50148c92c1beae0e3f1954bea815a644  329183.pdf
f6cac415a73fe9a4446fd95f956a8916e634f594  329183.pdf
06317667b047104db59a08df4e1871013a6a59fa0d440ea180fca52a1360e5fe  329183.pdf

Title:           Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV: A Multicohort Collaboration
Subject:         Background/Objectives: Whilst cancer is a leading cause of death in people with HIV, less is known about clinical outcomes after cancer. Methods: Participants from the RESPOND and D:A:D cohorts with the five most common cancers (Kaposi’s sarcoma (KS); non-Hodgkin lymphoma (NHL); and lung, anal and prostate cancers) were followed from first cancer diagnosis after 2006/2012 [D:A:D/RESPOND] until death, final follow-up or administrative censoring (2016/2021). Incidence rates (IR) were calculated for post-cancer mortality; for non-fatal events (cardiovascular disease, diabetes, another primary cancer, AIDS events) individually and as a non-fatal composite clinical outcome (CCO). Predictors or mortality and CCO were assessed using Poisson regression with generalized estimating equations. Results: Amongst 2485 participants with cancer, mortality and CCO IRs were highest after lung cancer (445.4/1000 person years [95% CI 399.7, 494.9], 117.1 [94.3, 143.8], respectively) compared to other cancers and lowest after KS (21.3 [16.9, 26.6], 43.9 [37.5, 51.3]). The most common non-fatal outcomes were AIDS events after NHL and KS, diabetes after lung and prostate cancer and another primary cancer after anal cancer. Among people with NHL and anal cancer, a diagnosis in more recent years was associated with lower mortality risk. Increasing the time-updated CD4 count reduced mortality by 15–40% (per 100 cells/L) after NHL and anal and lung cancers and reduced CCO risk by 17–28% after KS and NHL. Smoking, low BMI and multimorbidity increased CCO risks by two to three times after KS and NHL. Conclusions: Risk of post-cancer mortality and non-fatal outcomes varies by cancer type and risk profile, suggesting the need for personalized post-cancer clinical monitoring. 
Keywords:        cancer; HIV; mortality; non-fatal clinical outcomes; modifiable risk factors; immune status; comorbidities
Author:          Alisa Timiryasova, Lauren Greenberg, Pere Domingo, Philip E. Tarr, Alexander Egle, Charlotte Martin, Cristina Mussini, Ferdinand Wit, Antonella Cingolani, Clara Lehmann, Antonella Castagna, Kathy Petoumenos, Caroline A. Sabin, Fabrice Bonnet, Jens Lundgren, Martina Bottanelli, Sean Hosein, Christina Carlander, Alain Amstutz, Katharina Grabmeier-Pfistershammer, Harmony Garges, Andrea Marongiu, Lital A. Young, Lars Peters, Lene Ryom and on behalf of the D:A:D and RESPOND Study groups
Creator:         LaTeX with hyperref
Producer:        pdfTeX-1.40.25; modified using OpenPDF 1.4.2
CreationDate:    Wed Dec 17 09:49:34 2025 CET
ModDate:         Wed Dec 17 10:03:23 2025 CET
Custom Metadata: yes
Metadata Stream: no
Tagged:          no
UserProperties:  no
Suspects:        no
Form:            none
JavaScript:      no
Pages:           22
Encrypted:       no
Page size:       595.276 x 841.89 pts (A4)
Page rot:        0
File size:       1108385 bytes
Optimized:       no
PDF version:     1.7


name                                 type              encoding         emb sub uni object ID
------------------------------------ ----------------- ---------------- --- --- --- ---------
ARNIKL+URWPalladioL-Roma             Type 1            Custom           yes yes yes    127  0
UTDNFH+URWPalladioL-Ital             Type 1            Custom           yes yes yes    128  0
GNUGPE+VnURWPalladioL                Type 1            Custom           yes yes yes    129  0
UJAISG+URWPalladioL-Bold             Type 1            Custom           yes yes yes    130  0
OVNEXW+EURM10                        Type 1            Builtin          yes yes yes    171  0
IKKWKP+CMSY10                        Type 1            Builtin          yes yes yes    212  0
CIDFont+F3                           CID TrueType      Identity-H       yes no  yes    222  0
CIDFont+F2                           CID TrueType      Identity-H       yes no  yes    223  0
WBVKDJ+URWPalladioL-BoldItal         Type 1            Custom           yes yes yes    250  0
XIRVNA+EURB10                        Type 1            Builtin          yes yes yes    258  0
CIDFont+F1                           CID TrueType      Identity-H       yes no  yes    280  0
CIDFont+F2                           CID TrueType      Identity-H       yes no  yes    281  0


Jhove (Rel. 1.28.0, 2023-05-18)
 Date: 2026-06-23 04:12:20 CEST
 RepresentationInformation: 329183.pdf
  ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16)
  LastModified: 2026-06-22 13:48:01 CEST
  Size: 1108385
  Format: PDF
  Version: 1.7
  Status: Well-Formed and valid
  SignatureMatches:
   PDF-hul
  MIMEtype: application/pdf
  PDFMetadata: 
   Objects: 490
   FreeObjects: 1
   IncrementalUpdates: 0
   DocumentCatalog: 
    ViewerPreferences: 
     HideToolbar: false
     HideMenubar: false
     HideWindowUI: false
     FitWindow: true
     CenterWindow: false
     DisplayDocTitle: false
     NonFullScreenPageMode: UseNone
     Direction: L2R
     ViewArea: CropBox
     ViewClip: CropBox
     PrintArea: CropBox
     PageClip: CropBox
    PageLayout: SinglePage
    PageMode: UseNone
    Outlines: 
     Item: 
      Title: Introduction 
     Item: 
      Title: Materials and Methods 
      Children: 
       Item: 
        Title: Study Design 
       Item: 
        Title: Study Population 
       Item: 
        Title: Outcome Definitions 
       Item: 
        Title: Potential Risk Factors 
       Item: 
        Title: Statistical Analysis 
       Item: 
        Title: Sensitivity Analyses 
     Item: 
      Title: Results 
      Children: 
       Item: 
        Title: Baseline Characteristics 
       Item: 
        Title: Mortality After Cancer 
       Item: 
        Title: Predictors of Mortality After Cancer 
       Item: 
        Title: Non-Fatal Clinical Outcomes After Cancer 
       Item: 
        Title: Predictors of Non-Fatal Outcomes After Cancer 
       Item: 
        Title: Sensitivity Analyses 
     Item: 
      Title: Discussion 
     Item: 
      Title: Conclusions 
     Item: 
      Title: Appendix A
     Item: 
      Title: References
   Info: 
    Title: Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV: A Multicohort Collaboration
    Author: Alisa Timiryasova, Lauren Greenberg, Pere Domingo, Philip E. Tarr, Alexander Egle, Charlotte Martin, Cristina Mussini, Ferdinand Wit, Antonella Cingolani, Clara Lehmann, Antonella Castagna, Kathy Petoumenos, Caroline A. Sabin, Fabrice Bonnet, Jens Lundgren, Martina Bottanelli, Sean Hosein, Christina Carlander, Alain Amstutz, Katharina Grabmeier-Pfistershammer, Harmony Garges, Andrea Marongiu, Lital A. Young, Lars Peters, Lene Ryom and on behalf of the D:A:D and RESPOND Study groups
    Subject: Background/Objectives: Whilst cancer is a leading cause of death in people with HIV, less is known about clinical outcomes after cancer. Methods: Participants from the RESPOND and D:A:D cohorts with the five most common cancers (Kaposi’s sarcoma (KS); non-Hodgkin lymphoma (NHL); and lung, anal and prostate cancers) were followed from first cancer diagnosis after 2006/2012 [D:A:D/RESPOND] until death, final follow-up or administrative censoring (2016/2021). Incidence rates (IR) were calculated for post-cancer mortality; for non-fatal events (cardiovascular disease, diabetes, another primary cancer, AIDS events) individually and as a non-fatal composite clinical outcome (CCO). Predictors or mortality and CCO were assessed using Poisson regression with generalized estimating equations. Results: Amongst 2485 participants with cancer, mortality and CCO IRs were highest after lung cancer (445.4/1000 person years [95% CI 399.7, 494.9], 117.1 [94.3, 143.8], respectively) compared to other cancers and lowest after KS (21.3 [16.9, 26.6], 43.9 [37.5, 51.3]). The most common non-fatal outcomes were AIDS events after NHL and KS, diabetes after lung and prostate cancer and another primary cancer after anal cancer. Among people with NHL and anal cancer, a diagnosis in more recent years was associated with lower mortality risk. Increasing the time-updated CD4 count reduced mortality by 15–40% (per 100 cells/L) after NHL and anal and lung cancers and reduced CCO risk by 17–28% after KS and NHL. Smoking, low BMI and multimorbidity increased CCO risks by two to three times after KS and NHL. Conclusions: Risk of post-cancer mortality and non-fatal outcomes varies by cancer type and risk profile, suggesting the need for personalized post-cancer clinical monitoring. 
    Keywords: cancer; HIV; mortality; non-fatal clinical outcomes; modifiable risk factors; immune status; comorbidities
    Creator: LaTeX with hyperref
    Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2
    CreationDate: Wed Dec 17 09:49:34 CET 2025
    ModDate: Wed Dec 17 10:03:23 CET 2025
   ID: 0xb2348a6548900b43bd5c201398c360e5, 0x4f7decc022622049b29983df0acf928c
   Filters: 
    FilterPipeline: FlateDecode
   Fonts: 
    Type1: 
     Font: 
      BaseFont: UTDNFH+URWPalladioL-Ital
      FontSubset: true
      FirstChar: 2
      LastChar: 121
      FontDescriptor: 
       FontName: UTDNFH+URWPalladioL-Ital
       Flags: Symbolic
       FontBBox: -170, -305, 1010, 941
       FontFile: true
      EncodingDictionary: 
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: GNUGPE+VnURWPalladioL
      FontSubset: true
      FirstChar: 160
      LastChar: 230
      FontDescriptor: 
       FontName: GNUGPE+VnURWPalladioL
       Flags: Symbolic
       FontBBox: -166, -283, 1021, 943
       FontFile: true
      EncodingDictionary: 
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: UJAISG+URWPalladioL-Bold
      FontSubset: true
      FirstChar: 2
      LastChar: 134
      FontDescriptor: 
       FontName: UJAISG+URWPalladioL-Bold
       Flags: Symbolic
       FontBBox: -152, -301, 1000, 935
       FontFile: true
      EncodingDictionary: 
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: XIRVNA+EURB10
      FontSubset: true
      FirstChar: 22
      LastChar: 22
      FontDescriptor: 
       FontName: XIRVNA+EURB10
       Flags: Symbolic
       FontBBox: -30, -247, 1178, 723
       FontFile: true
      ToUnicode: true
     Font: 
      BaseFont: IKKWKP+CMSY10
      FontSubset: true
      FirstChar: 20
      LastChar: 21
      FontDescriptor: 
       FontName: IKKWKP+CMSY10
       Flags: Symbolic
       FontBBox: -29, -960, 1116, 775
       FontFile: true
      ToUnicode: true
     Font: 
      BaseFont: WBVKDJ+URWPalladioL-BoldItal
      FontSubset: true
      FirstChar: 112
      LastChar: 112
      FontDescriptor: 
       FontName: WBVKDJ+URWPalladioL-BoldItal
       Flags: Symbolic
       FontBBox: -170, -300, 1073, 935
       FontFile: true
      EncodingDictionary: 
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: OVNEXW+EURM10
      FontSubset: true
      FirstChar: 22
      LastChar: 22
      FontDescriptor: 
       FontName: OVNEXW+EURM10
       Flags: Symbolic
       FontBBox: -32, -243, 1060, 720
       FontFile: true
      ToUnicode: true
     Font: 
      BaseFont: ARNIKL+URWPalladioL-Roma
      FontSubset: true
      FirstChar: 2
      LastChar: 252
      FontDescriptor: 
       FontName: ARNIKL+URWPalladioL-Roma
       Flags: Symbolic
       FontBBox: -166, -283, 1021, 943
       FontFile: true
      EncodingDictionary: 
       Differences: true
      ToUnicode: true
   Pages: 
    Page: 
     Sequence: 1
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 81, 177, 152, 186
      Annotation: 
       Subtype: Link
       Rect: 34, 166, 113, 174
      Annotation: 
       Subtype: Link
       Rect: 36, 75, 152, 84
      Annotation: 
       Subtype: Link
       Rect: 34, 63, 89, 72
      Annotation: 
       Subtype: Link
       Rect: 34, 773, 130, 809
      Annotation: 
       Subtype: Link
       Rect: 515, 773, 560, 809
      Annotation: 
       Subtype: Link
       Rect: 130, 663, 141, 677
      Annotation: 
       Subtype: Link
       Rect: 318, 663, 329, 677
      Annotation: 
       Subtype: Link
       Rect: 399, 663, 410, 677
      Annotation: 
       Subtype: Link
       Rect: 489, 663, 501, 677
      Annotation: 
       Subtype: Link
       Rect: 118, 650, 129, 663
      Annotation: 
       Subtype: Link
       Rect: 398, 650, 409, 663
      Annotation: 
       Subtype: Link
       Rect: 332, 636, 343, 649
      Annotation: 
       Subtype: Link
       Rect: 129, 623, 140, 635
      Annotation: 
       Subtype: Link
       Rect: 420, 623, 431, 635
      Annotation: 
       Subtype: Link
       Rect: 409, 27, 560, 37
      Annotation: 
       Subtype: Link
       Rect: 34, 356, 87, 375
    Page: 
     Sequence: 2
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 468, 228, 475, 237
       ActionDest: 91
      Annotation: 
       Subtype: Link
       Rect: 475, 228, 482, 237
       ActionDest: 91
      Annotation: 
       Subtype: Link
       Rect: 431, 200, 438, 209
       ActionDest: 91
      Annotation: 
       Subtype: Link
       Rect: 439, 200, 446, 209
       ActionDest: 91
      Annotation: 
       Subtype: Link
       Rect: 361, 145, 368, 154
       ActionDest: 91
      Annotation: 
       Subtype: Link
       Rect: 369, 145, 376, 154
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 485, 131, 492, 140
       ActionDest: 91
      Annotation: 
       Subtype: Link
       Rect: 282, 103, 289, 112
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 292, 103, 299, 112
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 308, 75, 315, 84
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 315, 75, 327, 84
       ActionDest: 183
    Page: 
     Sequence: 3
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 407, 731, 419, 740
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 422, 730, 434, 740
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 348, 703, 360, 712
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 363, 703, 375, 712
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 256, 661, 268, 670
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 271, 661, 282, 670
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 345, 605, 357, 614
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 307, 351, 319, 360
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 319, 351, 331, 360
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 374, 268, 386, 277
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 389, 268, 401, 277
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 279, 102, 286, 111
       ActionDest: 91
    Page: 
     Sequence: 4
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 388, 730, 395, 740
       ActionDest: 91
      Annotation: 
       Subtype: Link
       Rect: 296, 565, 308, 574
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 182, 453, 194, 462
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 444, 412, 456, 421
       ActionDest: 183
    Page: 
     Sequence: 5
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 310, 505, 317, 517
       ActionDest: 42
      Annotation: 
       Subtype: Link
       Rect: 484, 135, 491, 147
       ActionDest: 248
    Page: 
     Sequence: 6
    Page: 
     Sequence: 7
    Page: 
     Sequence: 8
    Page: 
     Sequence: 9
    Page: 
     Sequence: 10
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 490, 683, 497, 695
       ActionDest: 56
      Annotation: 
       Subtype: Link
       Rect: 481, 669, 488, 681
       ActionDest: 61
      Annotation: 
       Subtype: Link
       Rect: 389, 558, 404, 570
       ActionDest: 91
    Page: 
     Sequence: 11
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 247, 357, 254, 369
       ActionDest: 268
    Page: 
     Sequence: 12
    Page: 
     Sequence: 13
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 285, 697, 292, 709
       ActionDest: 56
      Annotation: 
       Subtype: Link
       Rect: 523, 600, 530, 612
       ActionDest: 61
      Annotation: 
       Subtype: Link
       Rect: 487, 531, 494, 543
       ActionDest: 268
      Annotation: 
       Subtype: Link
       Rect: 221, 130, 228, 139
       ActionDest: 91
      Annotation: 
       Subtype: Link
       Rect: 229, 130, 240, 139
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 241, 130, 253, 139
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 215, 102, 227, 111
       ActionDest: 334
    Page: 
     Sequence: 14
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 375, 717, 387, 726
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 283, 689, 295, 698
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 296, 689, 308, 698
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 507, 661, 519, 670
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 519, 661, 531, 670
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 252, 564, 264, 572
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 264, 564, 276, 572
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 277, 563, 289, 572
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 271, 522, 283, 531
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 283, 522, 295, 531
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 298, 522, 310, 531
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 496, 438, 507, 447
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 519, 382, 531, 391
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 282, 341, 294, 350
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 297, 341, 309, 350
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 309, 341, 321, 350
       ActionDest: 183
      Annotation: 
       Subtype: Link
       Rect: 261, 173, 273, 182
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 405, 132, 417, 141
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 418, 132, 430, 141
       ActionDest: 334
    Page: 
     Sequence: 15
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 531, 745, 543, 754
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 544, 744, 556, 754
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 301, 717, 313, 726
       ActionDest: 334
      Annotation: 
       Subtype: Link
       Rect: 536, 159, 560, 170
      Annotation: 
       Subtype: Link
       Rect: 165, 145, 391, 156
    Page: 
     Sequence: 16
    Page: 
     Sequence: 17
    Page: 
     Sequence: 18
    Page: 
     Sequence: 19
    Page: 
     Sequence: 20
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 355, 227, 393, 238
      Annotation: 
       Subtype: Link
       Rect: 399, 227, 435, 238
      Annotation: 
       Subtype: Link
       Rect: 90, 190, 128, 200
      Annotation: 
       Subtype: Link
       Rect: 134, 190, 170, 200
      Annotation: 
       Subtype: Link
       Rect: 466, 163, 503, 174
      Annotation: 
       Subtype: Link
       Rect: 95, 126, 133, 136
      Annotation: 
       Subtype: Link
       Rect: 59, 87, 96, 98
    Page: 
     Sequence: 21
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 59, 731, 96, 742
      Annotation: 
       Subtype: Link
       Rect: 372, 693, 410, 703
      Annotation: 
       Subtype: Link
       Rect: 416, 693, 452, 703
      Annotation: 
       Subtype: Link
       Rect: 204, 654, 242, 665
      Annotation: 
       Subtype: Link
       Rect: 224, 629, 261, 639
      Annotation: 
       Subtype: Link
       Rect: 140, 591, 177, 601
      Annotation: 
       Subtype: Link
       Rect: 184, 591, 220, 601
      Annotation: 
       Subtype: Link
       Rect: 514, 565, 552, 576
      Annotation: 
       Subtype: Link
       Rect: 184, 527, 222, 537
      Annotation: 
       Subtype: Link
       Rect: 174, 489, 211, 499
      Annotation: 
       Subtype: Link
       Rect: 163, 450, 200, 461
      Annotation: 
       Subtype: Link
       Rect: 370, 424, 407, 435
      Annotation: 
       Subtype: Link
       Rect: 391, 399, 428, 410
      Annotation: 
       Subtype: Link
       Rect: 508, 373, 546, 384
      Annotation: 
       Subtype: Link
       Rect: 504, 360, 541, 371
      Annotation: 
       Subtype: Link
       Rect: 59, 336, 96, 346
      Annotation: 
       Subtype: Link
       Rect: 392, 322, 560, 333
      Annotation: 
       Subtype: Link
       Rect: 56, 309, 229, 320
      Annotation: 
       Subtype: Link
       Rect: 272, 271, 310, 282
      Annotation: 
       Subtype: Link
       Rect: 163, 233, 201, 244
      Annotation: 
       Subtype: Link
       Rect: 225, 207, 262, 218
      Annotation: 
       Subtype: Link
       Rect: 178, 182, 422, 193
      Annotation: 
       Subtype: Link
       Rect: 125, 156, 390, 167
      Annotation: 
       Subtype: Link
       Rect: 453, 143, 560, 154
      Annotation: 
       Subtype: Link
       Rect: 56, 130, 438, 141
      Annotation: 
       Subtype: Link
       Rect: 56, 79, 268, 90
    Page: 
     Sequence: 22
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 172, 731, 209, 742
      Annotation: 
       Subtype: Link
       Rect: 472, 718, 509, 729
      Annotation: 
       Subtype: Link
       Rect: 371, 692, 560, 703
      Annotation: 
       Subtype: Link
       Rect: 56, 679, 251, 690
      Annotation: 
       Subtype: Link
       Rect: 59, 642, 96, 652
      Annotation: 
       Subtype: Link
       Rect: 396, 616, 434, 627
      Annotation: 
       Subtype: Link
       Rect: 157, 578, 195, 588
      Annotation: 
       Subtype: Link
       Rect: 342, 539, 380, 550
      Annotation: 
       Subtype: Link
       Rect: 384, 513, 421, 524
      Annotation: 
       Subtype: Link
       Rect: 348, 488, 385, 499
      Annotation: 
       Subtype: Link
       Rect: 356, 450, 393, 461
      Annotation: 
       Subtype: Link
       Rect: 104, 412, 142, 422
      Annotation: 
       Subtype: Link
       Rect: 148, 412, 184, 422
      Annotation: 
       Subtype: Link
       Rect: 396, 386, 433, 397
      Annotation: 
       Subtype: Link
       Rect: 439, 386, 475, 397
      Annotation: 
       Subtype: Link
       Rect: 104, 348, 142, 358
      Annotation: 
       Subtype: Link
       Rect: 148, 348, 184, 358
      Annotation: 
       Subtype: Link
       Rect: 95, 310, 133, 320
      Annotation: 
       Subtype: Link
       Rect: 269, 258, 307, 269
      Annotation: 
       Subtype: Link
       Rect: 56, 207, 521, 218
  Checksum: ca211eb1
   Type: CRC32
  Checksum: 50148c92c1beae0e3f1954bea815a644
   Type: MD5
  Checksum: f6cac415a73fe9a4446fd95f956a8916e634f594
   Type: SHA-1
  Checksum: 06317667b047104db59a08df4e1871013a6a59fa0d440ea180fca52a1360e5fe
   Type: SHA-256