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