Global Cancer

The global health community, including such organizations as the World Health Organization and the U.S. Centers for Disease Control, are increasingly talking of a major shift in global health. Non-communicable diseases—diabetes, cardiovascular disease, and cancer—kill more people globally than infectious diseases. In response to this changing landscape and building on the existing infrastructure and long-term stability of IGHID’s flagship global programs, global oncology at UNC has increased dramatically since 2011. IGHID and the Lineberger Comprehensive Cancer Center are putting faculty expertise in virology and cancer, AIDS-associated malignancies, global cancer prevention, and global clinical trials to work to address the growing worldwide problem of cancer. Find more information about this at Malawi Cancer Consortium.

In developing countries, the lack of surgeons, specialists and access to treatment means that many otherwise treatable cancers are fatal. Satish Gopal, a UNC physician in hematology/oncology and infectious diseases, lives full-time at UNC Project-Malawi and is only one of two oncologists in the entire country of 15 million.

The UNC global cancer program has clinical sites in Brazil, Malawi, Kenya, South Africa, India, and China.

Research Areas

AIDS-Associated Malignancies

There are a number of malignancies associated with HIV/AIDS, especially Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and cervical carcinoma, which are all more prevalent in individuals with HIV/AIDS.  Because antiretroviral therapy has rendered HIV a chronic, manageable infection with a normal life expectancy, more people are developing AIDS-associated malignancies.

UNC is a clinical site for the National Cancer Institute-sponsored AIDS-associated malignancy consortium (AMC), which conducts clinical trials that enroll HIV-positive individuals with cancer.

In Malawi and Brazil, we are conducting a number of clinical trials around treatment for Kaposi’s sarcoma in people living with HIV/AID. In China, an HIV surveillance project in Xinjiang and Guangxi Provinces records all incidences of cancer among the HIV-infected population.

Cervical Cancer Screening and Treatment

Closer to home, Jennifer Smith and Noel Brewer in public health are leading an initiative to eradicate cervical cancer in North Carolina. The Cervical Cancer-Free NC initiative is a multi-year project aimed at preventing the disease through vaccination against (HPV) and effective screening for early signs of cervical cancer.

Blood Cancers

Hematologic malignancies account for almost 10 percent of cancer deaths in sub-Saharan Africa.  In the United States and other resource-rich settings, patients with diseases such as non-Hodgkin lymphoma, Hodgkin lymphoma, leukemia and multiple myeloma have benefited from treatment advances that have resulted in unprecedented rates of long-term cure and control.

Satish Gopal is conducting research into how these diseases can be effectively treated in a resource-limited setting and is leading the effort to set a research agenda to address the growing impact of cancers of the blood in sub-Saharan Africa.

Training

 

Who’s Involved

Recent Publications

Hilton IB, Simon JM, Lieb JD, Davis IJ, Damania B, Dittmer DP. The open chromatin landscape of Kaposi’s sarcoma-associated herpesvirus (Journal of Virology, 2013).

Yanik EL, Tamburro K, Eron JJ, Damania B, Napravnik S, Dittmer DP. Recent cancer incidence trends in an observational clinical cohort of HIV-infected patients in the US, 2000 to 2011 (Infectious Agents and Cancers, 2013) .

Bhatt AP, Damania B. AKTivation of PI3K/AKT/mTOR signaling pathway by KSHV (Frontiers in Immunology, 2013).

Dittmer DP, Damania B. Kaposi sarcoma associated herpesvirus pathogenesis (KSHV)–an update (Current Opinions in Virology, 2013).

Sin SH, Dittmer DP. Viral latency locus augments B-cell response in vivo to induce chronic marginal zone enlargement, plasma cell hyperplasia, and lymphoma.

White HL, Mulambia C, Sinkala M, Mwanahamuntu MH, Parham GP, et al. ‘Worse than HIV’ or ‘not as serious as other diseases’? Conceptualization of cervical cancer among newly screened women in Zambia(Social Science and Medicine, 2012).

White HL, Mulambia C, Sinkala M, Mwanahamuntu MH, Parham GP, et al. Motivations and experiences of women who accessed “see and treat” cervical cancer prevention services in Zambia (Journal of Psychosomatic Obstetrics and Gynecology, 2012).

Chibwesha CJ, Cu-Uvin S. See-and-treat approaches to cervical cancer prevention for HIV-infected women (Current HIV/AIDS Report, 2011).

Denslow SA, Rositch AF, Firnhaber C, Ting J, Smith JS. Incidence and progression of cervical lesions in women with HIV: A systematic global review (International Journal of STD & AIDS, 2013).

Denslow SA, Knop G, Klaus C, Brewer NT, Rao C, Smith JS. Burden of invasive cervical cancer in North Carolina (Preventative Medicine, 2012).

Sudenga SL, Rositch AF, Otieno WA, Smith JS. Knowledge, attitudes, practices, and perceived risk of cervical cancer among Kenyan women: brief report (International Journal of Gynecological Cancer, 2013).

Ting J, Mugo N, Kwatampora J, Hill C, Chitwa M, Patel S, et al. High-risk human papillomavirus messenger RNA testing in physician- and self-collected specimens for cervical lesion detection in high-risk women, Kenya (Sexually Transmitted Diseases, 2013).

Patel SJ, Mugo NR, Cohen CR, Ting J, Nguti R, et al. Multiple human papillomavirus infections and HIV seropositivity as risk factors for abnormal cervical cytology among female sex workers in Nairobi (International Journal of STD & AIDS, 2013).

Rositch AF, Gravitt PE, Smith JS Growing evidence that HPV infection is associated with an increase in HIV acquisition: exploring the issue of HPV vaccination.

Gopal S, Krysiak R, Liomba NG, Horner MJ, Shores CG, et al. Early experience after developing a pathology laboratory in Malawi, with emphasis on cancer diagnoses (PLoS One, 2013).

Gopal S, Patel MR, Yanik EL, Cole SR, Achenbach CJ, et al. Association of early HIV viremia with mortality after HIV-associated lymphoma (AIDS,2013).

Yanik EL, Napravnik S, Cole SR, Achenbach CJ, Gopal S, et al. Incidence and timing of cancer in HIV-infected individuals following initiation of combination antiretroviral therapy (Clinical Infectious Diseases, 2013).

Gopal S, Krysiak R, Liomba G. Building a pathology laboratory in Malawi (The Lancet Oncology, 2013).

Gopal S, Wood WA, Lee SJ, Shea TC, Naresh KN, et al. Meeting the challenge of hematologic malignancies in sub-Saharan Africa (Blood, 2012).

Gopal S, Martin KE, Richards KL, Eron JJ. Clinical presentation, treatment, and outcomes among 65 patients with HIV-associated lymphoma treated at the University of North Carolina, 2000-2010 (AIDS Research and Human Retroviruses, 2012).