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HUMAN IMMUNODEFICIENCY VIRUS AND CANCER IN CHILDREN IN SOUTH AFRICA

Stefan, Daniela Cristina (2012) HUMAN IMMUNODEFICIENCY VIRUS AND CANCER IN CHILDREN IN SOUTH AFRICA. MSc by research thesis, University of York.

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Abstract

Background. Infection with human immunodeficiency virus-1 (HIV) increases the incidence of certain cancers in adults. Much less is known about the impact of infection on the risk of cancer in children. Aim. This study aimed to: 1) investigate the association between HIV infection and various cancers in children; and 2) compare the outcomes after cancer therapy between children with and without HIV. Patients and methods. In the first study, the occurrence rates of various malignancies were analyzed on a group of 882 children with cancer, where 38 were HIV positive. The association between each cancer type and HIV was analyzed using all other cancers as controls – excluding those already known to be HIV-associated: Kaposi sarcoma (KS) and lymphomas. The association between HIV and outcome after treatment with standard cytostatic protocols and anti-retroviral medication was evaluated in a second study, on a group of 669 children with cancer out of which 99 were living with HIV. The data were processed with Student’s t-test and chi-square test in order to discern the statistical significance of the differences recorded. Kaplan-Meyer survival curves were constructed and compared by means of log rank (Mantel-Cox) tests. Results. In the first study, HIV infection was positively associated with KS - all 10 cases were HIV infected, p<0.001- and Burkitt lymphoma (BL) (OR=46.2, 95% CI 16.4–130.3, based on 13/33 infected cases). In the second study, the Kaplan-Meyer survival curves do not differ significantly by HIV serostatus. However, the proportion of children alive disease-free at the end of follow-up, to the total of children in the respective category, is significantly smaller in the HIV positive subjects: 32.1% vs. 47.7% (chi-squared, 1 degree of freedom, two-tailed p=0.01). Additionally, the proportion of children who died from toxicity (including infection due to marked leucopoenia), to the total in their respective group, is significantly larger in the HIV positive subjects: 11.9% vs. 0.2% (chi-squared, 1 degree of freedom, two-tailed p<0.0001). Conclusions. HIV is associated with KS and BL among children with cancer in South Africa. The proportion of children disease-free at end of follow-up is significantly lower in children infected with HIV while the proportion of deaths due to toxicity is significantly higher.

Item Type: Thesis (MSc by research)
Academic Units: The University of York > Health Sciences (York)
Depositing User: Prof Daniela Cristina Stefan
Date Deposited: 24 Jun 2013 09:02
Last Modified: 08 Aug 2013 08:53
URI: http://etheses.whiterose.ac.uk/id/eprint/4037

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