Changing Patterns of lung, liver, and head and neck non-AIDS-defining cancers relative to HIV status in Tanzania between 2002-2014

Abstract

BackgroundTanzania, like other low-income countries, has an increasing cancer burden that remains underestimated. Infection-associated malignancies, particularly HIV-infection, represent a great proportion of cancer burden in Tanzania and throughout Africa. Availability of HIV treatment and improved survival of HIV patients are suggested factors related to increasing prevalence of non-AIDS-defining cancers (NADCs). This study examined patterns of NADCs and proportions of HIV-positivity at the Ocean Road Cancer Institute (ORCI).MethodsWe reviewed logbooks of all ORCI patients diagnosed and/or treated for lung, liver, and head and neck cancers during 2002–2014. The number of total cancers diagnosed at ORCI during this period was used to calculate proportions of NADCs. We abstracted medical records to obtain demographic and clinical profiles and HIV status information for 1127 patients diagnosed or treated during 2010–2014. Trends in numbers and proportions of NADCs were analyzed using Joinpoint regression. Characteristics of NADC patients were analyzed using multinomial logistic regression.ResultsNADCs diagnosed at ORCI increased by 33.8% from 2002 to 2014 while the proportion of NADCs relative to all cancers significantly decreased from 6.8% in 2002 to 5.6% in 2014 (APC = -2.74%). Numbers and proportions of lung and liver cancers increased compared to all cancer diagnoses from 2002 to 2014. The number of head and neck cancers increased while decreasing proportionally compared to all cancer diagnoses from 2002 to 2014. Among patients with pathologically confirmed NADCs between 2010 and 2014, HIV prevalence showed a non-statistically significant decrease from 8.1 to 7.1% (APC = -3.77%).ConclusionsAbsolute numbers of lung, liver, and head and neck cancers increased at ORCI by 1/3 since 2002. Improving survivorship of HIV patients and varying immunodeficiency status may have contributed to the increasing number of NADCs. Total cancer diagnoses nearly doubled during this period, leading to a smaller relative proportion of NADCs diagnosed in 2014 compared to 2002. Late- stage diagnosis and short survival of NADCs included this study may explain possible underestimation and smaller increase in proportion of these particular NADCs compared to other NADCs studied in Tanzania. The slight decrease in proportion of HIV-positive NADC patients during 2010–2014 may suggest increasing patient longevity and more effective HIV management in Tanzania.

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

“…Cancer survival among people with HIV infection was usually described in developed countries, whereas little information is available from developing countries [84,85]. In a study conducted in Sao Paulo, Brazil, based on a probabilistic record linkage between the Cancer and the AIDS Registry, the overall survival after diagnosis of any NADC was lower in people with than without AIDS [84].…”

“…The disparity was mainly observed in the first year after cancer diagnosis, and was attributed to the persisting lack of national guidelines for the management of malignancies in HIV-infected people in Brazil. Especially in resourceslimited settings, therapeutic chances may be limited for subjects with HIV infection, which is often an exclusion criterion in randomized controlled trials [85].…”

The Trends and Risk Factors of AIDS-Defining Cancers and Non-AIDS-Defining Cancers in Adults Living with and without HIV: A Narrative Review

“…The majority of studies that reported on mortality in this review showed that when compared with ADCs, NADCs were responsible for more cancer-related deaths in PLHIV with lung cancer being the leading cause. The incidence of lung cancer has been found to be substantially higher in PLHIV, partly due to aging and tobacco use and also because of immunosuppression and inflammatory processes associated with chronic HIV infection [ 60 , 77 , 78 ]. Another study in this review found that women with cancer and HIV-infection with lower CD4 cell counts had shorter survival when compared with their HIV-negative counterparts [ 49 ].…”

Safety and Effectiveness of Transthoracic Core Needle Biopsy in a Newly Established Interventional Radiology Program in Tanzania

“…9 10 Tanzania lacks a national population-based cancer registry and the overall dearth of proper disease surveillance and screening in the country suggests that these figures are likely deflated. 11 The few existing facility-based studies on thoracic malignancies in Tanzania likewise do not provide a complete picture on the status of thoracic malignancies in the country. 12 It is evident that the lack of diagnostic capability has made it impossible to even begin to define the state of thoracic malignancy in Tanzania and the region.…”