A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

Abstract

The aim of this study was to assess the association between HIV infection and cancer risk in Rwanda approximately a decade after the introduction of antiretroviral therapy (cART). All persons seeking cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda from 2012 to 2016 were routinely screened for HIV, prior to being confirmed with or without cancer (cases and controls, respectively). Cases were coded according to ICD‐O‐3 and converted to ICD10. Associations between individual cancer types and HIV were estimated using adjusted unconditional logistic regression. 2,656 cases and 1,196 controls differed by gender (80.3% vs. 70.8% female), age (mean 45.5 vs. 37.7 years), place of residence and proportion of diagnoses made by histopathology (87.5% vs. 67.4%). After adjustment for these variables, HIV was significantly associated with Kaposi Sarcoma (n = 60; OR = 110.3, 95%CI 46.8–259.6), non‐Hodgkin lymphoma (NHL) (n = 265; OR = 2.5, 1.4–4.6), Hodgkin lymphoma (HL) (n = 76; OR = 5.2, 2.3–11.6) and cancers of the cervix (n = 560; OR = 5.9, 3.8–9.2), vulva (n = 23; OR = 17.8, 6.3–50.1), penis (n = 29; OR = 8.3, 2.5–27.4) and eye (n = 17; OR = 4.7, 1.0–25.0). Associations varied by NHL/HL subtype, with that for NHL being limited to DLBCL (n = 56; OR = 6.6, 3.1–14.1), particularly plasmablastic lymphoma (n = 6, OR = 106, 12.1–921). No significant associations were seen with other commonly diagnosed cancers, including female breast cancer (n = 559), head and neck (n = 116) and colorectal cancer (n = 106). In conclusion, in the era of cART in Rwanda, HIV is associated with increased risk of a range of infection‐related cancers, and accounts for an important fraction of cancers presenting to a referral hospital.

Immunology of EBV-Related Lymphoproliferative Disease in HIV-Positive Individuals

“…HIV positive children were more likely to have extrafacial disease, hepatic and thoracic masses and had poor overall survival compare to HIV negative individual (193). A study in Rwanda has indicated that HIV is associated with increased risk of infection related cancer including HL and NHL and accounting for significant proportion of referral cancer patients (194). The population most affected by these infections related cancer are children.…”

Cancer in Africa 2018: The role of infections

“…87,88 In Africa the relative risk of NHL associated with HIV tends to be an order of magnitude lower, and ranges from 3.8 in Uganda 89 to 12.9 in Rwanda 90 but lack of diagnostic resources and competitive risks from other AIDS-associated diseases may be responsible for the diverging findings. [91][92][93][94][95] For the purpose of estimation, relative risks of 5 for SSA and 50 for NA were used to calculate the PAFs for NHL.…”

Suppressive antiretroviral therapy associates with effective treatment of high-grade cervical intraepithelial neoplasia

“…PLWH have an increased risk for many cancers compared to the HIV-negative population, most importantly virus-related cancer 32,33 . This is due to HIV-induced immunosuppression causing impaired control of oncogenic viruses such as HPV, Epstein-Barr-virus, Humanherpes-virus-8, Hepatitis C and Hepatitis B 8 .…”

“…Initially there were two HPV vaccines, the 2-valent (bivalent) covering HPV and 18 and the 4-valent (quadrivalent) vaccine covering HPV 6, 11, 16 and 18 ( Figure 7). Later a 9valent (nanovalent) vaccine, covering HPV 6,11,16,18,31,33,45, 52 and 58, was launched. This is currently being used in HPV vaccination programs in some countries, such as the US and New Zealand 130,131 .…”