The changing pattern of ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin's lymphoma as non-AIDS-defining cancers, by HIV status, in Tanzania over 11years (2002-2012): a retrospective case-report study.

Clare Meernik,Crispin Kahesa,Julius Mwaiselage,Twalib Ngoma,Amr S Soliman,Sofia D Merajver

doi:10.1186/1750-9378-9-42

Abstract

BackgroundIn Tanzania, 5.1% of adults aged 15-49 are infected with HIV. While rates of HIV-related malignancies have declined globally with antiretroviral therapy (ART), including Tanzania, rates of non-AIDS-defining cancers (NADCs) are believed to have increased. Therefore, we determined trends of three NADCs in Tanzania: ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin’s lymphoma.MethodsThis study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam. All medical records of patients diagnosed with ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin’s lymphoma between 2002 and 2012 were reviewed regarding HIV status, cancer clinical characteristics and management. Analysis was conducted to determine trends and proportions in these three NADCs and patient characteristics.ResultsWe identified 980 NADCs. The relative proportion of these three NADCs at ORCI out of all cancers treated increased from 2.37% in 2002 to a peak of 4.34% in 2009. The prevalence of HIV in patients diagnosed with these NADCs also increased—from 6.67% in 2002 to 20.87% in 2010—and 85% of squamous cell carcinoma of the eye cancer patients with a reported HIV status were HIV-positive.ConclusionsThe frequency and proportions of these three NADCs in Tanzania have increased over the past 11 years, as has the prevalence of HIV positivity amongst these NADC patients. The current and possibly increasing burden of NADCs in Tanzania and other low- and middle-income countries with high HIV rates should be a focus for future cancer prevention and control and HIV therapy programs.

Highlights

In Tanzania, 5.1% of adults aged 15-49 are infected with HIV
The absolute number of cases tripled during the 11-year period for these three Non-AIDS-defining cancer (NADC), while the Tanzanian population increased by only 25% [17]
The relative proportion of cancer diagnosed at Ocean Road Cancer Institute (ORCI) as one of these three NADCs increased from 2.37% in 2002 to a peak of 4.34% in 2009 (Joinpoint logarithmic annual percent change (APC) = 4.68%) (Figure 1)

Summary

Introduction

In Tanzania, 5.1% of adults aged 15-49 are infected with HIV. While rates of HIV-related malignancies have declined globally with antiretroviral therapy (ART), including Tanzania, rates of non-AIDS-defining cancers (NADCs) are believed to have increased. The occurrence of 14.1 million incident cancer cases and 8.2 million cancer deaths in 2012 indicates that cancer is a major public health problem rising worldwide, especially in developing countries [1]. Infection-associated cancers comprise a greater proportion of the cancer burden in developing regions compared to high-income regions, with 32.7% of cancers in sub-Saharan Africa attributable to infections [2,3]. Especially in sub-Saharan Africa, are malignancies associated with HIV, as the majority of the 35.3 million people around the world living with HIV reside in low- and middle-income countries [4]. In Tanzania, 5.1% of adults aged 15-49 are infected with

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