Aids and cancer in Africa: the evolving epidemic in Zimbabwe

Chokunonga, Eric; Lévy, L.; Bassett, Mary T.; Borok, Margaret; Mauchaza, B.G.; Chirenje, Mike; Parkin, Donald Maxwell

doi:10.1097/00002030-199912240-00012

Cited by 102 publications

(71 citation statements)

References 14 publications

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“…These changes are the result of the evolution of the epidemic of HIV-AIDS in Zimbabwe, and the age-specific incidence of Kaposi sarcoma was noted to correspond closely to the age-specific reporting rates for AIDS. 21 HIV prevalence has been declining in Zimbabwe since 1997, 7 and these declines, resulting from either the natural dynamics of HIV epidemics or the impact of interventions, have been most marked in the younger age-groups where most individuals have had little previous exposure to infection and HIV prevalence reflects recent incidence. In older age-groups, ageing of persons infected at younger ages into these age-groups tends to offset the effects of mortality and reduced HIV incidence.…”

Section: Discussionmentioning

confidence: 99%

Trends in the incidence of cancer in the black population of Harare, Zimbabwe 1991–2010

Chokunonga¹,

Borok²,

Chirenje³

et al. 2013

Intl Journal of Cancer

175

188

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Incidence rates of different cancers have been calculated for the black population of Harare, Zimbabwe for a 20-year period (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) coinciding with continuing social and lifestyle changes, and the peak, and subsequent wane, of the HIV-AIDS epidemic. The overall risk of cancer increased during the period in both sexes, with rates of cervix and prostate cancers showing particularly dramatic increases (3.3% and 6.4% annually, respectively). By 2004, prostate cancer had become the most common cancer of men. The incidence of cancer of the esophagus, formerly the most common cancer of men, has remained relatively constant, whereas rates of breast and cervix cancers, the most common malignancies of women, have shown significant increases (4.9% and 3.3% annually, respectively). The incidence of Kaposi sarcoma increased to a maximum around 1998-2000 and then declined in all age groups, and in both sexes The incidence of squamous cell cancers of the conjunctiva is relatively high, with temporal trends similar to those of Kaposi sarcoma. Non-Hodgkin lymphoma, the fifth most common cancer of men and fourth of women, showed a steady increase in incidence throughout the period (6.7-6.9% annually), although rates in young adults (15-39) have decreased since 2001. Cancer control in Zimbabwe, as elsewhere in sub-Saharan Africa, involves meeting the challenge of emerging cancers associated with westernization of lifestyles (large bowel, breast and prostate), while the incidence of cancers associated with poverty and infection (liver, cervix and esophagus) shows little decline, and the residual burden of the AIDS-associated cancers remains significant.The Zimbabwe National Cancer Registry (ZNCR) began operations in Harare in 1986. Acceptably complete coverage of the population of the city of Harare was achieved in 1990, 1 and the incidence rates for this population have been published in three successive volumes of "Cancer Incidence in Five Continents." [2][3][4] As a result, it is one of only two cancer registries in Africa able to document the evolution of cancer patterns over a substantial period of time (the other being the Kampala cancer registry in Uganda 5,6 ). As in much of Africa, there have been marked social and lifestyle changes in the population in last 50 years. Progressive urbanization of the population has meant that Harare city has grown from a population of 1.18 million in 1992 to an estimated 1.53 million in 2010. Zimbabwe is one of the countries of Africa that have been severely affected by the epidemic of HIV/AIDS, with the prevalence of infection increasing to a maximum of 26.5% among adults (15-49) in 1997, before falling to 18.4% in 2005 and 13.1% in 2011. 7 These changes in HIV prevalence, as well as the increasing availability and use of antiretroviral therapy (ART) may be reflected in the trends of AIDS-related cancers.In our article, we examine trends in incidence in the black population of ...

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Section: Discussionmentioning

confidence: 99%

Trends in the incidence of cancer in the black population of Harare, Zimbabwe 1991–2010

Chokunonga¹,

Borok²,

Chirenje³

et al. 2013

Intl Journal of Cancer

175

188

View full text Add to dashboard Cite

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“…However, the available number of patients does not currently permit the mounting of large clinical trials in KS without the cooperation of multiple institutions, and other agents have displaced IFN as a priority in multicenter clinical studies. It is also important to recognize that KS incidence is extremely high in sub-Saharan Africa [70][71][72] where HIV and KSHV infection rates are both much higher than in resource-rich parts of the world and where the availability of HIV treatments is limited. In such settings, however, the use of an injectable agent is impractical, although there remains a critical need for effective KS therapy.…”

Section: Changes In Ks Incidencementioning

confidence: 99%

AIDS-associated Kaposi's sarcoma: Is there still a role for interferon alfa?

Krown

2007

Cytokine & Growth Factor Reviews

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Interferon alfa (IFNA) was one of the first agents to be used therapeutically in AIDS-associated Kaposi's sarcoma (KS) more than 25 years ago, and induces tumor regression in a subset of patients. Although much has been learned about the clinical role of IFNα in KS treatment, little is currently known about the mechanism(s) by which IFNA causes KS regression. This is despite a growing understanding of both KS pathogenesis and relevant IFNA activities. To a large extent other agents have supplanted IFNA as treatments for KS, but there may still remain a therapeutic role for IFNA, possibly in combination with other agents targeting angiogenesis and/or HHV-8-encoded human gene homologs that encode proteins involved in cell cycle regulation and signaling. KeywordsInterferon; Kaposi's sarcoma In 1995, when I was honored as a recipient of the ISICR Milstein Award, the AIDS epidemic had recently begun its 15 th year and the human immunodeficiency virus (HIV-1) had been isolated some 12 years previously [1]. However, the virus associated with Kaposi's sarcoma (KS), the most common AIDS-associated malignancy, had been described less than a year earlier [2], its significance was still in some question and its role in KS development had not been characterized, and the active combination drug regimens with which we now treat HIV infection had not yet become widely available. Recombinant interferon alfa preparations (IFNα2a and IFNα2b), which had received approval from the U.S. Food and Drug Administration (FDA) for treatment of AIDS-associated KS in 1988, were still the only approved drugs for systemic treatment of KS (the chemotherapeutic agent, liposomal doxorubicin, would receive FDA approval later in 1995, as did liposomal daunorubicin in 1996 and paclitaxel in 1997). Now, more than a quarter century after the first published reports describing AIDS and its association with KS [3-6] and our first modestly successful attempts to treat KS with IFNα [7], this agent is used infrequently to treat KS, although it still finds use in HIV-infected individuals co-infected with hepatitis C. In this brief review, I will summarize some of the history of IFNα in the treatment of AIDS-associated KS, concentrating on examples of clinical trials in which I have personally been involved, and consider whether there remains a potentially valuable role for this agent in KS treatment.

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“…EKS is currently the leading childhood tumor between the ages of 1-14 years, having overtaken retinoblastoma and leukemias. 5,6 Unlike endemic Kaposi's sarcoma, which responds well to treatment 7 and has long-term disease-free survival, EKS responds poorly to most forms of therapy because of the severe underlying immunodeficiency. Without access to HAART, the goal of treating EKS is palliation, and therefore quality of life (QOL) of patients is of paramount importance.…”

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confidence: 99%

Treatment of AIDS-associated Kaposi's sarcoma in Zimbabwe: Results of a randomized quality of life focused clinical trial

Olweny¹,

Borok

Gudza

et al. 2004

Int. J. Cancer

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Kaposi's sarcoma is currently the most common tumor in Zimbabwe. The purpose of our study is to compare the effectiveness of supportive care vs. 3 intervention approaches, namely oral Etoposide, a 3-drug combination, and radiotherapy using quality of life (QOL) as the primary measure of success. In addition, our study was to determine whether a disease-specific module has greater sensitivity to group differences than a generic QOL questionnaire and to determine the most pragmatic approach to treating epidemic Kaposi's sarcoma (EKS) in Zimbabwe. In addition, on the physical and psychological subscales, the Etoposide group had a significantly better QOL than the other 3 treatment groups (p < 0.04). The 3-drug combination, supportive care and radiotherapy groups did not differ significantly from each other with respect to the total FLI-C score or its subscales. There were no group differences with respect to survival. Oral Etoposide therapy resulted in better total FLI-C QOL score than radiotherapy. As well, Etoposide resulted in better physical and psychological subscale scores than radiotherapy, 3-drugs and supportive care. Thus, funds permitting, oral Etoposide is a pragmatic approach to treating EKS in an environment where antiretroviral drugs are not universally available. The study underscores the value of undertaking studies in areas of disease prevalence and the necessity of selecting appropriate outcome measures.

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Aids and cancer in Africa: the evolving epidemic in Zimbabwe

Abstract: The AIDS epidemic has had a dramatic effect on the profile of cancer. The changes in incidence involve several cancers previously linked to AIDS in North America and Europe.

Cited by 102 publications

References 14 publications

Trends in the incidence of cancer in the black population of Harare, Zimbabwe 1991–2010

Trends in the incidence of cancer in the black population of Harare, Zimbabwe 1991–2010

AIDS-associated Kaposi's sarcoma: Is there still a role for interferon alfa?

Treatment of AIDS-associated Kaposi's sarcoma in Zimbabwe: Results of a randomized quality of life focused clinical trial

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