Coghill AES, J. M.; Mahkoul, Z.; Orem, J.; Phipps, W.; Casper, C. Omega-3 decreases IL-6 levels in HIV and human herpesvirus-8 coinfected patients in Uganda. AIDS (London, England). 2018;32(4):505-12. Epub 2018/01/31. doi: 10.1097/qad.0000000000001722. PubMed PMID: 29381560.
Lombardo KAC, D. G.; Morales, A. J.; Carlson, C. S.; Towlerton, A. M. H.; Gerdts, S. E.; Nkrumah, F. K.; Neequaye, J.; Biggar, R. J.; Orem, J.; Casper, C.; Mbulaiteye, S. M.; Bhatia, K. G.; Warren, E. H. High-throughput sequencing of the B-cell receptor in African Burkitt lymphoma reveals clues to pathogenesis. Blood advances. 2017;1(9):535-44. Epub 2018/01/04. doi: 10.1182/bloodadvances.2016000794. PubMed PMID: 29296973; PubMed Central PMCID: PMCPMC5728594 Inc. The remaining authors declare no competing financial interests.
Menon MC, A.; Mutyaba, I.; Okuku, F.; Phipps, W.; Harlan, J.; Orem, J.; Casper, C. Whom to treat? Factors associated with chemotherapy recommendations and outcomes among patients with NHL at the Uganda Cancer Institute. PloS one. 2018;13(2):e0191967. Epub 2018/02/02. doi: 10.1371/journal.pone.0191967. PubMed PMID: 29389998; PubMed Central PMCID: PMCPMC5794100.
Coghill AES, J. M.; Mahkoul, Z.; Orem, J.; Phipps, W.; Casper, C. Omega-3 decreases interleukin-6 levels in HIV and HHV-8 co-infected patients: results from a randomized supplementation trial in Uganda. AIDS (London, England). 2017. Epub 2017/12/15. doi: 10.1097/qad.0000000000001722. PubMed PMID: 29239890.
Johnston CM, A.; Roychoudhury, P.; Greninger, A. L.; Reeves, D.; Schiffer, J.; Jerome, K. R.; Sather, C.; Diem, K.; Lingappa, J. R.; Celum, C.; Koelle, D. M.; Wald, A. Dual-strain genital herpes simplex virus type 2 (HSV-2) infection in the US, Peru, and 8 countries in sub-Saharan Africa: A nested cross-sectional viral genotyping study. PLoS medicine. 2017;14(12):e1002475. Epub 2017/12/28. doi: 10.1371/journal.pmed.1002475. PubMed PMID: 29281620; PubMed Central PMCID: PMCPMC5744910.
Low DM, E. C.; Menon, M.; Lyman, G. H.; Ddungu, H.; Namukwaya, E.; Leng, M.; Casper, C. Chemotherapy Use at the End of Life in Uganda. Journal of global oncology. 2017;3(6):711-9. Epub 2017/12/16. doi: 10.1200/jgo.2016.007385. PubMed PMID: 29244988; PubMed Central PMCID: PMCPMC5735970.
Low DM, E. C.; Menon, M.; Loggers, E.; Ddungu, H.; Leng, M.; Namukwaya, E.; Casper, C. End-of-Life Palliative Care Practices and Referrals in Uganda. Journal of palliative medicine. 2017. Epub 2017/10/24. doi: 10.1089/jpm.2017.0257. PubMed PMID: 29058504.
Matrajt LG, S.; Mayer, B. T.; Krantz, E. M.; Orem, J.; Wald, A.; Corey, L.; Schiffer, J. T.; Casper, C. Virus and host-specific differences in oral human herpesvirus shedding kinetics among Ugandan women and children. Scientific reports. 2017;7(1):13105. Epub 2017/10/14. doi: 10.1038/s41598-017-12994-0. PubMed PMID: 29026166; PubMed Central PMCID: PMCPMC5638921.
Okuku FK, E. M.; Kafeero, J.; Kamya, M. R.; Orem, J.; Casper, C.; Phipps, W. Evaluation of a Predictive Staging Model for HIV-Associated Kaposi Sarcoma in Uganda. Journal of acquired immune deficiency syndromes (1999). 2017;74(5):548-54. Epub 2017/01/21. doi: 10.1097/qai.0000000000001286. PubMed PMID: 28107226; PubMed Central PMCID: PMCPMC5340582.
Seremba ES, V.; Kalibbala, S.; Gray, R. H.; Wawer, M. J.; Nalugoda, F.; Casper, C.; Phipps, W.; Ocama, P.; Serwadda, D.; Thomas, D. L.; Reynolds, S. J. Hepatitis B incidence and prevention with antiretroviral therapy among HIV-positive individuals in Uganda. AIDS (London, England). 2017;31(6):781-6. Epub 2017/01/19. doi: 10.1097/qad.0000000000001399. PubMed PMID: 28099188; PubMed Central PMCID: PMCPMC5380792.
Duggan CD, A. L.; Tsu, V.; Jeronimo, J.; Constant, T. K. H.; Romanoff, A.; Scheel, J. R.; Patel, S.; Gralow, J. R.; Anderson, B. O. Resource-stratified implementation of a community-based breast cancer management programme in Peru. The Lancet Oncology. 2017;18(10):e607-e17. Epub 2017/10/04. doi: 10.1016/s1470-2045(17)30592-2. PubMed PMID: 28971827.
Gantt SO, J.; Krantz, E. M.; Morrow, R. A.; Selke, S.; Huang, M. L.; Schiffer, J. T.; Jerome, K. R.; Nakaganda, A.; Wald, A.; Casper, C.; Corey, L. Prospective Characterization of the Risk Factors for Transmission and Symptoms of Primary Human Herpesvirus Infections Among Ugandan Infants. The Journal of infectious diseases. 2016;214(1):36-44. Epub 2016/02/27. doi: 10.1093/infdis/jiw076. PubMed PMID: 26917575; PubMed Central PMCID: PMCPMC4907408.
Mayer BTM, L.; Casper, C.; Krantz, E. M.; Corey, L.; Wald, A.; Gantt, S.; Schiffer, J. T. Dynamics of Persistent Oral Cytomegalovirus Shedding During Primary Infection in Ugandan Infants. The Journal of infectious diseases. 2016;214(11):1735-43. Epub 2016/09/22. doi: 10.1093/infdis/jiw442. PubMed PMID: 27651417; PubMed Central PMCID: PMCPMC5144733.
Phipps WN-J, E.; Krantz, E. M.; Selke, S.; Huang, M. L.; Kambugu, F.; Orem, J.; Casper, C.; Corey, L.; Wald, A. Genital Herpes Simplex Virus Type 2 Shedding Among Adults With and Without HIV Infection in Uganda. The Journal of infectious diseases. 2016;213(3):439-47. Epub 2015/10/22. doi: 10.1093/infdis/jiv451. PubMed PMID: 26486633; PubMed Central PMCID: PMCPMC4704673.
Mutyaba IP, W.; Krantz, E. M.; Goldman, J. D.; Nambooze, S.; Orem, J.; Wabinga, H. R.; Casper, C. A Population-Level Evaluation of the Effect of Antiretroviral Therapy on Cancer Incidence in Kyadondo County, Uganda, 1999-2008. Journal of acquired immune deficiency syndromes (1999). 2015;69(4):481-6. Epub 2015/04/07. doi: 10.1097/qai.0000000000000620. PubMed PMID: 25844696; PubMed Central PMCID: PMCPMC4483147.
Adebamowo CAC, C.; Bhatia, K.; Mbulaiteye, S. M.; Sasco, A. J.; Phipps, W.; Vermund, S. H.; Krown, S. E. Challenges in the detection, prevention, and treatment of HIV-associated malignancies in low- and middle-income countries in Africa. Journal of acquired immune deficiency syndromes (1999). 2014;67 Suppl 1:S17-26. Epub 2014/08/15. doi: 10.1097/qai.0000000000000255. PubMed PMID: 25117957; PubMed Central PMCID: PMCPMC4392880.
Gray GEM, Z.; Metch, B.; Gilbert, P. B.; Bekker, L. G.; Churchyard, G.; Nchabeleng, M.; Mlisana, K.; Laher, F.; Roux, S.; Mngadi, K.; Innes, C.; Mathebula, M.; Allen, M.; McElrath, M. J.; Robertson, M.; Kublin, J.; Corey, L. Recombinant adenovirus type 5 HIV gag/pol/nef vaccine in South Africa: unblinded, long-term follow-up of the phase 2b HVTN 503/Phambili study. The Lancet Infectious diseases. 2014;14(5):388-96. Epub 2014/02/25. doi: 10.1016/s1473-3099(14)70020-9. PubMed PMID: 24560541; PubMed Central PMCID: PMCPMC4174314
Mackelprang RDC, M.; Thomas, K. K.; Hughes, J. P.; Baeten, J. M.; Wald, A.; Farquhar, C.; Fife, K.; Campbell, M. S.; Kapiga, S.; Gao, X.; Mullins, J. I.; Lingappa, J. R. Host genetic and viral determinants of HIV-1 RNA set point among HIV-1 seroconverters from sub-saharan Africa. Journal of virology. 2015;89(4):2104-11. Epub 2014/12/05. doi: 10.1128/jvi.01573-14. PubMed PMID: 25473042; PubMed Central PMCID: PMCPMC4338863.
Perti TN, M.; Gray, G.; De Bruyn, G.; Selke, S.; Magaret, A.; Huang, M. L.; Velaphi, S.; Corey, L.; Wald, A. Frequent genital HSV-2 shedding among women during labor in Soweto, South Africa. Infectious diseases in obstetrics and gynecology. 2014;2014:258291. Epub 2014/06/26. doi: 10.1155/2014/258291. PubMed PMID: 24963269; PubMed Central PMCID: PMCPMC4054931.
Phipps WS, M.; Selke, S.; Huang, M. L.; Jaoko, W.; Mandaliya, K.; Wald, A.; Casper, C.; McClelland, R. S. Oral HHV-8 replication among women in Mombasa, Kenya. Journal of medical virology. 2014;86(10):1759-65. Epub 2014/04/03. doi: 10.1002/jmv.23941. PubMed PMID: 24692069; PubMed Central PMCID: PMCPMC4289619.
Cardoso FB, N.; Distelhorst, S. R.; Bevilacqua, J. L.; Ginsburg, O.; Grunberg, S. M.; Gralla, R. J.; Steyn, A.; Pagani, O.; Partridge, A. H.; Knaul, F. M.; Aapro, M. S.; Andersen, B. L.; Thompson, B.; Gralow, J. R.; Anderson, B. O. Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. Breast (Edinburgh, Scotland). 2013;22(5):593-605. Epub 2013/09/05. doi: 10.1016/j.breast.2013.07.050. PubMed PMID: 24001709.
Cleary JD, H.; Distelhorst, S. R.; Ripamonti, C.; Rodin, G. M.; Bushnaq, M. A.; Clegg-Lamptey, J. N.; Connor, S. R.; Diwani, M. B.; Eniu, A.; Harford, J. B.; Kumar, S.; Rajagopal, M. R.; Thompson, B.; Gralow, J. R.; Anderson, B. O. Supportive and palliative care for metastatic breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. Breast (Edinburgh, Scotland). 2013;22(5):616-27. Epub 2013/08/27. doi: 10.1016/j.breast.2013.07.052. PubMed PMID: 23972474.
Coghill AEN, P. A.; Madeleine, M. M.; Richardson, B. A.; Mutyaba, I.; Okuku, F.; Phipps, W.; Wabinga, H.; Orem, J.; Casper, C. Contribution of HIV infection to mortality among cancer patients in Uganda. AIDS (London, England). 2013;27(18):2933-42. Epub 2013/08/08. doi: 10.1097/01.aids.0000433236.55937.cb. PubMed PMID: 23921614; PubMed Central PMCID: PMCPMC4319357.
Ganz PAY, C. H.; Gralow, J. R.; Distelhorst, S. R.; Albain, K. S.; Andersen, B. L.; Bevilacqua, J. L.; de Azambuja, E.; El Saghir, N. S.; Kaur, R.; McTiernan, A.; Partridge, A. H.; Rowland, J. H.; Singh-Carlson, S.; Vargo, M. M.; Thompson, B.; Anderson, B. O. Supportive care after curative treatment for breast cancer (survivorship care): resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. Breast (Edinburgh, Scotland). 2013;22(5):606-15. Epub 2013/09/07. doi: 10.1016/j.breast.2013.07.049. PubMed PMID: 24007941.
de Bruyn GM, A.; Baeten, J. M.; Lingappa, J. R.; Ndase, P.; Celum, C.; Wald, A. Mortality in members of HIV-1 serodiscordant couples in Africa and implications for antiretroviral therapy initiation: results of analyses from a multicenter randomized trial. BMC infectious diseases. 2012;12:277. Epub 2012/11/08. doi: 10.1186/1471-2334-12-277. PubMed PMID: 23130818; PubMed Central PMCID: PMCPMC3582549.
El Saghir NSA, C. A.; Anderson, B. O.; Carlson, R. W.; Bird, P. A.; Corbex, M.; Badwe, R. A.; Bushnaq, M. A.; Eniu, A.; Gralow, J. R.; Harness, J. K.; Masetti, R.; Perry, F.; Samiei, M.; Thomas, D. B.; Wiafe-Addai, B.; Cazap, E. Breast cancer management in low resource countries (LRCs): consensus statement from the Breast Health Global Initiative. Breast (Edinburgh, Scotland). 2011;20 Suppl 2:S3-11. Epub 2011/03/12. doi: 10.1016/j.breast.2011.02.006. PubMed PMID: 21392996.
Harford JBO, I. V.; Anderson, B. O.; Cazap, E.; Gradishar, W. J.; Gralow, J. R.; Kane, G. M.; Niens, L. M.; Porter, P. L.; Reeler, A. V.; Rieger, P. T.; Shockney, L. D.; Shulman, L. N.; Soldak, T.; Thomas, D. B.; Thompson, B.; Winchester, D. P.; Zelle, S. G.; Badwe, R. A. Problem solving for breast health care delivery in low and middle resource countries (LMCs): consensus statement from the Breast Health Global Initiative. Breast (Edinburgh, Scotland). 2011;20 Suppl 2:S20-9. Epub 2011/03/08. doi: 10.1016/j.breast.2011.02.007. PubMed PMID: 21376593.
Gantt SK, A.; Wald, A.; Walusansa, V.; Corey, L.; Casper, C.; Orem, J. Clinical presentation and outcome of epidemic Kaposi sarcoma in Ugandan children. Pediatric blood & cancer. 2010;54(5):670-4. Epub 2010/03/06. doi: 10.1002/pbc.22369. PubMed PMID: 20205254; PubMed Central PMCID: PMCPMC2839022.
Phipps WS, F.; Nguyen, H.; Saracino, M.; Wald, A.; Corey, L.; Orem, J.; Kambugu, A.; Casper, C. Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. PloS one. 2010;5(11):e13936. Epub 2010/11/26. doi: 10.1371/journal.pone.0013936. PubMed PMID: 21103057; PubMed Central PMCID: PMCPMC2980479
Johnston CO, J.; Okuku, F.; Kalinaki, M.; Saracino, M.; Katongole-Mbidde, E.; Sande, M.; Ronald, A.; McAdam, K.; Huang, M. L.; Drolette, L.; Selke, S.; Wald, A.; Corey, L.; Casper, C. Impact of HIV infection and Kaposi sarcoma on human herpesvirus-8 mucosal replication and dissemination in Uganda. PloS one. 2009;4(1):e4222. Epub 2009/01/22. doi: 10.1371/journal.pone.0004222. PubMed PMID: 19156206; PubMed Central PMCID: PMCPMC2625442.
Abu-Raddad LJM, A. S.; Celum, C.; Wald, A.; Longini, I. M., Jr.; Self, S. G.; Corey, L. Genital herpes has played a more important role than any other sexually transmitted infection in driving HIV prevalence in Africa. PloS one. 2008;3(5):e2230. Epub 2008/05/22. doi: 10.1371/journal.pone.0002230. PubMed PMID: 18493617; PubMed Central PMCID: PMCPMC2377333.
Cell Rep Med
Geographically dispersed patients, inconsistent treatment tracking, and limited infrastructure slow research for many orphan diseases. We assess the feasibility of a patient-powered study design to overcome these challenges for Castleman disease, a rare hematologic disorder. Here, we report initial results from the ACCELERATE natural history registry. ACCELERATE includes a traditional physician-reported arm and a patient-powered arm, which enables patients to directly contribute medical data and biospecimens. This study design enables successful enrollment, with the 5-year minimum enrollment goal being met in 2 years. A median of 683 clinical, laboratory, and imaging data elements are captured per patient in the patient-powered arm compared with 37 in the physician-reported arm. These data reveal subgrouping characteristics, identify off-label treatments, support treatment guidelines, and are used in 17 clinical and translational studies. This feasibility study demonstrates that the direct-to-patient design is effective for collecting natural history data and biospecimens, tracking therapies, and providing critical research infrastructure.
Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms (multicentric CD [MCD]). MCD includes human herpesvirus-8 (HHV-8)-associated MCD, POEMS-associated MCD, and HHV-8-/idiopathic MCD (iMCD). The first-ever diagnostic and treatment guidelines were recently developed for iMCD by an international expert consortium convened by the Castleman Disease Collaborative Network (CDCN). The focus of this report is to establish similar guidelines for the management of UCD. To this purpose, an international working group of 42 experts from 10 countries was convened to establish consensus recommendations based on review of treatment in published cases of UCD, the CDCN ACCELERATE registry, and expert opinion. Complete surgical resection is often curative and is therefore the preferred first-line therapy, if possible. The management of unresectable UCD is more challenging. Existing evidence supports that asymptomatic unresectable UCD may be observed. The anti-interleukin-6 monoclonal antibody siltuximab should be considered for unresectable UCD patients with an inflammatory syndrome. Unresectable UCD that is symptomatic as a result of compression of vital neighboring structures may be rendered amenable to resection by medical therapy (eg, rituximab, steroids), radiotherapy, or embolization. Further research is needed in UCD patients with persisting constitutional symptoms despite complete excision and normal laboratory markers. We hope that these guidelines will improve outcomes in UCD and help treating physicians decide the best therapeutic approach for their patients.
J Med Virol
BACKGROUND: Coronavirus disease 2019 (COVID-19) due to infection with SARS-CoV-2 causes substantial morbidity. Tocilizumab, an interleukin-6 receptor antagonist, might improve outcomes by mitigating inflammation. METHODS: We conducted a retrospective study of patients admitted to the University of Washington Hospital system with COVID-19 and requiring supplemental oxygen. Outcomes included clinical improvement, defined as a two-point reduction in severity on a 6-point ordinal scale or discharge, and mortality within 28 days. We used Cox proportional-hazards models with propensity score inverse probability weighting to compare outcomes in patients who did and did not receive tocilizumab. RESULTS: We evaluated 43 patients who received tocilizumab and 45 who did not. Patients receiving tocilizumab were younger with fewer comorbidities but higher baseline oxygen requirements. Tocilizumab treatment was associated with reduced CRP, fibrinogen, and temperature, but there were no meaningful differences in time to clinical improvement (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.38-2.22) or mortality (aHR, 0.57; 95% CI, 0.21-1.52). A numerically higher proportion of tocilizumab-treated patients had subsequent infections, transaminitis, and cytopenias. CONCLUSIONS: Tocilizumab did not improve outcomes in hospitalized patients with COVID-19. However, this study was not powered to detect small differences, and there remains the possibility for a survival benefit. This article is protected by copyright. All rights reserved.
In Sub-Saharan Africa, the cancer burden is predicted to increase by > 85% by 2030, the largest increase worldwide. This region has a large HIV-positive population. Drug-drug interactions (DDIs) from concomitant use of multiple drugs increase the risk of drug toxicities, sub-optimal therapy, and drug resistance. With the increase in polypharmacy, involving antiretroviral (ARV), and anticancer drugs, there is a greater need for an appreciation of clinically relevant DDIs. Anticancer and ARV drugs studied in this review were from The World Health Organization's Model List of Essential Medicines 2017. We reviewed; drug package inserts, <a href="http://www.drugbank.ca">www.drugbank.ca</a> and <a href="http://www.UpToDate.com">www.UpToDate.com</a>, to evaluate pharmacokinetic interactions with cytochrome P450 (CYP450) and ABCB1. The DDIs between drugs were assessed using the University Of Liverpool, UK HIV Drug Interactions Checker, and the LexiComp Drug Interaction tool of <a href="http://www.UpToDate.com">www.UpToDate.com</a>. About 70% of ARVs studied interact with CYP450, all involve CYP3A4, and 55% interact with ABCB1. About 65% of anticancer drugs interact with CYP450, 44% of which do so through CYP3A4. About 75% of anticancer drugs interact with ARV drugs, with nine absolute contraindications to concomitant therapy. There exist a substantial number of DDIs between ARV and anticancer drugs, primarily mediated through CYP450 enzymes. Dolutegravir based regimens offer the safest DDI profile for concurrent use with anticancer drugs. However, there are substantial gaps in our knowledge, and this study serves to highlight the need for additional research to better define these interactions and their effect on drug exposure, as attention to these DDIs is a relatively simple intervention that could lead to optimizing disease treatment.
Curr HIV/AIDS Rep
PURPOSE OF REVIEW: Immune checkpoint inhibitors targeting the programmed cell death-1 (PD-1) pathway are a class of anti-cancer immunotherapy agents changing treatment paradigms of many cancers that occur at higher rates in people living with HIV (PLWH) than in the general population. However, PLWH have been excluded from most of the initial clinical trials with these agents. RECENT FINDINGS: Two recent prospective studies of anti-PD-1 agents, along with observational studies and a meta-analysis, have demonstrated acceptable safety in PLWH. Preliminary evidence indicates activity in a range of tumors and across CD4+ T cell counts. Safety and preliminary activity data suggest monoclonal antibodies targeting PD-1 or its ligand, PD-L1, are generally appropriate for PLWH and cancers for which there are FDA-approved indications. Ongoing and future trials of anti-PD-1 and anti-PD-L1 therapy alone or in combination for HIV-associated cancers may further improve outcomes for this underserved population.
People living with HIV are a global population with increased cancer risk but their access to modern immunotherapies for cancer treatment has been limited by socioeconomic factors and inadequate research to support safety and efficacy in this population. These immunotherapies include immune checkpoint inhibitors and advances in cellular immunotherapy, particularly chimeric antigen receptor (CAR) T-cell therapy. Despite the field of cancer immunotherapy rapidly expanding with ongoing clinical trials, people with HIV are often excluded from such trials. In 2019, post-approval evaluation of anti-CD19 CAR T-cell therapy in people with HIV and aggressive B-cell lymphoma showed the feasibility of CAR T-cell therapy for cancer in this excluded group. Along with expanded treatment options for people with HIV is the ability to assess the effects of immunotherapy on the latent HIV reservoir, with certain immunotherapies showing the ability to alleviate this burden. This Series paper addresses the increased cancer burden in people with HIV, the increasing evidence for the safety and efficacy of immunotherapies in the context of HIV and cancer, and opportunities for novel applications of CAR-T therapy for the treatment of both haematological malignancies and HIV.
JCO Glob Oncol
PURPOSE: The aim of this study was to review the current status of clinical trials for HIV-associated malignancies in people living with HIV in sub-Saharan Africa (SSA) and efforts made by the AIDS Malignancy Consortium (AMC) to build capacity in SSA for HIV malignancy research. METHODS: All malignancy-related clinical trials in 49 SSA countries on ClinicalTrials.gov were reviewed and evaluated for inclusion and exclusion criteria pertaining to HIV status. Additional studies by AMC in SSA were compiled from Web-based resources, and narrative summaries were prepared to highlight AMC capacity building and training initiatives. RESULTS: Of 96 cancer trials identified in SSA, only 11 focused specifically on people living with HIV, including studies in Kaposi sarcoma, cervical dysplasia and cancer, non-Hodgkin lymphoma, and ocular surface squamous neoplasia. Recognizing the increasing cancer burden in the region, AMC expanded its clinical trial activities to SSA in 2010, with 4 trials completed to date and 6 others in progress or development, and has made ongoing investments in developing research infrastructure in the region. CONCLUSION: As the HIV-associated malignancy burden in SSA evolves, research into this domain has been limited. AMC, the only global HIV malignancy-focused research consortium, not only conducts vital HIV-associated malignancies research in SSA, but also develops pathology, personnel, and community-based infrastructure to meet these challenges in SSA. Nonetheless, there is an ongoing need to build on these efforts to improve HIV-associated malignancies outcomes in SSA.
Blood transfusion is fundamental in managing hematologic malignancies. We sought to evaluate the need and availability of blood products for patients with hematological malignancies at Uganda Cancer Institute. We prospectively studied the demand and supply of blood for patients with thrombocytopenia (platelet count ≤50 × 109/L), anemia (hemoglobin ≤10 g/dL), and bleeding (WHO grade ≥2). We used Poisson generalized estimating equation regression models for longitudinal binary outcomes. Among 91 patients, the median age was 26 years (IQR, 11-47). Thrombocytopenia occurred on ≥1 day in 58% of patients and on 49% of hospital days. Platelets were transfused to 39% of patients. The mean number of platelet units requested per day was 16.2 (range 0-30); 5.1 (range 0-15) were received. Anemia occurred on ≥1 day in 90% of patients; on 78% of days; and 68% received at least one blood transfusion. The mean number of blood units requested was 36.3 (range 8-57) units per day; 14 (range 0-30) were received. Bleeding occurred on ≥1 day in 19% of patients on 8% of hospital days. Thrombocytopenia and anemia were common, but product availability was substantially below that requested. We recommend increased blood collection and adherence to strict transfusion triggers as strategies to improve blood availability.