Malignancy and viral infections in Sub-Saharan Africa: A review

Abstract

The burden of malignancy related to viral infection is increasing in Sub-Saharan Africa (SSA). In 2018, approximately 2 million new cancer cases worldwide were attributable to infection. Prevention or treatment of these infections could reduce cancer cases by 23% in less developed regions and about 7% in developed regions. Contemporaneous increases in longevity and changes in lifestyle have contributed to the cancer burden in SSA. African hospitals are reporting more cases of cancer related to infection (e.g., cervical cancer in women and stomach and liver cancer in men). SSA populations also have elevated underlying prevalence of viral infections compared to other regions. Of 10 infectious agents identified as carcinogenic by the International Agency for Research on Cancer, six are viruses: hepatitis B and C viruses (HBV and HCV, respectively), Epstein-Barr virus (EBV), high-risk types of human papillomavirus (HPV), Human T-cell lymphotropic virus type 1 (HTLV-1), and Kaposi’s sarcoma herpesvirus (KSHV, also known as human herpesvirus type 8, HHV-8). Human immunodeficiency virus type 1 (HIV) also facilitates oncogenesis. EBV is associated with lymphomas and nasopharyngeal carcinoma; HBV and HCV are associated with hepatocellular carcinoma; KSHV causes Kaposi’s sarcoma; HTLV-1 causes T-cell leukemia and lymphoma; HPV causes carcinoma of the oropharynx and anogenital squamous cell cancer. HIV-1, for which SSA has the greatest global burden, has been linked to increasing risk of malignancy through immunologic dysregulation and clonal hematopoiesis. Public health approaches to prevent infection, such as vaccination, safer injection techniques, screening of blood products, antimicrobial treatments and safer sexual practices could reduce the burden of cancer in Africa. In SSA, inequalities in access to cancer screening and treatment are exacerbated by the perception of cancer as taboo. National level cancer registries, new screening strategies for detection of viral infection and public health messaging should be prioritized in SSA’s battle against malignancy. In this review, we discuss the impact of carcinogenic viruses in SSA with a focus on regional epidemiology.

The Impact of Co-Infections for Human Gammaherpesvirus Infection and Associated Pathologies

“…EBV-associated cancers account for approximately 1.5% of all human cancers globally [39] and are responsible for 137,900-208,700 cancer-related deaths annually [40]. The fact that EBV was initially discovered in African BL cell cultures is evidence of the disease's high impact in this region, especially with the lack of efficient healthcare infrastructure and virus control strategies [40,41]. Endemic BL has been shown to have a particularly high impact in SSA affecting 80% of all pediatric patients presenting with hematologic malignancies and is further exacerbated by the high incidences of Plasmodium sp.…”

Evaluating the use of antiviral drugs in HIV patients with cardiovascular diseases and how to reduce the incidence of cardiac events in these patients

“…Human immunodeficiency virus (HIV) affects an estimated 37.7 million people worldwide, with sub-Saharan Africa bearing the greatest load of the disease [1]. HIV infection is known to raise the risk of atherosclerotic cardiovascular disease (ASCVD), perhaps due to prolonged immunological activation and inflammation.…”