Antiretroviral therapy, cancer prevention and care in Africa

The experience of the IeDEA West Africa Collaboration

Pr Francois Dabis and Dr Antoine Jaquet

Institute of Public Health, Epidemiology & Development (ISPED), Bordeaux University

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IeDEA International Epidemiologic Databases to Evaluate AIDS

• International research consortium established in 2005 by the US National Institute of Allergy and Infectious Diseases (NIH)

• Resource for globally diverse HIV/AIDS data

• To address research questions in HIV/AIDS unanswerable by single cohorts

• First round 2006-2011;

Second round 2011-2016: currently year 9: July 2014 to June 2015

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IeDEA Regions

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• WADA: 17 adult and 11 pediatric centres in 10 countriesBenin, Burkina Faso, Côte d’Ivoire, Ghana, Guinea, Guinea-Bissau, Mali, Nigeria, Senegal, Togo

• Coordinating Center: ISPED, Univ Bordeaux, France• Regional Office: PAC-CI, CHU Treichville, Abidjan Côte d’Ivoire

IeDEA West Africa (WADA)

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WADA Objectives (1)

• To measure the effectiveness of ART in HIV-infected individuals in West Africa in the long-term, and to assess factors that influence program and treatment outcomes

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WADA Objectives (2)

• To measure the effectiveness of ART in HIV-infected individuals in West Africa in the long-term, and to assess factors that influence program and treatment outcomes

• To increase the capacity for delivering ART durably in West Africa by increasing the capacity for monitoring clinical outcomes at the individual and population levels in adults and children

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WADA Objectives (3)

• To measure the effectiveness of ART in HIV-infected individuals in West Africa in the long-term, and to assess factors that influence program and treatment outcomes

• To increase the capacity for delivering ART durably in West Africa by increasing the capacity for monitoring clinical outcomes at the individual and population levels in adults and children

• To document the morbidity burden in HIV-infected individuals in care in HIV programs throughout West Africa to look for prevention and care solutions

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WADA study design

• Observational prospective multi-center cohort

• Pooled database of HIV-infected adults and children data followed in reference clinics in West Africa

• Additional surveys to address specific questions / specific populations

• With a focus on cancer in people living with HIV

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Current WADA merger

Retrospective and prospective cohort

• HIV-infected adults on ART N= 59,941

• HIV-2 or (HIV-2 and HIV-1) positive N= 4,818

• HIV-exposed children N= 2,819

• HIV-infected children without ART N= 1,775

• HIV-infected children with ART N= 4,899

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Context

• How routinely collected data can help addressing priority research questions in the area of HIV-related malignancies in West Africa?

– No routine data collection on cancer and its risks factors available among HIV-infected patients

– Sparse functional cancer registries

– No national death registries and no national identification number

• Need to document HIV-related malignancies and their risk factors in West Africa using appropriate approaches

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Studying cancer risk factors

• Dedicated prevalence studies in WADA participating clinics

Alcohol and tobacco use in HIV-infected patients Jaquet et al. Int J Tub Lung Dis, 2009Jaquet et al. Addiction, 2010

– Documented the diversity of substance abuse across different countries using standardized & reproducible tools

– PerspectivesEnables the extension of this approach• In other IeDEA regions• Over time in the same sites to identify trends• Minimal data collection for clinical use?

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HIV-related malignancies (1)

• Cancer of the cervix & precancerous lesions– Cancer of the cervix sufficiently frequent and eligible to an affordable

preventive approach including screening and early treatment

– Operational characteristics related to the screening in HIV-positive women were documented (Horo et al. BMC Public Health 2012)

– Factors associated with precancerous lesions among ART-treated HIV-positive women were investigated (Jaquet et al. Plos One 2014)

– Perspectives

Follow-up of initially screened women to assess the incidence of new lesions as well as recurrent lesions in previously treated womenIntegration in routine HIV care?

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HIV-related malignancies (2)

• How to document less common HIV-related malignancies?• Extend the WADA network to cancer referral centers

HIV and cancer in referral hospitals from four West African countries– Systematic collection of HIV status in patients with a malignant

condition attending clinical wards from participating referral hospitals

– Allowed the comparison of HIV seroprevalence in selected cancers known or suspected to be linked to HIV to a referent group of patients with malignant conditions unrelated to HIV

– To be presented in the following session “Beyond Control of HIV: Comorbidities and Coinfections around the World” on Wednesday 16:30 (Melbourne Room 1)

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Conclusions

• The WADA network allowed the collection of various cancer risk factors and precancerous conditions amenable to prevention strategies in West Africa– Particularly important in a context of unaffordable therapeutic

approach for cancer with advances stages

• Limitations– Unable to collect reliable and detailed information of invasive

malignancies in HIV cohorts as morbid events

• Perspective– Initiate prospective sub-cohorts of “high-risk populations” within

the WADA collaboration focusing on selected types of cancers Ex: “Hepatocarcinoma among HIV/HBV co-infected cohorts”

Acknowledgments• All patients & medical staff that participated to the cancer

studies• HIV & Cancer studies coordinators & investigators• Bordeaux: E Balestre, A Sasco• Benin: J Akakpo, J Sehonou, DM Zannou• Côte d’Ivoire: A Tanon, A. Attia, SP Eholie, E. Bissagnene• Nigeria: E Oga, M Odutola, E Jedy-Agba, M Charurat, C

Adebamowo• Togo: DK Ekouevi, B Goilibe• PACCI regional center for data management : TA Azani, P Coffie

& colleagues• WADA PIs: E Bissagnene & F Dabis