Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa: Record Linkage Study

Julia Bohlius¹, Nicola Maxwell, Adrian Spoerri, Rosalind Wainwright, Shobna Sawry, Janet Poole, Brian Eley, Hans Prozesky, Helena Rabie, Daniela Garone, Karl-Günter Technau, Mhairi Maskew, Mary-Ann Davies, Alan Davidson, D Cristina Stefan, Matthias Egger; for IeDEA-Southern Africa

Affiliations

Affiliation

¹ From the *Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; †School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; ‡Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, South Africa; §Harriet Shezi Children's Clinic, University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa; ¶Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa; ‖Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital; **Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; ††Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa; ‡‡Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Tygerberg, Cape Town, South Africa; §§Khayelitsha ART Program, Médecins Sans Frontières, Cape Town, South Africa; ¶¶Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa; ‖‖Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ***Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and the University of Cape Town; and †††South African Medical Research Council, Cape Town, South Africa.

PMID: 26906162
PMCID: PMC4865449
DOI: 10.1097/INF.0000000000001117

Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa: Record Linkage Study

Julia Bohlius et al. Pediatr Infect Dis J. 2016 Jun.

. 2016 Jun;35(6):e164-70.

doi: 10.1097/INF.0000000000001117.

Authors

Affiliation

¹ From the *Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; †School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; ‡Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, South Africa; §Harriet Shezi Children's Clinic, University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa; ¶Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa; ‖Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital; **Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; ††Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa; ‡‡Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Tygerberg, Cape Town, South Africa; §§Khayelitsha ART Program, Médecins Sans Frontières, Cape Town, South Africa; ¶¶Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa; ‖‖Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ***Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and the University of Cape Town; and †††South African Medical Research Council, Cape Town, South Africa.

PMID: 26906162
PMCID: PMC4865449
DOI: 10.1097/INF.0000000000001117

Abstract

Background: Little is known on the risk of cancer in HIV-positive children in sub-Saharan Africa. We examined incidence and risk factors of AIDS-defining and other cancers in pediatric antiretroviral therapy (ART) programs in South Africa.

Methods: We linked the records of 5 ART programs in Johannesburg and Cape Town to those of pediatric oncology units, based on name and surname, date of birth, folder and civil identification numbers. We calculated incidence rates and obtained hazard ratios (HR) with 95% confidence intervals (CI) from Cox regression models including ART, sex, age and degree of immunodeficiency. Missing CD4 counts and CD4% were multiply imputed. Immunodeficiency was defined according to World Health Organization 2005 criteria.

Results: Data of 11,707 HIV-positive children were included in the analysis. During 29,348 person-years of follow-up 24 cancers were diagnosed, for an incidence rate of 82 per 100,000 person-years (95% CI: 55-122). The most frequent cancers were Kaposi sarcoma (34 per 100,000 person-years) and non-Hodgkin Lymphoma (31 per 100,000 person-years). The incidence of non AIDS-defining malignancies was 17 per 100,000. The risk of developing cancer was lower on ART (HR: 0.29; 95% CI: 0.09-0.86), and increased with age at enrollment (>10 vs. <3 years: HR: 7.3; 95% CI: 2.2-24.6) and immunodeficiency at enrollment (advanced/severe versus no/mild: HR: 3.5; 95% CI: 1.1-12.0). The HR for the effect of ART from complete case analysis was similar but ceased to be statistically significant (P = 0.078).

Conclusions: Early HIV diagnosis and linkage to care, with start of ART before advanced immunodeficiency develops, may substantially reduce the burden of cancer in HIV-positive children in South Africa and elsewhere.

PubMed Disclaimer

Figures

**Figure 1**
Identification of study population for analysis of antiretroviral therapy and cancer in HIV-infected children in South Africa. The flow diagram shows the number of included and excluded patients. ART, antiretroviral therapy; IeDEA, International epidemiologic Databases to Evaluate AIDS

See this image and copyright information in PMC

References

1. UNAIDS. [March 9th 2015];HIV estimates with uncertainty bounds 1990-2013. Available at: http://www.unaids.org/sites/default/files/HIV2013Estimates_1990-2013_22J....
1. Biggar RJ, Frisch M, Goedert JJ. Risk of cancer in children with AIDS. AIDS-Cancer Match Registry Study Group. JAMA. 2000;284:205–209. - PubMed
1. Kest H, Brogly S, McSherry G, Dashefsky B, Oleske J, Seage GR., 3rd. Malignancy in perinatally human immunodeficiency virus-infected children in the United States. Pediatric Infect Dis J. 2005;24:237–242. - PubMed
1. Simard EP, Shiels MS, Bhatia K, Engels EA. Long-term cancer risk among people diagnosed with AIDS during childhood. Cancer Epidemiol Biomarkers Prev. 2012;21:148–154. - PMC - PubMed
1. Stefan DC, Wessels G, Poole J, et al. Infection with human immunodeficiency virus-1 (HIV) among children with cancer in South Africa. Pediatr Blood Cancer. 2011;56:77–79. - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

U01 AI069924/AI/NIAID NIH HHS/United States

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa: Record Linkage Study

Affiliation

Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa: Record Linkage Study

Authors

Affiliation

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials