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.

Prevalence of Undiagnosed HIV Infection in Patients With Ocular Surface Squamous Neoplasia in a Tertiary Center in Karnataka, South India

“…3 HIV infection itself is a major risk factor leading to a 10 fold increase in conjunctival tumours in Africa. 5,7,19 Ocular manifestations occur in 50% to 75% of the patients with HIV infection sometime during the course of the disease. The most common ophthalmic manifestations associated with HIV infection in India have been reported to be HIV retinopathy, cytomegalovirus retinitis (20%), and opportunistic infections.…”

Human papillomaviruses and cancer in Uganda

“…Between 1994 and 1998, we recruited adults aged 15 years or older with a new diagnosis of cancer from the wards and outpatient clinics of the main hospitals in Kampala, Uganda (Ziegler et al, 1997Newton et al, 2001Newton et al, , 2002Newton et al, , 2003. After informed consent and counselling, patients were interviewed and tested for infection with human immunodeficiency virus (HIV)-1 using the Cambridge Bioscience Recombigen ELISA (Cambridge, Massachusetts, USA) on sera or the GACELISA method (Murex, Dartford, UK) on saliva.…”

“…In a case series of 13 patients from Uganda with squamous cell carcinoma of the penis, all tumour samples contained HPV-DNA, although the specific subtype was unclear (Tornesello et al, 1992). As part of a larger study of cancer in Uganda, we investigated the prevalence of antibodies against in the sera of patients with a range of different tumours (Ziegler et al, 1997Newton et al, 2001Newton et al, , 2002Newton et al, , 2003. Results in relation to conjunctival squamous cell carcinoma have been presented elsewhere, but no clear association with antibodies against HPV-16, -18 or -45 was identified (Newton et al, 2002).…”

B-cell non-Hodgkin lymphomas in Uganda: an immunohistochemical appraisal on tissue microarray

“…The possible influence of HIV infectionaffecting 1 000 000 people in Uganda in 2004 [23]-cannot be definitely assessed in our collective because of the lack of serologic information. It is of note, however, that several studies showed that the 3-fold increase of BL recorded in Central Africa during the last decades is independent of the HIV epidemic, most if not all patients being negative for the virus [15,23,24]. Moreover, in general, the prevalence of HIV-related lymphomas is much lower in sub-Saharan Africa than in the west (ie, 20 versus 8000-9000 per 100 000 persons per year), infections being the most common cause of death [23].…”