Anal squamous cell carcinoma in KwaZulu-Natal Province, South Africa, with special reference to the influence of HIV infection on clinical presentation and management outcome

Zuma, Nonhlanhla Yende; Ngidi, S; Madiba, T. E.

doi:10.7196/samj.2020.v110i3.14290

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…Subgroup analysis demonstrated that, even among African patients (who are generally younger overall), HIV positive patients were younger than HIV negative patients. International studies have similarly shown that HIV infected individuals present at a younger age in most cancers such as lung, liver, anal and breast 2,25 and more specifically in CRC [26][27][28] . It is tempting to speculate that this presentation at a young age may be related to accelerated aging seen in HIV-infected individuals 29,30 , or gut flora dynamics in the HIV-positive patient [30][31][32][33] .…”

Section: Discussionmentioning

confidence: 99%

Quantifying the relationship of HIV infection with clinicopathological spectrum and outcome among patients with colorectal cancer in a South African population

SK¹,

Moolla²,

Moodley³

et al. 2022

Afr H. Sci.

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Introduction: Literature is limited on HIV and colorectal cancer (CRC) in sub-Saharan Africa despite it being the epicentre of the HIV epidemic. Purpose: To compare clinicopathological features and outcome of CRC in HIV-negative and HIV-positive patients. Methods: Retrospective analysis of a prospective CRC database. Demographic details, HIV status, anatomical site, disease stage, treatment and follow-up were documented. Results: Of 715 patients with CRC, 145 and 570 tested positive and negative respectively for HIV. Median age was 45 (IQR 36-53 and 57 (IQR 45-66) years among HIV-positive and HIV-negative patients respectively (p<0.0001). Tumour differentiation differed between the two groups (p=0.003) but staging was not different (p=0.6). Surgical resection rate was 52% for HIV-positive patients versus 59% for HIV-negative patients (p=0.07). Median follow-up was 9 (IQR 2-20.5) months for HIV-positive patients and 12 (IQR 6-29) months for HIV-negative patients (p=0.154). Recurrence rate was 14.7% among HIV positive patients and 6.8% in HIV negative patients (p=0.089). Conclusion: When compared with HIV-negative patients, HIV-positive patients with CRC presented at a younger age and tended to have lower surgical resection rates. There was no difference between the two groups with CRC in terms of anatomical sub-site distribution, disease staging and recurrence rates. Keywords: Colorectal cancer; colon cancer; rectal cancer; HIV; Outcome.

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Section: Discussionmentioning

confidence: 99%

Quantifying the relationship of HIV infection with clinicopathological spectrum and outcome among patients with colorectal cancer in a South African population

SK¹,

Moolla²,

Moodley³

et al. 2022

Afr H. Sci.

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“…Large series of ASC and their outcomes have been reported in a South African cohort. 73 Obstetric fistula including RVF is most common in certain Middle Eastern and African countries where poor antenatal care and young age at first pregnancy are common. A qualitative study from Iran demonstrated the complex social, individual, and familial issues resulting from this debilitating condition.…”

Section: Colorectal Research In Lmicsmentioning

confidence: 99%

Colorectal Surgery Practice, Training, and Research in Low-Resource Settings

Chu

Bust

Forgan

2022

Clin Colon Rectal Surg

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Colorectal surgery (CRS) practice, training, and research differ between low- and middle-income countries (LMICs) and high-income countries due to disparity in resources. LMIC CRS is primarily done by general surgeons due to the paucity of fully trained colorectal surgeons. The majority of colon and rectal resections are done using open techniques, and laparoscopy and robotic platforms are only available in select private or academic centers. Multi-disciplinary teams are not available in most hospitals, so surgeons must have a broad knowledge base, and learn to adapt their practice. Formal CRS training opportunities through accredited post-residency fellowships and professional colorectal surgical associations are limited in LMICs. CRS is less established as an academic field, and less data are generated in LMICs. There are fewer staff and less dedicated funding for CRS research. However, LMIC colorectal surgeons and researchers can contribute valuable clinical findings especially on conditions of higher prevalence in their settings such as anal squamous cell carcinoma and obstetric fistulas. Effective surgical care for colorectal conditions requires significant investment in infrastructure, training, and governance in LMICs. This is critical to improve access to safe surgical care for all.

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“…A study from South Africa described the management of 268 patients with SCCA. 44 Half the patients were eligible for definitive therapy at the time of diagnosis. Notable within this study was the observation that the proportion of patients who did not receive any treatment at all was higher among HIV-positive patients than among those who were HIV-negative (24 vs 12%).…”

Section: Available Treatment Approaches and Outcomesmentioning

confidence: 99%

Anal Squamous Intraepithelial Lesions and Anal Cancer Management in Low Resource Settings

Hawkins

Fang

2022

Clin Colon Rectal Surg

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A low resource setting (LRS) is defined as a health care system which does not meet the criteria defined by the World Health Organization (WHO) or other national/international organizations in the following areas: infrastructure, materials, and human resources.1 Patients encounter barriers which limit their access to care and services that are considered standard of care. While LRS is most commonly associated with developing countries, it is easy to overlook communities in developed countries which lack the financial resources to afford basic health care. This article describes the societal implications and barriers to care for both squamous intraepithelial lesions (SILs) and anal cancer in LRS, the existing screening/surveillance approaches, available treatment approaches to anal cancer, and it also discusses potential evidence-based approaches to bridge the gap for these disparities in anal cancer care.

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Anal squamous cell carcinoma in KwaZulu-Natal Province, South Africa, with special reference to the influence of HIV infection on clinical presentation and management outcome

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 7 publications

References 19 publications

Quantifying the relationship of HIV infection with clinicopathological spectrum and outcome among patients with colorectal cancer in a South African population

Quantifying the relationship of HIV infection with clinicopathological spectrum and outcome among patients with colorectal cancer in a South African population

Colorectal Surgery Practice, Training, and Research in Low-Resource Settings

Anal Squamous Intraepithelial Lesions and Anal Cancer Management in Low Resource Settings

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