Cancer Among Children With Perinatal Exposure to HIV and ART
Cancer Among Children With Perinatal Exposure to HIV and ART
Between 1995 and 2008, 3421 children were born to HIV-infected women in New Jersey. Of these perinatally HIV-exposed children, 90% were not infected with HIV, resulting in 3085 exposed uninfected children. Of the 2721 (88%) children with information on ARV exposure, 2326 (85%) received ARV prophylaxis to prevent the establishment of HIV infection. Among these 2326 children, 81% received ARV prophylaxis prenatally, 81% during birth, and 98% postnatally (Fig. 1). Follow-up time for all HIV-exposed uninfected children totaled 29,099 person-years; median follow-up time per child was 9.8 years (range: <1 to 16 years).
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Figure 1.
Flowchart of study sample and ARV exposure type.
Perinatally HIV-exposed uninfected children were evenly distributed across sex categories with 52% being male (Table 1). The majority of children were non-Hispanic black (69%), followed by Hispanic (19%), and non-Hispanic white (10%). Seventy-three percent of children were delivered at full term. As of December 31, 2010, 54 children (2%) had been reported to the New Jersey Office of Vital Statistics and Registry as deceased. A smaller proportion of non-Hispanic blacks were perinatally exposed to ARV (84%) than children of other races/ethnicities (range: 88%–90%). Those who had been reported to the State as deceased had a significantly lower proportion of ARV exposure than those who were not reported as deceased (70% vs. 86%; P = 0.0015).
Among the 3085 perinatally HIV-exposed uninfected children born between 1995 and 2008, 4 were diagnosed with cancer (Hodgkin nodular sclerosis, acute myeloid leukemia, hepatocellular carcinoma, and pleuropulmonary blastoma) (Table 2). Three of the diagnoses (75%) were among males, and all diagnoses were among non-Hispanic blacks. Three of the 4 children with cancer diagnoses were exposed to ARV prophylaxis at some point before, during, or after birth. The age at cancer diagnosis ranged from <1 to 7 years.
The incidence of all cancer types identified among all HIV-exposed uninfected children was 13.7 per 100,000 person-years (95% CI: 3.7 to 35.2). Cancer incidence among HIV-exposed children who were not exposed to ARV prophylaxis [22.5 per 100,000 person-years (95% CI: 0.6 to 125.3)] did not differ significantly from the incidence among children who were exposed to any ARV prophylaxis [14.3 per 100,000 person-years (95% CI: 3.0 to 41.9)] or who were exposed to ARV prophylaxis prenatally [18.1 per 100,000 person-years (95% CI: 3.7 to 52.7)], during birth [12.3 per 100,000 person-years (95% CI: 1.5 to 44.3)], or postnatally [14.7 per 100,000 person-years (95% CI: 3.0 to 42.8)] (Table 3).
The number of cases observed among individuals exposed to ARV at any time did not differ significantly from cases expected based on state (SIR = 1.21; 95% CI: 0.25 to 3.54) and national (SIR = 1.27; 95% CI: 0.26 to 3.70) reference rates. Furthermore, the observed number of cancer cases among those exposed to ARV prophylaxis at each stage, prenatal, intrapartum, and postnatal, did not differ significantly from cases expected based on state and national rates (Table 4).
Results
Between 1995 and 2008, 3421 children were born to HIV-infected women in New Jersey. Of these perinatally HIV-exposed children, 90% were not infected with HIV, resulting in 3085 exposed uninfected children. Of the 2721 (88%) children with information on ARV exposure, 2326 (85%) received ARV prophylaxis to prevent the establishment of HIV infection. Among these 2326 children, 81% received ARV prophylaxis prenatally, 81% during birth, and 98% postnatally (Fig. 1). Follow-up time for all HIV-exposed uninfected children totaled 29,099 person-years; median follow-up time per child was 9.8 years (range: <1 to 16 years).
(Enlarge Image)
Figure 1.
Flowchart of study sample and ARV exposure type.
Perinatally HIV-exposed uninfected children were evenly distributed across sex categories with 52% being male (Table 1). The majority of children were non-Hispanic black (69%), followed by Hispanic (19%), and non-Hispanic white (10%). Seventy-three percent of children were delivered at full term. As of December 31, 2010, 54 children (2%) had been reported to the New Jersey Office of Vital Statistics and Registry as deceased. A smaller proportion of non-Hispanic blacks were perinatally exposed to ARV (84%) than children of other races/ethnicities (range: 88%–90%). Those who had been reported to the State as deceased had a significantly lower proportion of ARV exposure than those who were not reported as deceased (70% vs. 86%; P = 0.0015).
Among the 3085 perinatally HIV-exposed uninfected children born between 1995 and 2008, 4 were diagnosed with cancer (Hodgkin nodular sclerosis, acute myeloid leukemia, hepatocellular carcinoma, and pleuropulmonary blastoma) (Table 2). Three of the diagnoses (75%) were among males, and all diagnoses were among non-Hispanic blacks. Three of the 4 children with cancer diagnoses were exposed to ARV prophylaxis at some point before, during, or after birth. The age at cancer diagnosis ranged from <1 to 7 years.
The incidence of all cancer types identified among all HIV-exposed uninfected children was 13.7 per 100,000 person-years (95% CI: 3.7 to 35.2). Cancer incidence among HIV-exposed children who were not exposed to ARV prophylaxis [22.5 per 100,000 person-years (95% CI: 0.6 to 125.3)] did not differ significantly from the incidence among children who were exposed to any ARV prophylaxis [14.3 per 100,000 person-years (95% CI: 3.0 to 41.9)] or who were exposed to ARV prophylaxis prenatally [18.1 per 100,000 person-years (95% CI: 3.7 to 52.7)], during birth [12.3 per 100,000 person-years (95% CI: 1.5 to 44.3)], or postnatally [14.7 per 100,000 person-years (95% CI: 3.0 to 42.8)] (Table 3).
The number of cases observed among individuals exposed to ARV at any time did not differ significantly from cases expected based on state (SIR = 1.21; 95% CI: 0.25 to 3.54) and national (SIR = 1.27; 95% CI: 0.26 to 3.70) reference rates. Furthermore, the observed number of cancer cases among those exposed to ARV prophylaxis at each stage, prenatal, intrapartum, and postnatal, did not differ significantly from cases expected based on state and national rates (Table 4).