A case-control study of human immunodeficiency virus infection and cancer in adults and children residing in Kampala, Uganda

Abstract

Uganda offers a unique setting in which to study the effect of human immunodeficiency virus‐1 (HIV‐1) on cancer. HIV‐1 is prevalent there, and cancers which are known to be HIV‐associated, such as Kaposi's sarcoma and Burkitt's lymphoma, are endemic. Adults residing in Kampala, Uganda, presenting with cancer in city hospitals were interviewed and had an HIV test. Of the 302 adults recruited, 190 had cancers with a potentially infectious aetiology (cases). The remaining 112 adults with tumours not known to have an infectious aetiology formed the control group. In addition, 318 children who were also Kampala residents were recruited and tested for HIV: 128 with cancer (cases) and 190 with non‐malignant conditions (controls). HIV seroprevalence was 24% in adult controls and 6% in childhood controls. The odds of HIV seropositivity among cases with specific cancers (other than Kaposi's sarcoma in adults) were compared with that among controls, using odds ratios (ORs), estimated with unconditional logistic regression. All ORs were adjusted for age (<5, 5–14, 15–19, 30–44, 45+) and sex and, in adults, also for the number of lifetime sexual partners (1 or 2, 3–9, 10+). In adults, HIV infection was associated with a significantly (p < 0.05) increased risk of non‐Hodgkin's lymphoma [OR = 6.2, 95% confidence interval (CI) 1.9–19.9, based on 21 cases] and conjunctival squamous‐cell carcinoma (OR = 10.9, 95% CI 3.1–37.7, based on 22 cases) but not with cancer at other common sites, including liver and uterine cervix. In children, HIV infection was associated with a significantly increased risk of Kaposi's sarcoma (OR = 94.9, 95% CI 28.5–315.3, based on 36 cases) and Burkitt's lymphoma (OR = 7.5, 95% CI 2.8–20.1, based on 33 cases) but not with other cancers. The pattern of HIV‐associated cancers in Uganda is broadly similar to that described elsewhere, but the relative frequency of specific cancers, such as conjunctival carcinoma, in HIV‐infected people differs. © 2001 Wiley‐Liss, Inc.

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

“…We observed no HIV in BL, which is somewhat inconsistent with associations seen in other sub‐Saharan African populations,3, 4, 18, 19 and the fact that BL is a recognized AIDS‐defining subtype of NHL in adults 17. Of note, the endemic variant of BL in sub‐Saharan Africa mainly affects children and all cases occurred in persons <18 years old in Rwanda.…”

“…Neither was an association found with skin cancer, which has been reported in high‐income,1 and certain sub‐Saharan settings 4, 5. Nor did we see associations with stomach or liver cancer, corroborating previous negative associations in African studies 3, 4, 24, 35…”

“…), lends support to the appropriateness of the control group. In the end, we did not identify any associations with cancers without a known infectious cause, and the same significant associations would have been seen if we had used a set of a priori defined non‐infection‐related cancers as controls (ORs for KS = 103, vulva = 12.6, penis = 11.1, cervix = 4.0, HL = 6.4, eye = 5.1 and NHL = 2.6), lending support also to the validity of the case:referent design 3, 4, 5, 6. Last, age‐, gender‐ and province‐specific HIV prevalence in controls were broadly consistent with patterns estimated in a national Rwandan survey in 2015 9…”

“…HIV is an established risk factor for cervical cancer,2 but relative risks have been relatively weak in pre‐cART era studies in sub‐Saharan Africa 3, 4, 24, 25, 26. Risk for cervical cancer in Rwanda was the highest reported in sub‐Saharan Africa to date (OR = 5.9), likely related to early roll out of cART in Rwanda and increasing avoidance of competing HIV‐related mortality.…”

“…Valuable data have been published from Uganda,3 South Africa,4 Ivory Coast/Benin5 and a previous small study from Rwanda 6. However, most of these studies describe periods in which the majority of PHIV had no access to antiretroviral therapy (cART) and hence suffered severe competitive mortality from opportunistic infections.…”