Cervical cancer and HIV: the Bahia/Brazil situation

Abstract

stable on the level of 30,000 new cases per year for the last 5 years. The number of infected women is consistently increasing throughout the epidemic as man to women ratio is down to 1.5:1 from 3.2:1 10 years ago. There is an increasing geographic spread of the cases. In lower economic regions the incidence is still increasing while decreasing in the most developed areas of Brazil. Free drug therapy is a government policy and more than 150,000 individuals are under HAART therapy. As a consequence the number of opportunistic diseases decreased enormously and patient's median survival under treatment multiplied by 4 since 1996. The main AIDS-malignancy Kaposi's sarcoma (KS), in Bahia peaked 10 years ago and it is showing a tendency to decrease slowly (from up 40 cases [Incidence: 5.6%] in 1993-1994 to 24 [Incidence: 2.4%] in 2001-02) in the same direction Brain lymphoma seems to be decreasing. On the other hand the invasive cervical cancer associated to the HIV infections seems to be increasing peaking in the last 2 years with 13 cases. Non Hodgkin's Lymphoma (NHL) presentation seems to be stable as 5-8 cases are found biannually and male and females seems to have the same incidence (8.5/1,000 patients). Differently from KS and Burkitt Lymphoma that male stands for twice the incidence. Implemented 3 years ago the databank for AIDS related malignancies at University Hospital (HUPES) has already catalogued 2150 cases of the most important malignancies related to infectious diseases mostly to AIDS. Annually more than 500 cancer cases are tested. The median age of individuals enrolled is 50 years, with the NHL patients in the upper bound of the bell shaped age distribution curve. Most of our patients come from the main reference hospital for cancer patients in the State-Hospital Aristides Maltez, seconded by the CICAN, and State Reference Outpatient Cancer Center.