Ocular surface squamous neoplasia in patients with HIV infection in sub-Saharan Africa

Abstract

Purpose of review Ocular surface squamous neoplasia (OSSN) in sub-Saharan countries is an aggressive tumor that affects younger patients and appears to be increasing in incidence. There are data to suggest the association of this disease with solar radiation exposure, HIV, and human papilloma virus (HPV). This trend possibly reflects the association of the high incidence of HIV, concomitant high incidence of exposure to HPV, and the solar radiation exposure that people in this region of the world receive. We undertook a PubMed search with the terms ‘ocular surface squamous neoplasia’, ‘conjunctival carcinoma’, ‘HIV’ and ‘HPV’, and ‘sub-Saharan/Africa’ to ascertain the scope of the problem and to review the available data, with an emphasis on publications of 2009 and the first quarter of 2010. Recent findings There is increasing evidence of a significant association between HIV seropositivity and OSSN. The role of HPV as contributing to the cause of OSSN is being investigated. Summary Patients with conjunctival cancer in sub-Saharan Africa are typically younger and more than 50% have underlying HIV infection. Initial presentation can be asymptomatic; however, many of these patients have advanced disease before they seek medical help and OSSN appears to have a more aggressive clinical course in sub-Saharan Africa. Treatment in Africa is primarily surgical. Chemotherapy and antiviral agents have been used. A diagnosis of OSSN in younger patients in sub-Saharan Africa should prompt HIV serotesting.

American Joint Committee on Cancer Staging and Clinicopathological High-Risk Predictors of Ocular Surface Squamous Neoplasia: A Study From a Tertiary Eye Center in India

“…Human papillomavirus and human immunodeficiency virus have also been cited as possible cofactors in OSSN that may influence the prognosis. 3,[18][19][20] Recurrence developed in 17% of 48 patients herein with follow-up data, which is similar to that in other studies (17%-41%). 1,7 Larger tumors (2 cm) and those with a diffuse growth pattern had a higher risk of recurrence.…”

“…2 Ocular surface squamous neoplasia occurs predominantly in older men, although an increased incidence has recently been observed in individuals younger than 50 years. 3 While the lesions are usually confined to the ocular surface, they have the capability to metastasize (0%-16%) [4][5][6] and recur (17%-24% for CIN 7 and 30%-41% for SCC 1 ). Available data regarding prognostic features affecting survival in patients with OSSN are limited and are mostly inconclusive.…”

Screening for Ocular Surface Squamous Neoplasia (OSSN) by Slit-lamp Assisted Visual Inspection (SAVI) following a short course of mild topical steroid-test qualities

“…These observations have been made in other studies conducted in Africa 15 . Thus, age and HIV status are other parameters that may be considered as part of clinical judgement in suspect case of OSSN.…”

“…OSSN calls for a very aggressive approach to save life and reduce morbidity when compared to non-OSSN tumours and surgery is the recommended standard management of OSSN lesions 9,10,[14][15] . The confusion between OSSN and benign conjunctival tumours experienced by clinicians impacts negatively on the speed at which surgical intervention is offered to OSSN patients in Zimbabwe.…”

Comparative Analysis of Clinical Factors Associated with Ocular Surface Squamous Neoplasia in HIV Infected and Non HIV Patients

“…In other studies a similar trend was observed. OSSN have become more prevalent and aggressive over recent decades in Sub-Saharan Africa, with higher rates of young people being affected [11]. These changes are largely attributed to human immunodeficiency virus (HIV) infection [12][13][14][15].…”