Cancer in patients with and without HIV infection in the national cancer registry of Rwanda

Abstract

Objective:As antiretroviral therapy (ART) has been widely scaled up in Rwanda, life expectancies among people with HIV (PWH) have increased. With increasing viral suppression, AIDS-defining cancers (ADCs) typically decrease; however, as the PWH population ages, non-AIDS-defining cancers (NADCs) will be expected to increase. The aim of this study was to compare cancer diagnoses between PWH and patients without HIV in Rwanda and to describe the changes in the number and types of cancer over time.Design:Retrospective cohort study.Methods:Rwanda National Cancer Registry (RNCR) recorded the HIV status, primary site, and morphological description for cancer diagnoses from 2007 to 2018. Descriptive analyses were carried out by cancer group (HIV+ and HIV–). A portion of patients whose HIV status was unknown (63%) were excluded from the present analysis.Results:Among the 20 258 cases registered in the Registry, there were 1048 PWH and 6359 HIV– individuals. The proportion of ADCs were significantly higher in the PWH group compared to those without HIV (P < 0.001). Among PWH, there was a longitudinal increase in NADCs and a decrease in ADCs (P < 0.001) over time. Among the ADCs in the PWH group, there was a significant decline in Kaposi sarcoma cases over time.Conclusions:The study demonstrates a decreasing frequency of ADCs driven by declines in Kaposi sarcoma diagnoses and an increased frequency of NADCs among PWH in Rwanda over time. These findings support a need for focusing early detection and management efforts on NADCs, as they begin to play a larger role in the disease processes that affect the aging PWH population.