A review of the pattern of AIDS defining, HIV associated neoplasms and premalignant lesions diagnosed from 2000–2011 at Kenyatta National Hospital, Kenya

Abstract

BackgroundSub-Sahara Africa hosts up to 71 % of all HIV infected people in the world. With this high incidence of Human immunodeficiency virus ( HIV) comes the burden of co-morbidities such as malignant and premalignant lesions. Aids defining malignancies have been listed as Kaposi’s sarcoma, Non-Hodgkin’s lymphoma and invasive squamous cell carcinoma of the cervix. People with HIV/AIDS(PLWAS) have a higher risk of developing these neoplasms than the rest of the population. The pathogenesis of these neoplasms in people with HIV has been linked to immune suppression, persistent antigenic stimulation and cytokine dysregulation.Current study analyzes and presents the patterns and trends in the presentation of HIV related malignancies in patients diagnosed through histopathology at Kenyatta National Hospital.AimTo describe the patterns of AIDS- defining and non-AIDS- defining malignancies and premalignant lesions 10 years pre- and post HAART period at Kenyatta National hospital, Kenya.Methods and techniquesThis was a hospital based descriptive cross sectional study. The Formalin fixed paraffin embedded (FFPE) blocks and histological reports of patients diagnosed between 2000 and 2011 were traced from archives. The patients’ demographic data and clinical presentation was entered in an excel spreadsheet and the diagnosis and coding confirmed by a histopathologist. The data was then cleaned and analyzed using SSPS version 17.0 Ink.ResultsA total of 173 lesions were reviewed and analyzed. Of these 118 (68 %) were from females and 55 from males (32 %). The male to female ratio was 1:2. The age range was from two to 56 years with a median of 36 years. Kaposi sarcoma is the leading AIDS defining malignancy in Kenya while invasive squamous cell carcinoma of the conjunctiva is the leading non-AIDS defining malignancy. This is closely followed by invasive squamous cell carcinoma of the cervix and NHL.ConclusionKaposi sarcoma is the leading AIDS associated neoplasm in Kenya. Physicians and caretakers managing and following up on HIV/AIDS patients should look out for Kaposi sarcoma as a form of IRIS following the institution of HAART in all HIV/AIDS patients. The incidence of invasive squamous cell carcinoma of the conjunctiva is increasing in PLWAS in Kenya. There is therefore a need to introduce early screening programs for squamous intraepithelial neoplasm of the conjunctiva in HIV/AIDS patients.

Record linkage to correct under‐ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project

“…Conjunctival cancer was common in this cohort with an incidence rate of 49 (95% CI 25–110) per 100,000 pys. This is consistent with previous studies which have shown an association between HIV and conjunctival cancer in African populations . Over two‐thirds (63%) of HIV patients with cancer were female.…”

“…This is consistent with previous studies which have shown an association between HIV and conjunctival cancer in African populations. [29][30][31] Over two-thirds (63%) of HIV patients with cancer were female. This is comparable with the Nigerian Cancer Match Study where 74% of cancer patients were female 5 and is expected since the HIV population in South Africa accessing ART is predominantly female.…”

Diagnosis and Treatment of Kaposi Sarcoma

“…Here, transmission is seen in the pediatric population (mother-to-child) as well as in the adult population and KSHV seroprevalence was substantial prior to the emergence of HIV. High quality incidence data are difficult to obtain, but WHO globocan [43, 44] and several other studies indicate that KS continues to comprise a significant percentage of total cancer burden in Sub-Saharan Africa, with 24% in Mozambique, 27% in Uganda and 35% in Zimbabwe [45–52]. The introduction of ART has significantly reduced the incidence of KS in HIV-infected patients, as eloquently illustrated by Bohlius et al [53], who found that the early introduction of ART decreased the risk to develop KS by 80% in a cohort of HIV-infected South African patients.…”

HIV-associated malignancies in sub-Saharan Africa

“…Similarly, in both China and Brazil, relative ADC declines and NADC increases are occurring as in high-income countries [16*, 17*]. Conversely, in most of SSA, ADC still dominate with incidence declines most consistently observed for KS, although KS incidence remains high throughout the region and is often among the most frequent cancers overall [15**, 18*, 19*, 20, 21**, 22]. HIVAM are therefore unlikely to recede as a public health problem in LMIC in the near term despite ART scale-up.…”