Documentation of HIV Testing and Treatment Status Among Patients Presenting for Cancer Care in Uganda

Abstract

23 HIV increases the incidence and mortality of cancer; knowledge of HIV status and treatment is essential for management of patients with HIV-associated malignancies (HIVAM). In Uganda, where the prevalence of HIV infection is 7.4%, the incidence of AIDS-defining cancers (ADCs) is high, and non-AIDS defining cancers (NADCs) are increasingly common. We investigated how often cancer providers documented HIV status and clinical parameters of HIV infection among patients at the Uganda Cancer Institute (UCI). Medical records of patients aged ≥18 who registered at the UCI June - September 2015 were abstracted for demographics and cancer and HIV parameters. We calculated binomial proportions and used χ2 tests to evaluate factors associated with HIV. Among 1,130 patients in this analysis, 71% of charts documented HIV status. Of those documenting HIV status, 32% were HIV+, and 58% of HIV+ individuals had an ADC. The documented HIV prevalence in NADCs was 21%. Women were more likely to lack HIV results (RR 1.32, p=0.009); 36% of women lacked results, including 40% with cervical cancer. HIV+ patients were younger than HIV-negative patients (median age 41 vs. 49, p<0.001). 62% of HIV-infected patients had a CD4 count recorded; CD4 counts were lower among persons with ADC (median 270 cells/ml, IQR 80-460) compared with NADC (median 370, IQR 215-564), p=0.006. There was no difference in the proportion of HIV patients with ADCs and NADCs receiving ART (both 86%, p=0.45). HIV prevalence was 4.5 times higher in Ugandan cancer patients with documented status than in the general population. Though the majority of cancer patients had HIV testing performed, gaps remained in documenting HIV status, even among cancers considered AIDS-defining in HIV. This study highlights opportunities to educate cancer clinicians in Africa on the burden of HIV in cancer patients and opportunities to coordinate management of both cancer and HIV. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Matine J. Ghadrshenas No relationship to disclose Rachel A. Bender Ignacio No relationship to disclose Daniel H. Low No relationship to disclose Warren Phipps No relationship to disclose Jackson Orem No relationship to disclose Ann Duerr No relationship to disclose Corey Casper Leadership: Temptime Consulting or Advisory Role: Janssen Pharmaceuticals Research Funding: Janssen Pharmaceuticals Travel, Accommodations, Expenses: Temptime Corporation, GlaxoSmithKline