Spectrum and Trends of Cancer Among HIV Patients in Southwestern Uganda

Overview

Journal PLoS One

Date 2025 Jan 27

PMID 39869644

Authors

Raymond Atwine

Mitala Yekosani

Abraham Birungi

Brian Ssenkumba

Barbra Tuhamize

Richard Ezinga

Keneth Male

Taseera Kabanda

Affiliations

Soon will be listed here.

Abstract

Background: Antiretroviral therapy (ART) restores cellular immunity, significantly reducing AIDS-related mortality and morbidity thus improving the quality of life among People living with HIV (PLHIV). Studies done in several countries show a decline in AIDS defining cancers (ADCs) with the introduction of ART however the increased longevity has led to the increase of Non-AIDS defining cancers (NADCs). The study was aimed at studying the changing spectrum and trends of cancer among Human Immunodeficiency Virus (HIV) patients in southwestern Uganda.

Methods: The study was a retrospective chart review of records of HIV-positive patients attending/receiving care from the Oncology clinic and ISS clinic of Mbarara Regional Referral Hospital (MRRH) who were, diagnosed with cancer for the past 10 years (January 2012-2021). Data were statistically analyzed using STATA version 17 (Stata Corp, Texas, US) at P < 0.05.

Results: Males were more common at 64.5% while the median age was 37 years (IQR 29-47 years). ADCs were seen in 77.5% of the population while participants with NADCs were older (p < 0.001). The majority 73.3% (283/386) were in later stages (3 and 4). Having either ADCs or NADCs was different across HIV stages (p < 0.001). The median baseline CD4 count was 205 cells/μl (IQR: 90-400 cells/μl). The median duration on ART was 15 months (IQR 3-65 months). Participants with ADCs had been on ART for a shorter duration of time (p < 0.001). Only the outcome of patients with ADCs were available. The outcome varied with sex (p < 0.036), baseline CD4 (p < 0.048), and HIV stage (p < 0.002). Males were more likely to die (30/38 or 78.95%) and lost to follow-up (26/41 or 60.98%). Participants with baseline CD4 cell count > 200 cells/μl were more than twice likely to be active in care. The Commonest ADC was Kaposi Sarcoma (KS) while the commonest NADC was Squamous cell carcinoma, Not otherwise specified. Age above 50 years was associated with a significantly reduced risk of ADCs (OR: 0.11; 95% CI: 0.03-0.43; p value: 0.002). The risk of ADCs increased from stage 2 (OR: 0.46, p-value: 0.03; 95% CI: 0.23-0.91) to stage 3 (OR: 1.13; p-value: 0.66; 95% CI: 0.65-1.97) but this was not statistically significant. The risk of ADCs decreased with increasing ART duration (P value < 0.05).

Conclusion: ADCs are still a major health challenge in Southwestern Uganda despite the increasing the coverage and uptake of ART in region. These have mostly affected the young people, people who have been on HAART for a shorter period and those with lower CD4 cell count at initiation of ART.

References

Bedimo R, Chen R, Accortt N, Raper J, Linn C, Allison J . Trends in AIDS-defining and non-AIDS-defining malignancies among HIV-infected patients: 1989-2002. Clin Infect Dis. 2004; 39(9):1380-4. DOI: 10.1086/424883. View

Rihana N, Nanjappa S, Sullivan C, Velez A, Tienchai N, Greene J . Malignancy Trends in HIV-Infected Patients Over the Past 10 Years in a Single-Center Retrospective Observational Study in the United States. Cancer Control. 2018; 25(1):1073274818797955. PMC: 6128080. DOI: 10.1177/1073274818797955. View

Spacek L, Shihab H, Kamya M, Mwesigire D, Ronald A, Mayanja H . Response to antiretroviral therapy in HIV-infected patients attending a public, urban clinic in Kampala, Uganda. Clin Infect Dis. 2005; 42(2):252-9. DOI: 10.1086/499044. View

Engels E, Pfeiffer R, Goedert J, Virgo P, McNeel T, Scoppa S . Trends in cancer risk among people with AIDS in the United States 1980-2002. AIDS. 2006; 20(12):1645-54. DOI: 10.1097/01.aids.0000238411.75324.59. View

Biggar R, Chaturvedi A, Goedert J, Engels E . AIDS-related cancer and severity of immunosuppression in persons with AIDS. J Natl Cancer Inst. 2007; 99(12):962-72. DOI: 10.1093/jnci/djm010. View

Crum-Cianflone N, Hullsiek K, Marconi V, Weintrob A, Ganesan A, Barthel R . Trends in the incidence of cancers among HIV-infected persons and the impact of antiretroviral therapy: a 20-year cohort study. AIDS. 2008; 23(1):41-50. PMC: 2727153. DOI: 10.1097/QAD.0b013e328317cc2d. View

Newton R, Ziegler J, Beral V, Mbidde E, Carpenter L, Wabinga H . A case-control study of human immunodeficiency virus infection and cancer in adults and children residing in Kampala, Uganda. Int J Cancer. 2001; 92(5):622-7. DOI: 10.1002/1097-0215(20010601)92:5<622::aid-ijc1256>3.0.co;2-k. View

Engels E . Non-AIDS-defining malignancies in HIV-infected persons: etiologic puzzles, epidemiologic perils, prevention opportunities. AIDS. 2009; 23(8):875-85. PMC: 2677638. DOI: 10.1097/QAD.0b013e328329216a. View

Kasamba I, Baisley K, Mayanja B, Maher D, Grosskurth H . The impact of antiretroviral treatment on mortality trends of HIV-positive adults in rural Uganda: a longitudinal population-based study, 1999-2009. Trop Med Int Health. 2012; 17(8):e66-73. PMC: 3443388. DOI: 10.1111/j.1365-3156.2012.02841.x. View

10.

Rubaihayo J, Tumwesigye N, Konde-Lule J, Makumbi F, Nakku E, Wamani H . Trends and Predictors of Mortality Among HIV Positive Patients in the Era of Highly Active Antiretroviral Therapy in Uganda. Infect Dis Rep. 2015; 7(3):5967. PMC: 4593885. DOI: 10.4081/idr.2015.5967. View

11.

Engels E, Biggar R, Hall H, Cross H, Crutchfield A, Finch J . Cancer risk in people infected with human immunodeficiency virus in the United States. Int J Cancer. 2008; 123(1):187-94. DOI: 10.1002/ijc.23487. View

12.

Frisch M, Biggar R, Engels E, Goedert J . Association of cancer with AIDS-related immunosuppression in adults. JAMA. 2001; 285(13):1736-45. DOI: 10.1001/jama.285.13.1736. View

13.

Shiels M, Pfeiffer R, Gail M, Hall H, Li J, Chaturvedi A . Cancer burden in the HIV-infected population in the United States. J Natl Cancer Inst. 2011; 103(9):753-62. PMC: 3086877. DOI: 10.1093/jnci/djr076. View

14.

. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. Lancet HIV. 2016; 3(8):e361-e387. PMC: 5056319. DOI: 10.1016/S2352-3018(16)30087-X. View

15.

Ybarra M, Bull S, Prescott T, Birungi R . Acceptability and feasibility of CyberSenga: an Internet-based HIV-prevention program for adolescents in Mbarara, Uganda. AIDS Care. 2013; 26(4):441-7. PMC: 3947249. DOI: 10.1080/09540121.2013.841837. View

16.

Makurumidze R, Mutasa-Apollo T, Decroo T, Choto R, Takarinda K, Dzangare J . Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe's national antiretroviral therapy programme between 2012 and 2015. PLoS One. 2020; 15(1):e0222309. PMC: 6946589. DOI: 10.1371/journal.pone.0222309. View

17.

Msyamboza K, Dzamalala C, Mdokwe C, Kamiza S, Lemerani M, Dzowela T . Burden of cancer in Malawi; common types, incidence and trends: national population-based cancer registry. BMC Res Notes. 2012; 5:149. PMC: 3327635. DOI: 10.1186/1756-0500-5-149. View

18.

Mbulaiteye S, Biggar R, Goedert J, Engels E . Immune deficiency and risk for malignancy among persons with AIDS. J Acquir Immune Defic Syndr. 2003; 32(5):527-33. DOI: 10.1097/00126334-200304150-00010. View

19.

Bukenya D, Mayanja B, Nakamanya S, Muhumuza R, Seeley J . What causes non-adherence among some individuals on long term antiretroviral therapy? Experiences of individuals with poor viral suppression in Uganda. AIDS Res Ther. 2019; 16(1):2. PMC: 6340167. DOI: 10.1186/s12981-018-0214-y. View

20.

Kazooba P, Kasamba I, Baisley K, Mayanja B, Maher D . Access to, and uptake of, antiretroviral therapy in a developing country with high HIV prevalence: a population-based cohort study in rural Uganda, 2004-2008. Trop Med Int Health. 2012; 17(8):e49-57. PMC: 3443381. DOI: 10.1111/j.1365-3156.2012.02942.x. View