Challenges in the detection, prevention, and treatment of HIV-associated malignancies in low- and middle-income countries in Africa

Abstract

Cancers associated with immunosuppression and infections have long been recognized as a major complication of HIV/AIDS. More recently, persons living with HIV are increasingly diagnosed with a wider spectrum of HIV-associated malignancies (HIVAM) as they live longer on combination antiretroviral therapy. This has spurred research to characterize the epidemiology and determine the optimal management of HIVAM with a focus on low-and middle-income countries (LMICs). Given background coinfections, environmental exposures, host genetic profiles, antiretroviral therapy usage, and varying capacities for early diagnosis and treatment, one can expect the biology of cancers in HIV-infected persons in LMICs to have a significant impact on chronic HIV care, as is now the case in high-income countries. Thus, new strategies must be developed to effectively prevent, diagnose, and treat HIVAM in LMICs; provide physical/clinical infrastructures; train the cancer and HIV workforce; and expand research capacity-particularly given the challenges posed by the limitations on available transportation and financial resources and the population's general rural concentration. Opportunities exist to extend resources supported by the President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria to improve the health-care infrastructure and train the personnel required to prevent and manage cancers in persons living with HIV. These HIV chronic care infrastructures could also serve cancer patients regardless of their HIV status, facilitating long-term care and treatment for persons who do not live near cancer centers, so that they receive the same degree of care as those receiving chronic HIV care today.

FIGURE 1

Incidence of ADCs in the general population of African countries compared with the United States (data from IARC, Globocan 2012). ICC, invasive cervical carcinoma. Note: Nations/territories from left to right: Malawi, Zimbabwe, Mozambique, Zambia, Swaziland, Tanzania, Uganda, Comoros, Lesotho, Burundi, Kenya, Rwanda, Madagascar, Mali, Senegal, South Sudan, Botswana, South Africa, Guinea, Ghana, Cameroon, Somalia, Angola, Democratic Republic of Congo, Western Sahara, Ethiopia, Nigeria, Guinea-Bissau, Sierra Leone, Liberia, Mauritania, equatorial Guinea, Benin, Cape Verde, Gambia, Central African Republic, Republic of Congo, Togo, Burkina Faso, Gabon, Eritrea, Chad, Namibia, Côte d’Ivoire, Djibouti, Morocco, La Réunion, Libya, Sudan, Algeria, Niger, Tunisia, Egypt, United States.