Cancer and HIV infection in Rwanda

Newton, Robert; Grulich, Andrew E.; Beral, Valerie; Sindikubwabo, B; Ngilimana, P J; Nganyira, A; Parkin, D M

doi:10.1016/s0140-6736(95)92583-x

Cited by 62 publications

(45 citation statements)

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“…Among those with HIV, the lesions often affect young adults, in a fashion reminiscent of Kaposi's sarcoma in HIV-seropositive people (Ateenyi-Agaba, 1995;Kestelyn et al, 1990;Waddell et al, 1996). This study, together with others from Africa and the USA indicate about a 10-fold increased risk of the tumour in HIV infected, compared to HIV uninfected individuals (AteenyiAgaba, 1995; Kestelyn et al, 1990;Goedert and Coté, 1995;Newton et al, 1995Newton et al, , 2001Waddell et al, 1996). Indeed, the spread of HIV in Uganda probably accounts for much of the approximately eightfold increase in incidence of conjunctival carcinoma observed there since the 1960s (Wabinga et al, 2000).…”

Section: Discussionsupporting

confidence: 49%

The epidemiology of conjunctival squamous cell carcinoma in Uganda

et al. 2002

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As part of a larger investigation of cancer in Uganda, we conducted a case -control study of conjunctival squamous cell carcinoma in adults presenting at hospitals in Kampala. Participants were interviewed about social and lifestyle factors and had blood tested for antibodies to HIV, . The odds of each factor among 60 people with conjunctival cancer was compared to that among 1214 controls with other cancer sites or types, using odds ratios, estimated with unconditional logistic regression. Conjunctival cancer was associated with HIV infection (OR 10.1, 95% confidence intervals [CI] 5.2 -19.4; P50.001), and was less common in those with a higher personal income (OR 0.4, 95% CI 0.3 -1.2; P50.001). The risk of conjunctival cancer increased with increasing time spent in cultivation and therefore in direct sunlight (w 2 trend=3.9, P=0.05), but decreased with decreasing age at leaving home (w 2 trend=3.9, P=0.05), perhaps reflecting less exposure to sunlight consequent to working in towns, although both results were of borderline statistical significance. To reduce confounding, sexual and reproductive variables were examined among HIV seropositive individuals only. Cases were more likely than controls to report that they had given or received gifts for sex (OR 3.5, 95% CI 1.2 -10.4; P=0.03), but this may have been a chance finding as no other sexual or reproductive variable was associated with conjunctival cancer, including the number of self-reported lifetime sexual partners (P=0.4). The seroprevalence of antibodies against HPV-18 and -45 was too low to make reliable conclusions. The presence of anti-HPV-16 antibodies was not significantly associated with squamous cell carcinoma of the conjunctiva (OR 1.5, 95% CI 0.5 -4.3; P=0.5) and nor were anti-KSHV antibodies (OR 0.9, 95% CI 0.4 -2.1; P=0.8). The 10-fold increased risk of conjunctival cancer in HIV infected individuals is similar to results from other studies. Squamous cell carcinoma of the conjunctiva is thought to be an extreme form of a spectrum of clinical conditions, collectively known as 'ocular surface squamous neoplasias', which range in severity from mild dysplasia, to carcinoma in situ and, ultimately, to invasive carcinoma. Symptoms can range from none, to severe pain and visual loss. Lesions generally arise on exposed areas of the eye, particularly on the nasal side, and treatment involves local excision, or in more severe cases, orbital clearance. Metastases are rare and the prognosis is usually favourable.Although relatively rare everywhere, conjunctival carcinoma is more frequent in parts of sub-Saharan Africa. Uganda offers a good setting in which to investigate the epidemiology of squamous cell carcinoma of the conjunctiva, because the tumour was relatively frequent there, even before the onset of the HIV epidemic (Templeton, 1973;Wabinga et al, 2000). In this report, we examine the association of conjunctival tumours with over 50 possible risk factors, including evidence of infection with HIV-1, HPV-16, -18 and -45 and Kaposi's sarcoma-associa...

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Section: Discussionsupporting

confidence: 49%

The epidemiology of conjunctival squamous cell carcinoma in Uganda

et al. 2002

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“…The odds ratio for developing KS in relation to HIV infection in this study of .2) for men and women combined was broadly similar to the odds found in the only other comparable study from Rwanda (Newton et al, 1995) (OR = 35.0; 95% CI 8.2-206.7). Although statistically non-significant, the greater odds of developing KS in relation to HIV infection in men, 231.4 compared with 52.6 for women is noteworthy and could be as a result of the epidemiology of Kaposi's sarcoma-associated herpesvirus (Chang et al, 1994) or other factors.…”

Section: Discussionsupporting

confidence: 86%

“…However, the number of histologically diagnosed KS cases from Baragwanath hospital increased from eight in 1989 (12 months) to 20 cases between January and June 1996 (National Cancer Registry, unpublished data). The odds ratio of NHL in association with HIV (men and women combined) of 4.8 (95% CI 1.5-14.8) was lower than that found in Rwanda, 12.6 (95% CI 2.2-54.4) (Newton et al, 1995) but much lower than that observed in the USA of around 60 . In the (South) African setting, persons may succumb to other opportunistic infections before the onset of NHL, but data from transplant patients suggest that excesses of NHL occur even 6 months after the start of immunosuppressive treatment (Kinlen, 1992).…”

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confidence: 60%

Section: Methodsmentioning

confidence: 99%

“…'Controls' comprised patients with cancers other than those suspected to have an infectious cause (see Table 1 for list). The choice of controls comprising cancers other than those thought to be associated with the exposure of interest has been used successfully in other contexts (tobacco, alcohol) (Barra et al, 1991;Parkin et al, 1994) and in Rwanda (infection-related cancers) (Newton et al, 1995).Unmatched unconditional maximum-likelihood logistic regression (PROC LOGISTIC, SAS, 1988) was used to calculate odds ratios (ORs), 95% confidence intervals (95% CI) and two-sided Pvalues (2P), adjusted for age (15-34, 35-50 years), sex, marital status (never married, other) and year of diagnosis (before and after December 1994). A separate term was included for each adjustment factor in the regression formula.…”

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confidence: 99%

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Association between human immunodeficiency virus type 1 infection and cancer in the black population of Johannesburg and Soweto, South Africa

Sitas

Bezwoda²,

Levin³

et al. 1997

Br J Cancer

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Summary A case-control study of 913 black cancer patients (aged 15-50 years) was undertaken to measure the association between human immunodeficiency (HIV) infection and cancers believed to have an infective aetiology. Controls were patients with cancers believed not to be infective in origin. The prevalence of HIV in the controls of 7.3% (24 of 325) was similar to the background HIV seropositivity in this population. Odds ratios (ORs) and 95% confidence intervals (Cl) adjusted for age, year of diagnosis, marital status and sex were calculated. There was a strong association between HIV infection and Kaposi's sarcoma (KS), with 27 of 33 cases being HIV seropositive, OR = 61.8 and an elevated association with non-Hodgkin's lymphoma (NHL), with 27 of 40 cases being HIV seropositive [OR = 4.8 (95% Cl 1.5-14.8)]. The elevated odds ratio for KS associated with HIV infection accords with the observed increases in the incidence of KS in several sub-Saharan African countries where the prevalence of HIV is high. The odds ratio for NHL associated with HIV infection was lower than that reported in developed countries, and the reason for this is not clear. No other cancers, including cervical and liver cancers, showed significantly elevated odds ratios associated with HIV infection.Keywords: human immunodeficiency virus type 1; South Africa; case-control studyThe association between infectious agents and a number of cancers has been documented elsewhere (Weiss, 1984; ZurHausen, 1991). In South Africa about a third of the female and a sixth of the male cancers are thought to be infective in origin (Sitas et al, 1996). HIV-induced immune suppression in populations with a high prevalence of HIV has led to an increased incidence of a number of these infection-associated cancers, notably Kaposi's sarcoma (KS) and non-Hodgkin lymphoma (NHL) (and perhaps other cancers) in, for example, San Francisco single men (Rabkin et al, 1994) and sub-Saharan Africa (Bourdeaux et al, 1988;Wabinga et al, 1993;Bassett et al, 1995). In South Africa, the first notifications of HIV were in 1981, but by 1994 the HIV seroprevalence in female antenatal clinic attenders in Johannesburg and Soweto had increased to 7.9% in blacks and 0.6% in whites (Department of Health, 1995). An attempt was therefore made to quantify the association between HIV infection and certain infection-related cancers. MATERIALS AND METHODSThe study, which was approved by the University of the Witwatwersrand Ethics Committee, was conducted between (Beral, 1991; Rabkin and Blattner, 1991). In addition, certain cancers were added to the case group 1704 HIV and cancer in South Africa 1705 because of varying degrees of suspicion of an infectious cause namely stomach (International Agency for Research on Cancer, 1994), oral (International Agency for Research on Cancer, 1995), oesophageal (Dillner et al, 1995), squamous cell skin, penile and vaginal cancers (Zur Hausen, 1991). 'Controls' comprised patients with cancers other than those suspected to have an infectious cause (see Tab...

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Cancer in Rwanda

et al. 1996

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Data are presented on the frequency of malignant tumours registered at the population-based cancer registry in the southern prefecture of Butare, Rwanda, from May 1991 until 2 months before the outbreak of civil war in April 1994. Beginning in 1992, subjects were also interviewed about socio-demographic and lifestyle factors that have been associated with cancer risk in the West. The distribution of cancer in Rwanda is similar to that in other countries in sub-Saharan Africa. The most frequent cancers are those with possible infectious aetiolo-gies: liver cancer (I 2%), cervical cancer (I 29'0) and stomach cancer (9%). In addition, cancers known to be associated with HIV infection are relatively frequent (Kaposi's sarcoma [6%] and non-Hodgkin's lymphoma [3%]). Chronic infection, including infection with HIV, high parity and multiple sexual partners are important determinants of cancer incidence in this population. Tobacco consumption is low in Rwanda and there are few tobacco-related tumours, such as lung and laryngeal cancer. Other tumours believed to be associated with aspects of Western lifestyle , such as colorectal and breast cancer, are also relatively infrequent.

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Cancer and HIV infection in Rwanda

Cited by 62 publications

References 3 publications

The epidemiology of conjunctival squamous cell carcinoma in Uganda

The epidemiology of conjunctival squamous cell carcinoma in Uganda

Association between human immunodeficiency virus type 1 infection and cancer in the black population of Johannesburg and Soweto, South Africa

Cancer in Rwanda

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