<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_401"
                     title="Perinatal HIV Infection Highest Among Blacks"
                     score="0.01"
                     href="http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/18305?impressionId=1265795649303"
                     
      &lt;p&gt;The rate of mother-to-child HIV transmission among infants is 23 times higher for blacks than whites, the CDC reported.&lt;/p&gt;
&lt;p&gt;Although rates of perinatal HIV infection have fallen by more than 90% since the 1990s, racial and ethnic disparities not only remain but may be increasing, the agency said in the Feb. 5 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The finding comes from an analysis of surveillance data from the 34 states that have had confidential name-based reporting since at least December 2003, the agency said.&lt;/p&gt;
&lt;p&gt;In those states, from 2004 through 2007, the overall rate of diagnoses of perinatal HIV infection among children a year old or younger was 2.7 per 100,000, the agency said.&lt;/p&gt;
&lt;p&gt;But the rate among blacks was 12.3 per 100,000, compared with 2.0 for children who were Hispanic, 1.6 for those of other or multiple races, and 0.5 for white infants.&lt;/p&gt;
&lt;p&gt;Compared with the rate among white infants, the rate ratios were 23.1, 3.8, and 3.1 for black, Hispanic, and children of other or multiple races, respectively, the CDC said.&lt;/p&gt;
&lt;p&gt;On the positive side, rates fell significantly during the period for black and Hispanic children  --  from 14.8 to 10.2 per 100,000 for blacks and from 2.9 to 1.7 per 100,000 for Hispanics, the CDC found. The changes were significant at &lt;em&gt;P&lt;/em&gt;=0.003 and &lt;em&gt;P&lt;/em&gt;=0.04, respectively.&lt;/p&gt;
&lt;p&gt;There were no significant changes for white children and those of other or multiple races, the CDC said.&lt;/p&gt;
&lt;p&gt;During the study period, 69% of all children younger than 13 who were diagnosed with HIV were black, 16% were Hispanic, 11% were white, and 4% were of other or multiple races.&lt;/p&gt;
&lt;p&gt;The CDC said that racial and ethnic disparities in HIV/AIDS incidence among children have been known since 1981-1986, when 78% of children with AIDS were either black or Hispanic. Similar disparities have been seen in rates of perinatal HIV infection, the CDC said.&lt;/p&gt;
&lt;p&gt;The annual total of perinatal HIV infections has fallen about 90% since 1991, the agency said, but, despite that, 85% of reported infections during 2004-2007 were in children who were black or Hispanic.&lt;/p&gt;
&lt;p&gt;One limitation of the study, the CDC said, is that the data come from only 34 states and may not give a complete picture, especially since some areas with high AIDS morbidity  --  such as California and the District of Columbia  --  were left out.&lt;/p&gt;
&lt;p&gt;But, the agency argued, the findings in this report are &quot;consistent&quot; with disparities seen among people with AIDS from all 50 states.&lt;/p&gt;
&lt;p&gt;To eliminate perinatal HIV transmission, the CDC said all HIV-infected pregnant women must: &lt;ul&gt; &lt;li&gt;Be diagnosed before they get pregnant or soon after&lt;/li&gt; &lt;li&gt;Get prenatal care&lt;/li&gt; &lt;li&gt;Follow an antiretroviral regimen during pregnancy&lt;/li&gt; &lt;li&gt;Have a cesarean delivery at 38 weeks&apos; gestation if the virus has not been suppressed&lt;/li&gt; &lt;li&gt;Get antiretroviral medication during labor and delivery&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Antiretroviral medication also should be given to the newborns within the first hours after birth and for the first six weeks of life, the CDC said.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_330"
                     title="Immune Cells Point to Skin Cancer Risk after Transplants (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/Nephrology/KidneyTransplantation/tb/18200?impressionId=1265795649303"
                     
      Monitoring two types of immune cells in kidney transplant recipients might identify patients with an increased risk of skin cancer, British investigators reported.&lt;br&gt;
&lt;br&gt;Increased levels of T-regulatory cells (Tregs) more than doubled the risk of squamous cell cancer of the skin. Decreased levels of natural killer (NK) cells were associated with more than a five-fold increased risk of skin cancer.&lt;br&gt;
&lt;br&gt;Both immune parameters had substantially greater predictive power than a history of squamous-cell skin cancer, according to an online report in the &lt;em&gt;Journal of the American Society of Nephrology&lt;/em&gt; by a team of Oxford University investigators.&lt;/p&gt;
&lt;p&gt;&quot;Squamous cell cancer of the skin affects about 30% of kidney transplant patients after 10 years of immunosuppression,&quot; Robert Carroll, MD, currently of Queen Elizabeth Hospital in Woodville, Australia, observed in a statement.&lt;/p&gt;
&lt;p&gt;&quot;A small number of patients develop multiple skin cancers per year, but there is no laboratory test to determine which transplant recipients will develop multiple skin cancers in the future.&quot;&lt;/p&gt;
&lt;p&gt;&quot;If a test can confirm high risk of skin cancer development, this may help clinicians to tailor immunosuppressive regimens for individual patients,&quot; he added.&lt;/p&gt;
&lt;p&gt;Long-term immunosuppression, such as that required for transplant recipients, confers an increased risk of squamous-cell skin cancer.&lt;/p&gt;
&lt;p&gt;Estimates of the magnitude have ranged as high as 200 times greater than the general population, the authors wrote. Additionally, 3% of organ transplant recipients require extensive plastic surgery each year as a result of skin cancer lesions.&lt;/p&gt;
&lt;p&gt;Age at transplantation and the immunosuppression dosage are the principal determinants of skin-cancer risk, and the dosage of immunosuppression also influences the risk of metastasis from squamous-cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;In the general population, cancer has been associated with increased levels of Tregs, including CDR&lt;sup&gt;+&lt;/sup&gt;CD25&lt;sup&gt;high&lt;/sup&gt;FOXP3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt;CD28&lt;sup&gt;-&lt;/sup&gt; cells. The same types of cells could play a role in the risk of skin cancer among organ transplant recipients, the authors wrote.&lt;/p&gt;
&lt;p&gt;Within the tumor microenvironment, Tregs may impair the antitumor activity of CD8&lt;sup&gt;+&lt;/sup&gt; and NK cell. However, in organ transplant recipients, Tregs help control or prevent rejections and may help improve long-term outcomes.&lt;/p&gt;
&lt;p&gt;Different immunosuppressive drugs affect Tregs differently, the authors continued. Sirolimus (Rapamune), for example, increases the number of FOXP3&lt;sup&gt;+&lt;/sup&gt; cells, whereas cyclosporine decreases Treg numbers.&lt;/p&gt;
&lt;p&gt;&quot;Tregs have not been assessed in relation to cancer after transplantation,&quot; the authors wrote. &quot;We therefore investigated the hypothesis that squamous-cell cancer in kidney transplant recipients would be associated with an increased number of Tregs.&quot;&lt;/p&gt;
&lt;p&gt;To examine the hypothesis, investigators phenotyped peripheral blood from 65 kidney transplant recipients with squamous skin cancer and 51 recipients without skin cancer, matched for age, sex, and duration of immunosuppression.&lt;/p&gt;
&lt;p&gt;They also quantified lymphocyte populations in skin cancer lesions from a subset of 25 patients and matched them with 25 other nontransplant patients with squamous cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;The kidney transplant recipients had a median follow-up of 340 days. The investigators found that a concentration of &amp;gt;35 peripheral FOXP3&lt;sup&gt;+&lt;/sup&gt;CD4&lt;sup&gt;+&lt;/sup&gt;CD127&lt;sup&gt;low&lt;/sup&gt; regulatory T cells/&amp;#181;L was associated with a hazard ratio for squamous cell skin cancer of 2.48 (95% CI 1.04 to 5.98).&lt;/p&gt;
&lt;p&gt;An NK cell count &amp;lt;100 cells/&amp;#181;L was associated with a skin cancer hazard ratio of 5.6 (95% CI 1.31 to 24). A history of squamous cell cancer of the skin increased the risk of skin cancer recurrence by a third (HR 1.33, 95% CI 1.15 to 1.53).&lt;/p&gt;
&lt;p&gt;&quot;If similar immune phenotypes are predictive in other kidney transplant recipient populations, then immune phenotype method has the potential to inform immunosuppressive regimen manipulation in kidney transplant recipients at high risk for developing multiple squamous cell cancers,&quot; the authors concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_196"
                     title="Adjuvant Therapy Improves Survival in Pancreatic Cancer (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Oncology/OtherCancers/tb/18039?impressionId=1265795649303"
                     
      &lt;p&gt;Adjuvant chemoradiotherapy significantly improves survival of patients with resectable pancreatic cancer, according to medical records of almost 3,000 patients.&lt;/p&gt;
&lt;p&gt;Chemoradiotherapy extended median survival by more than 30% compared with surgical resection only, researchers reported in the January &lt;em&gt;Archives of Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&lt;em&gt; &lt;/em&gt;In a multivariate analysis, adjuvant chemoradiotherapy proved to be one of only three predictors of improved survival, the other two being treatment at high-volume and academic centers.&lt;/p&gt;
&lt;p&gt;&quot;This analysis provides strong evidence in a real-world setting that postoperative chemoradiotherapy and possibly adjuvant radiotherapy alone improve clinical outcome in patients with pancreatic cancer,&quot; Relin Yang, MD, of the University of Miami, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;We further substantiate that this benefit is independent of the improved clinical outcomes obtained at high-volume centers and teaching facilities,&quot; they added.&lt;/p&gt;
&lt;p&gt;&quot;Nonetheless, this benefit remains modest, underscoring that further investigation is needed to establish a better adjuvant regimen after complete resection of pancreatic cancer.&quot;&lt;/p&gt;
&lt;p&gt;Complete surgical resection remains the only curative option for patients with early-stage pancreatic adenocarcinoma. Fewer than 25% of patients have cancer amenable to resection. For that small subset of patients, the role of adjuvant therapy remains controversial, the authors wrote.&lt;/p&gt;
&lt;p&gt;To address the issue, Yang and colleagues analyzed data from a population-based cancer registry. They augmented the data&apos;s predictive potential with information related to patient demographics, comorbidities, treatment, and type of facility.&lt;/p&gt;
&lt;p&gt;The authors identified 2,877 patients whose pancreatic adenocarcinoma was diagnosed and treated surgically with curative intent from 1998 to 2002. About 60% of the patients were older than 65. Some 90% were white (86.7% non-Hispanic), and 90% had no history of alcohol abuse.&lt;/p&gt;
&lt;p&gt;The authors reported that 51.9% of patients received neither chemotherapy nor chemoradiotherapy. About 25% received chemoradiotherapy, and another 10% received chemotherapy alone. Most patients were treated at low-volume centers (57.6%) and nonteaching facilities (72.8%).&lt;/p&gt;
&lt;p&gt;Median overall survival was 15 months, and 90-day postsurgical survival was 88.8%. Patients younger than 40 had the best survival (25.7 months versus 13.4 months for patients older than 65, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Race, ethnicity, and abstention from alcohol and tobacco did not significantly influence survival. Survival decreased as a patient&apos;s poverty level increased. Localized disease, well-differentiated tumors, and smaller tumor size were associated with significantly better survival (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Patients treated with surgery only had a significantly lower (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) median overall survival of 12.6 months compared with patients who received chemotherapy or radiation preoperatively (19.9 months) or postoperatively (17.0 months).&lt;/p&gt;
&lt;p&gt;Median survival was 18.2 months among patients treated at high-volume centers versus 13.1 months at low-volume centers (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001). Treatment at a teaching facility was associated with a median survival of 19.8 months compared with 13.6 months for nonteaching facilities (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Multivariate analysis correcting for comorbidities showed that postoperative chemoradiotherapy significantly reduced the mortality hazard ratio (HR 0.69, &lt;em&gt;P&lt;/em&gt;=0.04). The reduced hazard exceeded the benefit associated with treatment at a high-volume center (HR 0.85, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) or at a teaching facility (HR 0.84, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) and was independent of facility type.&lt;/p&gt;
&lt;p&gt;The authors confirmed findings from other studies showing a beneficial effect of treatment in high-volume and teaching facilities, and a benefit for all patients who receive adjuvant chemoradiotherapy, Nita Ahuja, MD, of Johns Hopkins, wrote in a commentary.&lt;/p&gt;
&lt;p&gt;However, the study had several prominent weaknesses: missing information on cancer stage in more than 50% of patients, unknown margin status, and no information on the type or duration of adjuvant therapy.&lt;/p&gt;
&lt;p&gt;The study also did not address another major controversy involving adjuvant therapy for pancreatic cancer.&lt;/p&gt;
&lt;p&gt;&quot;At the end of the day, the present study will do little to quell the debate over the relative benefits of adjuvant chemoradiotherapy compared with chemotherapy alone after surgical resection of pancreatic cancer,&quot; Ahuja wrote.&lt;/p&gt;
&lt;p&gt;North Americans have a bias toward adjuvant chemoradiotherapy, supported primarily by data from a single small randomized clinical trial and several retrospective studies, Ahuja continued. European clinicians favor adjuvant chemotherapy based on one large clinical trial showing a benefit for chemotherapy and another showing no survival advantage for chemoradiotherapy.&lt;/p&gt;
&lt;p&gt;&quot;The present study will do little to change the minds of either camp,&quot; Ahuja concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Neither Yang and co-authors nor Ahuja had any disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_192"
                     title="High Marks for Laparoscopic Liver Resection (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Oncology/OtherCancers/tb/18031?impressionId=1265795649303"
                     
      &lt;p&gt;Laparoscopic liver resection compares favorably with laparotomy for removal of colorectal cancer metastases, data from a 10-year retrospective study suggest.&lt;/p&gt;
&lt;p&gt;Laparoscopic resection was associated with intraoperative (&amp;lt;7%) and postoperative (&amp;lt;13%) complication rates comparable to those of a historical cohort whose liver metastases were treated by open surgery.&lt;/p&gt;
&lt;p&gt;The 30-day mortality was &amp;lt;1% with laparoscopic resection, also comparable to laparotomy, as was long-term survival, Norwegian investigators reported in the January issue of &lt;em&gt;Archives of Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Few cases required conversion to open surgery, and most of the cases involved recurrence following prior laparotomic resection.&lt;/p&gt;
&lt;p&gt;&quot;Laparoscopic liver resection is a favorable alternative to open resection for benign and malignant liver lesions,&quot; Airazat M. Kazaryan, MD, of Rikshospitalet University Hospital in Oslo, and colleagues concluded. &quot;It is associated with low morbidity and mortality. Long-term survival after laparoscopic resection of colorectal metastases is comparable to that after open resections.&quot;&lt;/p&gt;
&lt;p&gt;Laparoscopy has documented advantages of open surgery for a variety of abdominal procedures, the authors noted. Moreover, the feasibility and safety of laparoscopic liver resection have been documented in several reports. However, many centers continue to offer only open surgery because of surgeon training and learning curve issues.&lt;/p&gt;
&lt;p&gt;Additionally, long-term oncologic outcomes with laparoscopic surgery have been poorly documented, the authors conceded.&lt;/p&gt;
&lt;p&gt;To fill in some of these blanks, Kazaryan and colleagues reviewed their experience with laparoscopic liver resection from 1998 to 2008.&lt;/p&gt;
&lt;p&gt;The analysis included 149 laparoscopic procedures and 177 liver resections for malignant and benign lesions. The total included 113 patients with malignant lesions, 96 of which were colorectal metastases.&lt;/p&gt;
&lt;p&gt;Six patients had carcinoid tumors, one had pancreatic glucagonoma, two had melanoma, and one had pancreatic cancer. Additionally, seven patients had primary hepatic malignancies.&lt;/p&gt;
&lt;p&gt;Five (3.4%) procedures were converted to open surgery and one to laparoscopic radiofrequency tumor ablation.&lt;/p&gt;
&lt;p&gt;Median operative time was 164 minutes and median blood loss was 350 mL. Of 143 procedures that did not require conversion to open surgery, blood loss &amp;gt;1000 mL occurred in 24 (16.8%) cases and blood loss &amp;gt;500 mL in 47 (32.9%) of cases.&lt;/p&gt;
&lt;p&gt;Intraoperative complications occurred during 10 (6.7%) procedures, including seven perforations of adherent or adjacent organs. One patient died.&lt;/p&gt;
&lt;p&gt;Postoperatively, 121 (84.6%) patients were discharged home and the remainder to local hospitals. Postoperative complications occurred in 18 (12.6%) procedures.&lt;/p&gt;
&lt;p&gt;The oncologic resections resulted in tumor-free surgical margins in 94% of specimens. Patients undergoing procedures for colorectal metastases had a five-year survival of 46%.&lt;/p&gt;
&lt;p&gt;&quot;The training of surgeons is a major issue for general acceptance of this technique,&quot; the authors wrote. &quot;Healthcare managers should be encouraged to promote training in this advanced technique. The time has come to prove the observed benefits of laparoscopic approach by randomized prospective trials.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2420"
                     title="Immunosuppression Linked to HPV-Related Cancers in AIDS Patients"
                     score="-0.006"
                     href="http://www.medpagetoday.com/InfectiousDisease/HIVAIDS/tb/15329?impressionId=1265795649303"
                     
       SAN FRANCISCO, July 31 -- The elevated risk of human papillomavirus (HPV)-related cancers in AIDS patients rises with the degree of immunosuppression, researchers found. 
              &lt;br&gt;&lt;br&gt;The excess risk was at least 1.6-fold for invasive cancers and at least 8.9-fold for in situ tumors, Anil K. Chaturvedi, PhD, of the National Cancer Institute in Rockville, Md., and colleagues reported online in the &lt;em&gt;Journal of the National Cancer Institute&lt;/em&gt;. 
              &lt;br&gt;&lt;br&gt;Low CD4 T-cell count at the time of AIDS onset predicted significantly higher risk of invasive anal cancer among men (&lt;em&gt;P&lt;/em&gt;=0.006) and a trend for higher risk among women for in situ cancer of the vagina or vulva as well (&lt;em&gt;P&lt;/em&gt;=0.077 and &lt;em&gt;P&lt;/em&gt;=0.055). 
              &lt;br&gt;&lt;br&gt;Statistical power may have been an issue for the other, less common cancer types in association with immunity, Dr. Chaturvedi noted. 
              &lt;br&gt;&lt;br&gt;&quot;Given that individuals currently infected with HIV may obtain little benefit from available HPV vaccines . . . our results underscore the need for effective screening for cervical cancer and anal cancer among persons with HIV infection or AIDS,&quot; the authors wrote. 
              &lt;p&gt;These retrospective study findings add to mounting evidence for a biological link between HIV/AIDS -- and immunosuppression in general -- with risk of HPV-associated cancers, commented Howard D. Strickler, MD, MPH, of Albert Einstein College of Medicine in New York. 
              &lt;p&gt;But his accompanying commentary cautioned that this relationship is still unproven and has only moderate strength that varies by cancer type. 
              &lt;p&gt;Nevertheless, &quot;as the population of HIV-infected patients survives longer through use of HAART [highly active antiretroviral therapy] and increasingly enters the older age groups in which HPV-related cancer rates reach their peak,&quot; he wrote, &quot;these tumors will represent an increasing clinical and public health burden (regardless of whether these are biological relationships).&quot; 
              &lt;p&gt;The researchers examined rates of HPV-associated cancers in cancer registries for 499,230 individuals diagnosed with AIDS from 1980 through 2004. 
              &lt;p&gt;Compared with the general population, the standardized incidence ratios were significantly elevated for the following HPV-associated cancers in the five years after AIDS diagnosis: 
              &lt;ul&gt;
              &lt;li&gt;Anal cancer in men (SIR for in situ 68.6 and 34.6 for invasive)
              &lt;li&gt;Anal cancer in women (SIR 33.0 for in situ and 14.5 for invasive)
              &lt;li&gt;Cervical cancer (SIR 8.9 for in situ and 5.6 for invasive)
              &lt;li&gt;Cancer of the penis (SIR 19.7 for in situ and 5.3 for invasive)
              &lt;li&gt;Cancer of the vagina or vulva (SIR 27.2 for in situ and 5.8 for invasive)
              &lt;li&gt;Oropharyngeal cancer (SIR 1.6 for invasive)
              &lt;/ul&gt; 
              &lt;p&gt;Extending the observation period to the five years before AIDS onset revealed significantly increasing trends in risk over time for all the HPV-related cancers except in situ anal cancer among women and invasive cancers of the penis or oropharynx. 
              &lt;p&gt;Invasive cervical cancer -- an AIDS-defining illness -- was excluded from this analysis since no cases can occur before AIDS onset by definition. 
              &lt;p&gt;Not only did individuals have greater risk of HPV-associated cancers with longer duration of immune-suppressing viral infection, but incidence rose across eras too. 
              &lt;p&gt;For individuals diagnosed in the HAART era from 1996 through 2004, incidence in the five years after their diagnosis was higher than for those diagnosed in 1980-1989 or 1990-1995 for in situ (incidence rose from 1.7 to 18.3 cases to 29.5 cases per 100,000 person-years) and invasive anal cancer among men (incidence rose from 10.5 to 20.7 to 42.3 cases per 100 000 person-years). 
              &lt;p&gt;Even after adjusting for calendar period, incidence rose with duration of AIDS diagnosis as well for the following cancers:
              &lt;ul&gt; 
              &lt;li&gt;Invasive anal cancer among men (&lt;em&gt;P&lt;/em&gt;=0.043)
              &lt;li&gt;In situ penile cancer (&lt;em&gt;P&lt;/em&gt;=0.028)
              &lt;li&gt;In situ vagina or vulva cancer (&lt;em&gt;P&lt;/em&gt;=0.025)
              &lt;li&gt;In situ anal cancer among men (&lt;em&gt;P&lt;/em&gt;=0.093) 
               &lt;/ul&gt;
              &lt;p&gt;These findings suggest that immunosuppression during HIV before transition to AIDS plays a role in susceptibility, Dr. Chaturvedi&apos;s group noted. 
              &lt;p&gt;And because HAART does not substantially alter HPV persistence or progression of premalignant anal or genital lesions, &quot;it has been speculated that the incidence of HPV-associated cancers may increase as persons with AIDS live longer in the HAART era,&quot; they said. 
              &lt;p&gt;Prior studies have found a significantly elevated risk of HPV-related cancers in AIDS but not the association with immunosuppression. 
              &lt;p&gt;Part of the reason for the difference may have been the substantially larger size of Dr. Chaturvedi&apos;s study, they suggested. 
              &lt;p&gt;More intensive screening for anal and cervical cancer in persons with AIDS may have been an alternative explanation for the changes seen over time, but the lack of changes in staging over time argued against this, the investigators said. 
              &lt;p&gt;An important limitation of the study was lack of repeat CD4 T-cell counts -- which typically rise with HAART as a marker of immunosuppression from the virus. 
              &lt;p&gt;The researchers argued, though, that CD4 counts at AIDS onset reflect immunosuppression during HIV infection and also track with CD4 count improvements during treatment.  
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The study was funded by the National Cancer Institute.
              &lt;p&gt;The researchers reported no conflicts of interest. 
              &lt;p&gt;Dr. Strickler reported partial funding through a grant from the National Cancer Institute.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
</recommendedContent>
