Abstract
BackgroundAlthough Nigeria has a large HIV epidemic, the impact of HIV on cancer in Nigerians is unknown.MethodsWe conducted a registry linkage study using a probabilistic matching algorithm among a cohort of HIV positive persons registered at health facilities where the Institute of Human Virology Nigeria (IHVN) provides HIV prevention and treatment services. Their data was linked to data from 2009 to 2012 in the Abuja Cancer Registry. Match compatible files with first name, last name, sex, date of birth and unique HIV cohort identification numbers were provided by each registry and used for the linkage analysis. We describe demographic characteristics of the HIV clients and compute Standardized Incidence Ratios (SIRs) to evaluate the association of various cancers with HIV infection.ResultsBetween 2005 and 2012, 17,826 persons living with HIV (PLWA) were registered at IHVN. Their median age (Interquartile range (IQR)) was 33 (27–40) years; 41% (7246/17826) were men and 59% (10580/17826) were women. From 2009 to 2012, 2,029 clients with invasive cancers were registered at the Abuja Cancer Registry. The median age (IQR) of the cancer clients was 45 (35–68) years. Among PLWA, 39 cancer cases were identified, 69% (27/39) were incident cancers and 31% (12/39) were prevalent cancers. The SIR (95% CI) for the AIDS Defining Cancers were 5.7 (4.1, 7.2) and 2.0 (0.4, 3.5), for Kaposi Sarcoma and Cervical Cancer respectively.ConclusionThe risk of Kaposi Sarcoma but not Cervical Cancer or Non-Hodgkin’s Lymphoma, was significantly increased among HIV positive persons, compared to the general population in Nigeria.
Highlights
Nigeria has a large Human immunodeficiency virus (HIV) epidemic, the impact of HIV on cancer in Nigerians is unknown
Most of the studies conducted to investigate the relationship between HIV infection and malignancies in sub-Saharan Africa to date have largely emanated from East and Southern Africa and this may not accurately reflect the pattern of Acquired immunodeficiency syndrome (AIDS) associated malignancies in Africa [7-13]
Among the AIDS defining cancers (ADC), only Kaposi sarcoma (KS) was significantly increased among HIV positive persons and there was no statistically significant increase in incidence of non-Hodgkin’s lymphoma (NHL), CC and Non-AIDS defining cancers (NADC)
Summary
Nigeria has a large HIV epidemic, the impact of HIV on cancer in Nigerians is unknown. The Centers for Disease Control and Prevention (CDC) designated Kaposi sarcoma (KS) cervical cancer (CC) and non-Hodgkin’s lymphoma (NHL) as AIDS defining cancers (ADCs) because of the association of these cancers with increased risk of HIV infection. 70% of cancers occurring in the studied HIV infected population in Uganda were ADCs. The risks of five other NADCs - cancers of the kidney, thyroid, uterus, conjunctiva and Hodgkin’s lymphoma - were increased [12]. The risks of five other NADCs - cancers of the kidney, thyroid, uterus, conjunctiva and Hodgkin’s lymphoma - were increased [12] Apart from such systematic studies, other reports from Africa were based on hospital or pathology case series with a majority of such studies emanating from Nigeria, West Africa.
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