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. 2013 Nov 28;27(18):2933-42.
doi: 10.1097/01.aids.0000433236.55937.cb.

Contribution of HIV infection to mortality among cancer patients in Uganda

Anna E Coghill  1 , Polly A Newcomb, Margaret M Madeleine, Barbra A Richardson, Innocent Mutyaba, Fred Okuku, Warren Phipps, Henry Wabinga, Jackson Orem, Corey Casper
Affiliations

Contribution of HIV infection to mortality among cancer patients in Uganda

Anna E Coghill et al. AIDS. .

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.

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Conflict of interest statement

Conflicts of interest

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1. Ascertainment source and vital status at 1 year of cohort patients, according to cancer diagnosis
Ascertainment sources include KCR: medical records retrieved by providing the list of names from the KCR database to the records officers, and non-KCR: medical records retrieved by the records officers scanning clinic log books for additional cases who met eligibility criteria. KCR, Kampala Cancer Registry.
Fig. 2
Fig. 2
Percentage distribution of stage of disease at presentation, according to cancer diagnosis and HIV status.
Fig. 3
Fig. 3. Association between HIV and 1-year cancer survival, according to HIV treatment availability
Estimated HIV treatment availability in Uganda [26]: 2003–2005: 5–25%; 2006–2008: 30–45%; 2009–2010: assumed to have increased above 50%.
See this image and copyright information in PMC

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