Association between Antiretroviral Therapy and Cancers among Children Living with HIV in Sub-Saharan Africa

Abstract

Approximately 91% of the world’s children living with HIV (CLWH) are in sub-Saharan Africa (SSA). Living with HIV confers a risk of developing HIV-associated cancers. To determine the incidence and risk factors for cancer among CLWH, we conducted a nested case-control study of children 0–18 years from 2004–2014 at five centers in four SSA countries. Incident cases of cancer and HIV were frequency-matched to controls with HIV and no cancer. We calculated the incidence density by cancer type, logistic regression, and relative risk to evaluate risk factors of cancer. The adjusted incidence density of all cancers, Kaposi sarcoma, and lymphoma were 47.6, 36.6, and 8.94 per 100,000 person-years, respectively. Delayed ART until after 2 years of age was associated with cancer (OR = 2.71, 95% CI 1.51, 4.89) even after adjusting for World Health Organization clinical stage at the time of enrolment for HIV care (OR = 2.85, 95% CI 1.57, 5.13). The relative risk of cancer associated with severe CD4 suppression was 6.19 (p = 0.0002), 2.33 (p = 0.0042), and 1.77 (p = 0.0305) at 1, 5, and 10 years of ART, respectively. The study demonstrates the high risk of cancers in CLWH and the potential benefit of reducing this risk by the early initiation of ART.

Mapping evidence on the risk factors associated with pediatric cancers in sub-Saharan Africa: a scoping review

“…This review included 15 studies that highlight risk factors for pediatric cancers [ 14 , 27 – 29 , 36 , 53 – 59 , 61 , 73 , 75 ]. Overall, there was limited evidence on the risk factors associated with pediatric cancers in SSA.…”

“…A substantially small portion of SSA countries gave evidence on the risk factors associated with pediatric cancer ( n =6). Evidence from the retrieved studies suggests that most childhood cancers in the SSA region are infection induced ( n =12) [ 14 , 27 , 28 , 36 , 53 , 55 , 57 – 59 , 61 , 73 , 75 ]. The type of cancer mostly reported is Burkitt Lymphoma and is diagnosed mostly the tropical region of SSA.…”

“…In Tanzania infection with human herpes virus (HHV8) and HIV reflected an indirect effect or direct effect on the development of Kaposi sarcoma lesions [ 14 ]. In a recent study from four countries Botswana, Malawi, Tanzania, and Uganda, it was observed that late ART initiation and severe immunosuppression led to a higher risk of cancer among children living with HIV [ 73 ]. Kaposi sarcoma in particular had a high incidence among children living with HIV [ 73 ].…”

“…In a recent study from four countries Botswana, Malawi, Tanzania, and Uganda, it was observed that late ART initiation and severe immunosuppression led to a higher risk of cancer among children living with HIV [ 73 ]. Kaposi sarcoma in particular had a high incidence among children living with HIV [ 73 ].…”

Incidence and Clinical Description of Lymphomas in Children and Adolescents with Vertical Transmission of HIV in Rio de Janeiro, Brazil, in Pre- and Post-Combined Antiretroviral Therapy Eras: A Multicentric Hospital-Based Survival Analysis Study

“…The combined antiretroviral therapy (cART), which includes antiretroviral drugs from at least three different classes (e.g., protease inhibitors, nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors), or some two-drug based regimens, was thought to change the natural history of HIV infection [ 9 , 17 , 21 , 22 ]. It has been massively proved by previous studies that early cART access and maintenance of immune recovery during HIV infection remains a key strategy for the prevention of infection-related malignancies, including lymphomas [ 23 , 24 ].…”