HIV-associated malignancies in sub-Saharan Africa

Abstract

Purpose of review Summarize recent developments for HIV-associated malignancies (HIVAM) in low- and middle-income countries (LMIC) with particular focus on sub-Saharan Africa (SSA). Recent findings Antiretroviral therapy (ART) scale-up is leading to epidemiologic transitions in LMIC similar to high-income countries, with aging and growth of HIV-infected populations, declining infectious deaths, increasing cancer deaths, and transitions from AIDS-defining cancers (ADC) to non-AIDS defining cancers (NADC). Despite ART scale-up, HIVAM burden remains high including enormous ADC burden in SSA. For Kaposi sarcoma (KS), patients treated with ART and chemotherapy can experience good outcomes even in rural SSA, but KS heterogeneity remains insufficiently understood including virologic, immunologic, and inflammatory features which may be unique to LMIC. For cervical cancer, scale-up of prevention efforts including vaccination and screening is underway, with benefits already apparent despite continuing high disease burden. For non-Hodgkin lymphoma (NHL), curative treatment is possible in the ART era even in SSA, and multifaceted approaches can improve outcomes further. For many other prevalent HIVAM, care and research efforts are being established to guide treatment and prevention specifically in LMIC. Summary Sustained investment for HIVAM in LMIC can help catalyze a cancer care and research agenda which benefits HIV-positive and HIV-negative patients worldwide.

p16INK4a Expression and Immunologic Aging in Chronic HIV Infection

“…This is in part because of the persistent viral replication and repeated stimulation of HIV-specific T cells that gradually drive these cells to senescence, characterized by exhaustion of their replicative capacity and even resulting in the loss of certain anti-HIV T cell clones (reviewed in [2]). Depending on the timing of ART initiation, some of these processes are not prevented, and in spite of low viral loads and normal CD4 + T cell counts, young individuals experience aging-related immune complications [3]. One study reported that HIV-infected persons on ART with a median age of 56 years, robust immune reconstitution and viral suppression had T cell characteristics similar to those of a group of HIV-uninfected subjects with a median age of 88 years (reviewed in [4]).…”

Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria

“…The finding that patient-reported HIV was significantly associated with provider-referral at first CCS is particularly important since several studies have found that HIV infected women are at greater risk of developing precancer and ICC [ 21 , 30 – 34 ]. Because of this risk, studies have demonstrated the critical role of health care providers in linking HIV infected women to important reproductive health services including CCS in areas with a high HIV burden [ 35 ].…”

Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya

“…In many areas of Africa affected by the HIV epidemic, HIV-associated malignancies are among the most common cancers in the overall population [1]. For example, despite growing availability of antiretroviral therapy (ART), Kaposi's sarcoma (KS), as of 2018, remains the most incident cancer in many parts of eastern and southeastern Africa, including Malawi, Mozambique, Uganda, and Zambia [2].…”