The spectrum of cancers in West Africa: associations with human immunodeficiency virus

Abstract

Background: Cancer is a growing co-morbidity among HIV-infected patients worldwide. With the scale-up of antiretroviral therapy (ART) in developing countries, cancer will contribute more and more to the HIV/AIDS disease burden. Our objective was to estimate the association between HIV infection and selected types of cancers among patients hospitalized for diagnosis or treatment of cancer in West Africa.

Methods: A case-referent study was conducted in referral hospitals in Côte d'Ivoire and Benin. Each participating clinical ward enrolled all adult patients seeking care for a confirmed diagnosis of cancer and clinicians systematically proposed an HIV test. HIV prevalence was compared between AIDS-defining cancers and a subset of selected non-AIDS defining cancers to a referent group of non-AIDS defining cancers not reported in the literature to be positively or inversely associated with HIV. An unconditional logistic model was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of the risk of being HIV-infected for selected cancers sites compared to a referent group of other cancers.

Results: The HIV overall prevalence was 12.3% (CI 10.3-14.4) among the 1,017 cancer cases included. A total of 442 patients constituted the referent group with an HIV prevalence of 4.7% (CI 2.8-6.7). In multivariate analysis, Kaposi sarcoma (OR 62.2 [CI 22.1-175.5]), non-Hodgkin lymphoma (4.0 [CI 2.0-8.0]), cervical cancer (OR 7.9 [CI 3.8-16.7]), anogenital cancer (OR 11.6 [CI 2.9-46.3]) and liver cancer (OR 2.7 [CI 1.1-7.7]) were all associated with HIV infection.

Conclusions: In a time of expanding access to ART, AIDS-defining cancers remain highly associated with HIV infection. This is to our knowledge, the first study reporting a significant association between HIV infection and liver cancer in sub-Saharan Africa.

Figure 1. Distribution of patients according to their cancer primary site and HIV status in Côte d’Ivoire and Benin (N = 1,017), the IeDEA West Africa collaboration. 2009–2011.

*Other than Kaposi sarcoma †Except melanoma ∫Other locations including esophagus (n = 10), endocrine tumors (N = 9), gallbladder & bile ducts (N = 8) and other minor cancer types (n = 20).

Figure 2. Distribution of ART use in HIV-positive patients according to the different AIDS and non-AIDS defining cancers

in Côte d’Ivoire and Benin, the IeDEA West Africa Collaboration, 2009–2011. *Patients not known to be HIV-positive prior t the study conduction † Patients with a previously documented HIV infection.