Abstract
The eruption of Kaposi sarcoma (KS) and aggressive non-Hodgkin lymphoma (NHL) in young homosexual men in 1981 in the West heralded the onset of the human immunodeficiency virus (HIV) infection epidemic, which remains one of the biggest challenges to global public health and science ever. Because KS and NHL were increased >10,000 and 50-600 times, respectively, with HIV, they were designated AIDS defining cancers (ADC). Cervical cancer (CC), increased 5-10 times was also designated as an ADC. A few other cancers are elevated with HIV, including Hodgkin lymphoma (10 times), anal cancer (15-30 times), and lung cancer (4 times) are designated as non-AIDS defining cancers (NADCs). Since 1996 when combination antiretroviral therapy (cART) became widely available in the West, dramatic decreases in HIV mortality have been observed and substantial decrease in the incidence of ADCs. Coincidentally, the burden of NADCs has increased as people with HIV age with chronic HIV infection. The impact of HIV infection on cancer in sub-Saharan Africa, where two thirds of the epidemic is concentrated, remains poorly understood. The few studies conducted indicate that risks for ADCs are also increased, but quantitatively less so than in the West. The risks for many cancers with established viral associations, including liver and nasopharynx, which are found in Africa, do not appear to be increased. These data are limited because of competing mortality, and cancer is under diagnosed, pathological confirmation is rare, and cancer registration not widely practiced. The expansion of access to life-extending cART in sub-Saharan Africa, through programs such as the Global Fund for AIDS, Malaria, and Tuberculosis and the US President's Emergency Program for AIDS Relief (PEPFAR), is leading to dramatic lengthening of life of HIV patients, which will likely influence the spectrum and burden of cancer in patients with HIV. In this paper, we review current literature and explore merits for integrating cancer research in established HIV programs to obtain timely data about the incidence and burden of cancer in HIV-infected persons in Africa.
Highlights
The global cancer burden has been increasing rapidly over the past 30 years [1], both in developed and developing countries [2]
A few other cancers are elevated with human immunodeficiency virus (HIV), including Hodgkin lymphoma (10 times), anal cancer (15-30 times), and lung cancer (4 times) are designated as non-AIDS defining cancers (NADCs)
The burden of NADCs has increased as people with HIV age with chronic HIV infection
Summary
The global cancer burden has been increasing rapidly over the past 30 years [1], both in developed and developing countries [2]. The International Epidemiology Databases to Evaluate AIDS (IeDEA), a global consortium funded by the National Institutes of Health, has linked 183 clinics in 17 countries in sub-Saharan Africa serving 286,793 individuals [124] These large linked clinics offer three broad-based opportunities: to define: a) the spectrum of common and rare cancers in HIVinfected individuals and to obtain precise estimates of risk and heterogeneity of risk; b) temporal trends on common and rare cancers, including before and after introduction of cART; and c) test specific hypothesis, such as investigating the risk of KS with immune reconstitution syndrome [64,125], the role of antimalarials in NHL or other cancers, and the role of genetic and/or viral co-infections in cancer [20], or assess impact of interventions. Competing interests The authors declare that they have no competing interests
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