Contribution of HIV infection to mortality among cancer patients in Uganda

Abstract

Objective HIV infection is associated with cancer risk. This relationship has resulted in a growing cancer burden, especially in resource-limited countries where HIV is highly prevalent. Little is known, however, about how HIV affects cancer survival in these settings. We therefore investigated the role of HIV in cancer survival in Uganda. Design Retrospective cohort (N = 802). Methods Eligible cancer patients were residents of Kyadondo County, at least 18 years of age at cancer diagnosis, and diagnosed between 2003 and 2010 with one of the following: breast cancer, cervical cancer, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, or esophageal cancer. Patients were classified as HIV-infected at cancer diagnosis based on a documented positive HIV antibody test, medical history indicating HIV infection, or an HIV clinic referral letter. The primary outcome, vital status at 1 year following cancer diagnosis, was abstracted from the medical record or determined through linkage to the national hospice database. The risk of death during the year after cancer diagnosis was compared between cancer patients with and without evidence of HIV infection using Cox proportional hazards regression. Results HIV-infected cancer patients in Uganda experienced a more than two-fold increased risk of death during the year following cancer diagnosis compared to HIV-uninfected cancer patients [hazard ratio 2.28; 95% confidence interval (CI) 1.61–3.23]. This association between HIV and 1-year cancer survival was observed for both cancers with (hazard ratio 1.56; 95% CI 1.04–2.34) and without (hazard ratio 2.68; 95% CI 1.20–5.99) an infectious cause. Conclusion This study demonstrates the role of HIV in cancer survival for both cancers with and without an infectious cause in a resource-limited, HIV-endemic setting.

HIV-associated malignancies in sub-Saharan Africa

“…Outcomes are principally determined by NHL disease characteristics (international prognostic index score) rather than HIV status, and neutropenia is by far the most frequent toxicity among HIV-positive patients which might be easily addressed with greater availability of hematopoietic growth factors. Based on our experience and other similar reports from SSA [51–53], continued efforts to diagnose patients earlier, treat them with standardized protocols, improve supportive care, and incorporate newer non-cytotoxic therapies can likely increase cure rates substantially even for HIV-infected patients in highly resource-limited settings [54]. Strategies testing lower-intensity, oral, metronomic approaches are also under evaluation with some promising early experience [55, 56].…”

African Breast Cancer—Disparities in Outcomes (ABC-DO): protocol of a multicountry mobile health prospective study of breast cancer survival in sub-Saharan Africa

“…Radiotherapy facilities in particular are lacking in much of SSA, while centralised oncology facilities are often at large distances from rural health centres and women's homes. Finally, SSA settings have a considerable number of HIV-positive patients with breast cancer23 whose survival and treatment tolerance need further investigation 24…”

Survival among HIV-Infected and HIV-Uninfected Individuals with Common Non–AIDS-Defining Cancers

“…Of studies comparing cancer prognosis by HIV status, HIV infection has been associated with increased mortality from multiple NADCs, including HL (13–15) and lung, (13,14,16,17) colorectal, (13,14) anal, (14,18) and prostate (14) cancers. However, while mortality from AIDS and other causes may result in reduced survival for HIV-infected individuals, few studies have examined cancer-specific mortality (16); furthermore, several were conducted among individuals living with AIDS, (13,14) who are at particularly high risk of death from non-cancer causes.…”