spoerri

Egger

et al. 2016

Intl Journal of Cancer

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The surveillance of HIV‐related cancers in South Africa is hampered by the lack of systematic collection of cancer diagnoses in HIV cohorts and the absence of HIV status in cancer registries. To improve cancer ascertainment and estimate cancer incidence, we linked records of adults (aged ≥ 16 years) on antiretroviral treatment (ART) enrolled at Sinikithemba HIV clinic, McCord Hospital in KwaZulu‐Natal (KZN) with the cancer records of public laboratories in KZN province using probabilistic record linkage (PRL) methods. We calculated incidence rates for all cancers, Kaposi sarcoma (KS), cervix, non‐Hodgkin's lymphoma and non‐AIDS defining cancers (NADCs) before and after inclusion of linkage‐identified cancers with 95% confidence intervals (CIs). A total of 8,721 records of HIV‐positive patients were linked with 35,536 cancer records. Between 2004 and 2010, we identified 448 cancers, 82% (n = 367) were recorded in the cancer registry only, 10% (n = 43) in the HIV cohort only and 8% (n = 38) both in the HIV cohort and the cancer registry. The overall cancer incidence rate in patients starting ART increased from 134 (95% CI 91–212) to 877 (95% CI 744–1,041) per 100,000 person‐years after inclusion of linkage‐identified cancers. Incidence rates were highest for KS (432, 95% CI 341–555), followed by cervix (259, 95% CI 179–390) and NADCs (294, 95% CI 223–395) per 100,000 person‐years. Ascertainment of cancer in HIV cohorts is incomplete, PRL is both feasible and essential for cancer ascertainment.

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Section: Discussionmentioning

confidence: 99%

Record linkage to correct under‐ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project

Sengayi

Spoerri

Egger

et al. 2016

Intl Journal of Cancer

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“…Similarly, in both China and Brazil, relative ADC declines and NADC increases are occurring as in high-income countries [16*, 17*]. Conversely, in most of SSA, ADC still dominate with incidence declines most consistently observed for KS, although KS incidence remains high throughout the region and is often among the most frequent cancers overall [15**, 18*, 19*, 20, 21**, 22]. HIVAM are therefore unlikely to recede as a public health problem in LMIC in the near term despite ART scale-up.…”

Section: Epidemiologymentioning

confidence: 99%

HIV-associated malignancies in sub-Saharan Africa

Chinula

Moses

Gopal

2017

Current Opinion in HIV and AIDS

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Purpose of review Summarize recent developments for HIV-associated malignancies (HIVAM) in low- and middle-income countries (LMIC) with particular focus on sub-Saharan Africa (SSA). Recent findings Antiretroviral therapy (ART) scale-up is leading to epidemiologic transitions in LMIC similar to high-income countries, with aging and growth of HIV-infected populations, declining infectious deaths, increasing cancer deaths, and transitions from AIDS-defining cancers (ADC) to non-AIDS defining cancers (NADC). Despite ART scale-up, HIVAM burden remains high including enormous ADC burden in SSA. For Kaposi sarcoma (KS), patients treated with ART and chemotherapy can experience good outcomes even in rural SSA, but KS heterogeneity remains insufficiently understood including virologic, immunologic, and inflammatory features which may be unique to LMIC. For cervical cancer, scale-up of prevention efforts including vaccination and screening is underway, with benefits already apparent despite continuing high disease burden. For non-Hodgkin lymphoma (NHL), curative treatment is possible in the ART era even in SSA, and multifaceted approaches can improve outcomes further. For many other prevalent HIVAM, care and research efforts are being established to guide treatment and prevention specifically in LMIC. Summary Sustained investment for HIVAM in LMIC can help catalyze a cancer care and research agenda which benefits HIV-positive and HIV-negative patients worldwide.

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“…Participants in this trial were not treated with antiretroviral therapy, which is known to prevent cryptococcal meningitis in HIV-positive people; therefore this estimate may not be applicable to HIV-positive people on antiretroviral therapy. This trial did not include any children. 13 Prevalence of Kaposi's sarcoma of 1.4% in HIV-positive adults on clinic enrolment taken from Semeere 2016, a multi-centre prospective cohort study performed in Uganda and Kenya. 14 Downgraded by two for serious imprecision: the CI around the summary effect estimate is very wide, and possible effects range from large benefits to significant harms. 15 Downgraded by one for indirectness: only one trial included HIV-positive people and assessed HIV-related adverse events (Elliott 2004). Participants in this trial were not treated with antiretroviral therapy, which is known to treat and prevent Kaposi's sarcoma in HIV-positive people, therefore this estimate may not be applicable to HIV-positive people on antiretroviral therapy.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

“… 13 Prevalence of Kaposi's sarcoma of 1.4% in HIV-positive adults on clinic enrolment taken from Semeere 2016, a multi-centre prospective cohort study performed in Uganda and Kenya.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

Corticosteroids for tuberculous pleurisy

Ryan

Yoo

Darsini

2017

Cochrane Database of Systematic Reviews

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Background Corticosteroids used in addition to antituberculous therapy have been reported to benefit people with tuberculous pleurisy. However, research findings are inconsistent and raise doubt as to whether such treatment is worthwhile. There is also concern regarding the potential adverse effects of corticosteroids, especially in HIV‐positive people. Objectives To evaluate the effects of adding corticosteroids to drug regimens for tuberculous pleural effusion. Search methods In April 2016, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (the Cochrane Library), MEDLINE, Embase, LILACS, Current Controlled Trials, and the reference lists of articles identified by the literature search. Selection criteria Randomized controlled trials (RCTs) and quasi‐RCTs that compared any corticosteroid with no treatment, placebo, or other active treatment (both groups should have received the same antituberculous drug regimen) in people diagnosed with tuberculous pleurisy. Data collection and analysis Two review authors independently screened the search results, extracted data from the included trials, and assessed trial methodological quality using the Cochrane 'Risk of bias' tool. We analysed the data using risk ratios (RR) with 95% confidence intervals (CIs). We applied the fixed‐effect model in the absence of statistically significant heterogeneity. Main results Six trials with 590 participants met the inclusion criteria, which were conducted in Asia (three trials), Africa (two trials), and Europe (one trial). Two trials were in HIV‐negative people, one trial was in HIV‐positive people, and three trials did not report HIV status. Corticosteroids may reduce the time to resolution of pleural effusion. Risk of residual pleural effusion on chest X‐ray was reduced by 45% at eight weeks (RR 0.54, 95% CI 0.37 to 0.78; 237 participants, 2 trials, low certainty evidence ), and 65% at 24 weeks (RR 0.35, 95% CI 0.18 to 0.66; 237 participants, 2 trials, low certainty evidence ). Compared with control, corticosteroids may reduce the risk of having pleural changes (such as pleural thickening or pleural adhesions), on chest X‐ray at the end of follow‐up by almost one third (RR 0.72, 95% CI 0.57 to 0.92; 393 participants, 5 trials, low certainty evidence ), which translates to an absolute risk reduction of 16%. One trial reported deaths in people that were HIV‐positive, with no obvious difference between the groups; the trial authors' analysis suggests that the deaths observed in this trial were related to HIV disease rather than pleural TB (RR 0.91, 95% CI 0.64 to 1.31; 197 participants, 1 trial). We found limited data on long‐term functional respiratory impairment on 187 people in two trials, which...

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A prospective ascertainment of cancer incidence in sub‐Saharan Africa: The case of Kaposi sarcoma

Cited by 48 publications

References 17 publications

Record linkage to correct under‐ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project

Record linkage to correct under‐ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project

HIV-associated malignancies in sub-Saharan Africa

Corticosteroids for tuberculous pleurisy

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