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Article

Association between Antiretroviral Therapy and Cancers among Children Living with HIV in Sub-Saharan Africa

1
Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
2
Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Houston, TX 77030, USA
3
Baylor College of Medicine Children’s Foundation-Uganda, Kampala, Uganda
4
Baylor College of Medicine Children’s Foundation-Tanzania, Mbeya, Tanzania
5
Baylor College of Medicine Children’s Foundation-Lesotho, Maseru, Lesotho
6
Global Hematology Oncology Pediatric Excellence Program, Texas Children’s Cancer and Hematology Centers, Houston, TX 77030, USA
7
Baylor College of Medicine Children’s Foundation-Malawi, Lilongwe, Malawi
8
Botswana-Baylor Children’s Clinical Centre of Excellence, Gabarone, Botswana
*
Author to whom correspondence should be addressed.
Current address: Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT 84112, USA.
Current address: Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, 02115, USA.
§
Michael E. Scheurer and Joseph Lubega contributed equally as senior authors.
Academic Editor: Tomi Akinyemiju
Cancers 2021, 13(6), 1379; https://doi.org/10.3390/cancers13061379
Received: 20 January 2021 / Revised: 2 March 2021 / Accepted: 14 March 2021 / Published: 18 March 2021
(This article belongs to the Special Issue Social and Molecular Basis of Cancer Health Disparities)
Most children infected with HIV live in Sub-Sahara Africa (SSA). These children are at risk of cancers related to HIV infection, but the degree of this risk and how it is influenced by antiretroviral therapy (ART) is unknown. In this study, we determined the subtypes, incidence, and risk factors of cancers in children with HIV in SSA and receiving ART with the goal of learning how we may prevent these cancers. We found that Kaposi sarcoma and lymphoma are the most common, comprising about 77% and 19% of cancers in these children, respectively. For every 100,000 person-years, 47.6 children developed cancer. Waiting to start ART until after 2 years old and having had severe immunosuppression were the two biggest risk factors for cancer that we identified. The findings justify the recommendations to start children on ART as soon as they are diagnosed with HIV regardless of their CD4 immune status.
Approximately 91% of the world’s children living with HIV (CLWH) are in sub-Saharan Africa (SSA). Living with HIV confers a risk of developing HIV-associated cancers. To determine the incidence and risk factors for cancer among CLWH, we conducted a nested case-control study of children 0–18 years from 2004–2014 at five centers in four SSA countries. Incident cases of cancer and HIV were frequency-matched to controls with HIV and no cancer. We calculated the incidence density by cancer type, logistic regression, and relative risk to evaluate risk factors of cancer. The adjusted incidence density of all cancers, Kaposi sarcoma, and lymphoma were 47.6, 36.6, and 8.94 per 100,000 person-years, respectively. Delayed ART until after 2 years of age was associated with cancer (OR = 2.71, 95% CI 1.51, 4.89) even after adjusting for World Health Organization clinical stage at the time of enrolment for HIV care (OR = 2.85, 95% CI 1.57, 5.13). The relative risk of cancer associated with severe CD4 suppression was 6.19 (p = 0.0002), 2.33 (p = 0.0042), and 1.77 (p = 0.0305) at 1, 5, and 10 years of ART, respectively. The study demonstrates the high risk of cancers in CLWH and the potential benefit of reducing this risk by the early initiation of ART. View Full-Text
Keywords: pediatric; HIV-associated cancers; Kaposi sarcoma; lymphoma; antiretroviral therapy; sub-Sahara Africa pediatric; HIV-associated cancers; Kaposi sarcoma; lymphoma; antiretroviral therapy; sub-Sahara Africa
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MDPI and ACS Style

Haq, H.; Elyanu, P.; Bulsara, S.; Bacha, J.M.; Campbell, L.R.; El-Mallawany, N.K.; Keating, E.M.; Kisitu, G.P.; Mehta, P.S.; Rees, C.A.; Slone, J.S.; Kekitiinwa, A.R.; Matshaba, M.; Mizwa, M.B.; Mwita, L.; Schutze, G.E.; Wanless, S.R.; Scheurer, M.E.; Lubega, J. Association between Antiretroviral Therapy and Cancers among Children Living with HIV in Sub-Saharan Africa. Cancers 2021, 13, 1379. https://doi.org/10.3390/cancers13061379

AMA Style

Haq H, Elyanu P, Bulsara S, Bacha JM, Campbell LR, El-Mallawany NK, Keating EM, Kisitu GP, Mehta PS, Rees CA, Slone JS, Kekitiinwa AR, Matshaba M, Mizwa MB, Mwita L, Schutze GE, Wanless SR, Scheurer ME, Lubega J. Association between Antiretroviral Therapy and Cancers among Children Living with HIV in Sub-Saharan Africa. Cancers. 2021; 13(6):1379. https://doi.org/10.3390/cancers13061379

Chicago/Turabian Style

Haq, Heather, Peter Elyanu, Shaun Bulsara, Jason M. Bacha, Liane R. Campbell, Nader K. El-Mallawany, Elizabeth M. Keating, Grace P. Kisitu, Parth S. Mehta, Chris A. Rees, Jeremy S. Slone, Adeodata R. Kekitiinwa, Mogomotsi Matshaba, Michael B. Mizwa, Lumumba Mwita, Gordon E. Schutze, Sebastian R. Wanless, Michael E. Scheurer, and Joseph Lubega. 2021. "Association between Antiretroviral Therapy and Cancers among Children Living with HIV in Sub-Saharan Africa" Cancers 13, no. 6: 1379. https://doi.org/10.3390/cancers13061379

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