RESUMO
BACKGROUND: To clarify which types of cancer result from AIDS, we compared the cancer experiences of people with AIDS with those of the general population by matching population-based cancer and AIDS registries in the USA and Puerto Rico. METHODS: We used a probabilistic matching algorithm to compare names, birth dates, and, where available, social-security numbers of 98,336 people with AIDS and 1,125,098 people with cancer aged less than 70 years. We defined AIDS-related cancers as those with both significantly raised incidence post-AIDS and increasing prevalence from 5 years pre-AIDS to 2 years post-AIDS. FINDINGS: Among people with AIDS, we found 7028 cases of Kaposi's sarcoma (KS), 1793 of non-Hodgkin lymphoma (NHL), and 712 other cases of histologically defined cancer. Incidence rates among people with AIDS were increased 310-fold for KS, 113-fold for NHL, and 1.9-fold (95% CI 1.5-2.3) for other cancers. Of 38 malignant disorders other than KS and NHL, only angiosarcoma (36.7-fold), Hodgkin's disease (7.6-fold), multiple myeloma (4.5-fold), brain cancer (3.5-fold), and seminoma (2.9-fold) were raised and increasing significantly (p<0.02) from the pre-AIDS to the post-AIDS period. INTERPRETATION: Interpretation is complicated by screening and shared risk factors, such as sexual behaviour and cigarette smoking. However, our data indicate that AIDS leads to a significantly increased risk of Hodgkin's disease, multiple myeloma, brain cancer, and seminoma. Immunological failure to control herpes or other viral infections may contribute to these malignant diseases.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Linfoma não Hodgkin/epidemiologia , Neoplasias/epidemiologia , Sarcoma de Kaposi/epidemiologia , Adulto , Algoritmos , Feminino , Humanos , Incidência , Linfoma não Hodgkin/virologia , Masculino , Pessoa de Meia-Idade , Neoplasias/virologia , Vigilância da População , Prevalência , Porto Rico/epidemiologia , Sistema de Registros , Risco , Fatores de Risco , Sarcoma de Kaposi/virologia , Estados Unidos/epidemiologiaRESUMO
PIP: 146 HIV-1-positive pregnant women and 143 matched HIV-1-uninfected pregnant women participated in a study to assess the association of human herpes virus 8 (HHV8) and the development of Kaposi's sarcoma. 98 of the 189 evaluable infants born to the women were born to HIV-1-positive mothers; 26 of these 98 infants were infected with HIV-1. Maternal serum samples were available for all but 18. The sera were diluted and screened for antibodies to the HHV8 latency-associated nuclear antigens (LANA) expressed in the BCBL-1 cell line. Coded sera randomly included from 10 healthy blood donors were negative for anti-LANA, while sera from two patients with AIDS and Kaposi's sarcoma were positive. 12 of the 289 pregnant women were seropositive for anti-HHV8, a proportion consistent with other findings in high-risk non-pregnant women. HIV-1-infected Haitians have an increased risk of Kaposi's sarcoma. The present cohort included 91 women of Haitian origin, nine who were seropositive for anti-HHV8. The proportion of HHV8 seropositive women among Haitians is significantly higher than among other women. HHV8 seropositivity was not increased among women with HIV-1 infection and all 189 infants were seronegative for HHV8. These findings support the association between HHV8 infection and the risk of Kaposi's sarcoma.^ieng
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/virologia , Anticorpos Antivirais/sangue , Infecções por Herpesviridae/virologia , Herpesvirus Humano 8/imunologia , Complicações Infecciosas na Gravidez/virologia , Estudos de Casos e Controles , Feminino , Haiti/etnologia , Humanos , Cidade de Nova Iorque , Gravidez , Prevalência , Características de ResidênciaRESUMO
BACKGROUND: We evaluated data from prospectively identified twins to understand better the mechanisms and covariates of mother-to-infant transmission of human immunodeficiency virus (HIV). METHODS: Using data obtained from an international collaboration and multivariate quasilikelihood modeling, we assessed concordance, birth order, route of delivery, and other factors for HIV infection in 115 prospectively studied twin pairs born to HIV-infected women. Actuarial methods were used to evaluate overall survival and survival free of acquired immunodeficiency syndrome for HIV-infected twins. RESULTS: Infection with HIV occurred in 35% of vaginally delivered firstborn (A) twins, 16% of cesarean-delivered A twins, 15% of vaginally delivered second-born (B) twins, and 8% of cesarean-delivered B twins. In a multivariate model, the adjusted odds ratios for HIV infection were 11.8 (confidence interval: 3.1 to 45.3) for concordance of infection with the co-twin, 2.8 (confidence interval: 1.6 to 5.0) for A versus B twins, and 2.7 (confidence interval: 1.1 to 6.6) for vaginally delivered versus cesarean-delivered twins. Among A twins, 52% (lower confidence limit: 6%) of the transmission risk was related to vaginal delivery. Comparing vaginally delivered A twins (infants most exposed to vaginal mucus and blood) to cesarean-delivered B twins (infants least exposed), 76% (lower confidence limit: 48%) of the transmission risk was related to vaginal exposure. Infected B twins had slightly reduced Quetelet indexes and more rapid development of illnesses related to acquired immunodeficiency syndrome. CONCLUSIONS: These results indicate that HIV infection of B twins occurs predominantly in utero, whereas infection of A twins (and, by implication, singletons) occurs predominantly intrapartum. We propose that intrapartum transmission is responsible for the majority of pediatric HIV infections and that reducing exposure to HIV in the birth canal may reduce transmission of the virus from mother to infant.
Assuntos
Doenças em Gêmeos , Infecções por HIV/transmissão , HIV-1 , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/virologia , Gêmeos , Ordem de Nascimento , Parto Obstétrico , Progressão da Doença , Doenças em Gêmeos/epidemiologia , Feminino , Infecções por HIV/congênito , Infecções por HIV/mortalidade , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Gravidez , Probabilidade , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Análise de SobrevidaRESUMO
Adult T-cell leukemia/lymphoma (ATL), a malignancy of mature CD4-positive lymphocytes, has been etiologically linked to the human retrovirus HTLV-I. Although a long latent period is suggested from migrant studies, little prospective information on the risk of developing ATL among persons with HTLV-I infection is available. We present here a model for ATL risk based upon age- and sex-specific HTLV-I seroprevalence data from a cross-sectional survey of 13,000 Jamaicans and ATL incidence data from a 2 1/2-year case-control study. By examining the age-specific incidence of ATL relative to both adult and childhood-acquired seropositivity versus childhood-acquired seropositivity alone, we provide evidence in support of the hypothesis that childhood infection with HTLV-I is important to the development of ATL. Using this model, the cumulative lifetime risk of ATL for those infected before age 20 is estimated to be 4.0% for males and 4.2% for females. Under this hypothesis, HTLV-I-associated diseases with shorter latent periods, such as tropical spastic paraparesis, should have a higher incidence in adult females than in adult males.
Assuntos
Leucemia-Linfoma de Células T do Adulto/etiologia , Modelos Biológicos , Adolescente , Adulto , Fatores Etários , Criança , Feminino , Infecções por HTLV-I/epidemiologia , Humanos , Jamaica , Leucemia-Linfoma de Células T do Adulto/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores de TempoRESUMO
Adult T-cell leukemia/lymphoma (ATL), a malignancy of mature CD4-positive lymphocytes, has been etiologically linked to the human retrovirus HTLV-I. Although a long latent period is suggested from malignant studies, little prospective information on the risk of developing ATL among persons with HTLV-I infection is available. We present here a model of ATL risk based upon age- and sex-specific HTLV-I seroprevalence data from a cross-sectional survey of 13,000 Jamaicans and ATL incidence data from a 2« year case-control study. By examining the age-specific incidence of ATL relative to both adult and childhood-acquired seropositivity versus childhood-acquired seropositivity alone, we provide evidence in support of the hypothesis that childhood infection with HTLV-I is important to the development of ATL. Using this model, the cumulative lifetime risk of ATL for those infected before age 20 is estimated to be 4.0 percent for males and 4.2 percent for females. Under this hypothesis, HTLV-I-associated diseases with shorter latent periods, such as tropical spastic paraparesis, should have a higher incidence in adult females than in adult males. (AU)
Assuntos
Humanos , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Leucemia-Linfoma de Células T do Adulto/etiologia , Modelos Biológicos , Fatores Etários , Infecções por HTLV-I/epidemiologia , Jamaica , Leucemia-Linfoma de Células T do Adulto/epidemiologia , Fatores Sexuais , Fatores de TempoRESUMO
The discovery of human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) has opened a window to the understanding of the spectrum of the acquired immunodeficiency syndrome (AIDS) and related clinical syndromes. Analysis of risk factors for seropositivity has shown that HTLV-III is transmitted most efficiently via routes that involve close personal contact or parenteral exposure. Longitudinal studies have shown that HTLV-III infection has a long latent period. The prevalence of AIDS in different geographic areas and among different risk groups appears to depend in part on duration of exposure. Co-factors for AIDS outcome such as manner and route of exposure, underlying immune status, and host susceptibility are also likely to play a role in risk.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Anticorpos Antivirais/análise , Deltaretrovirus/imunologia , Síndrome da Imunodeficiência Adquirida/transmissão , Eletroforese , Ensaio de Imunoadsorção Enzimática , Reações Falso-Positivas , Haiti/etnologia , Hemofilia A/terapia , Homossexualidade , Humanos , Injeções Intravenosas , Doenças Linfáticas/microbiologia , Masculino , Risco , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/complicações , Fatores de TempoRESUMO
The incidence of Kaposi's sarcoma (KS) was examined with the use of data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. KS is a manifestation of the recent epidemic of acquired immunodeficiency syndrome (AIDS) that has occurred particularly among homosexual men. The incidence of KS in 1973-79 was found to be higher (0.29 male and 0.07 female cases/100,000/yr) than is usually cited for the pre-AIDS KS incidence rates. Collectively, the 9 SEER registries in the United States showed only a slight increase in the incidence of KS between 1973-79 and 1980-81. However, the SEER registry covering San Francisco, which is a high-risk area for AIDS, showed a marked excess of KS in 1981. The KS case rate among never-married men younger than 50 years old, a surrogate index of homosexuality, was found to be markedly elevated in the post-AIDS period, compared with the case rate of a reference disease, mycosis fungoides. Never-married men younger than 50 years old, therefore, constitute a SEER-identifiable population who can be monitored for risk of KS and other neoplasms that might be related to AIDS. In addition, the incidence rate of KS in the SEER registry of Puerto Rico was generally higher than that in the U.S. SEER registries, despite data that suggested that KS may be underreported. The demographic characteristics of patients diagnosed as having KS in Puerto Rico suggested the classical rather than the AIDS-related form of KS.