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. 2023 Apr:9:e2200262.
doi: 10.1200/GO.22.00262.

Virologic Nonsuppression Among Patients With HIV Newly Diagnosed With Cancer at Uganda Cancer Institute: A Cross-Sectional Study

Geraldine Kauma  1 , Henry Ddungu  1 , Isaac Ssewanyana  2 , Sharon Nyesiga  3 , Naghib Bogere  1 , Teddy Namulema-Diiro  4 , Pauline Byakika-Kibwika  5 , Elizabeth Namukwaya  5 , Harriet Mayanja Kizza  5   6
Affiliations

Virologic Nonsuppression Among Patients With HIV Newly Diagnosed With Cancer at Uganda Cancer Institute: A Cross-Sectional Study

Geraldine Kauma et al. JCO Glob Oncol. 2023 Apr.

Abstract

Purpose: AIDS-related mortality declined markedly since the introduction of antiretroviral therapy (ART); however, cancer mortality in Africa was higher than its incidence in 2020. People living with HIV (PLWHIV) are at an increased risk of malignancy and death from malignancy compared with the general population. In Uganda, AIDS-defining malignancies (ADMs), including cervical cancer, Kaposi sarcoma, and non-Hodgkin lymphoma, are among the commonest malignancies. Virologic nonsuppression has been identified as an important predictor of mortality among PLWHIV diagnosed with cancer. This study aimed to determine the prevalence and to identify factors associated with virologic nonsuppression among PLWHIV newly diagnosed with cancer.

Methods: This was a cross-sectional study that was carried out between December 2018 and April 2019 at the Uganda Cancer Institute. PLWHIV who had been on ART for at least 6 months and were newly diagnosed with cancer were enrolled.

Results: A total of 167 participants were enrolled. Cervical cancer was the commonest ADM (n = 45; 50.6%) of all ADMs, while esophageal and breast cancers were the commonest non-ADMs, accounting for 17.5% (n = 14) each of all non-ADMs. The prevalence of virologic nonsuppression was 15%. Having Kaposi sarcoma (odds ratio [OR], 8.15; P = .003), being poorly adherent to ART (OR, 4.1; P = .045), and being on second-line ART (OR, 5.68; P = .011) were associated with virologic nonsuppression.

Conclusion: The prevalence of virologic nonsuppression is high among patients with HIV newly diagnosed with cancer. These findings emphasize the need for strengthening of adherence strategies, optimizing ART regimens, and prioritization of viral load testing among PLWHIV with newly diagnosed malignancy.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/go/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Figures

FIG 1
FIG 1
Cancer type distribution among the patients. *AIDS-defining malignancy: cancer in which patients with HIV are at higher risk of acquiring compared with uninfected people of the same age, and include Kaposi sarcoma, cervical cancer, and lymphoma. **Others: Hodgkin lymphoma, sarcoma, anaplastic carcinoma, cancer of conjunctiva, cancer of epiglottis, cancer of larynx, prostate cancer, cancer of vulva, gastrointestinal stromal tumor, cancer of hypopharynx, oral pharyngeal cancer, postcricoid cancer, squamous cell carcinoma of eye, cancer of palate, spindle cell intra-abdominal neoplasm, multicentric Castleman's disease, and penile cancer.
FIG A1
FIG A1
Table for determining ART adherence level (extracted from consolidated HIV guidelines 2020). ART, antiretroviral therapy.
FIG A2
FIG A2
Patient flow diagram. ART, antiretroviral therapy; PLWHIV, people living with HIV; UCI, Uganda Cancer Institute.
See this image and copyright information in PMC

References

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    1. Ministry of Health of Uganda Uganda Population-Based HIV Impact Assessment (UPHIA). Kampala, Uganda, Ministry of Health, Uganda. 2020.
    1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–249. - PubMed
    1. Ministry of Health of Uganda . Consolidated Guidelines for the Prevention and Treatment of HIV and AIDS in Uganda. Kampala, Uganda, Ministry of Health, Uganda, 2020.
    1. Deeken JF, Tjen-A-Looi A, Rudek MA, et al. The rising challenge of non-AIDS-defining cancers in HIV-infected patients. Clin Infect Dis. 2012;55:1228–1235. - PMC - PubMed

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