HIV Status and Associated Clinical Characteristics Among Adult Patients With Cancer at the Uganda Cancer Institute

Abstract

PurposeHIV increases cancer incidence and mortality. In Uganda, the HIV epidemic has led to an elevated incidence of AIDS-defining cancers (ADCs) and non–AIDS-defining cancers (NADCs). Limited information exists about how frequently HIV infection complicates the presentation and manifestations of cancer in sub-Saharan Africa.MethodsWe abstracted medical records from patients with cancer who were age 18 years or older who registered at the Uganda Cancer Institute from June through September 2015 to determine the burden of HIV. We used χ2 tests and generalized linear models to evaluate factors associated with HIV positivity. A sensitivity analysis estimated HIV prevalence in those untested. ResultsAmong 1,137 patients with cancer, 23% were HIV infected, 48% were HIV negative, and 29% had no recorded HIV status. Of those with recorded HIV status, 32% were HIV positive. Forty-two percent (149 of 361 patients) with ADCs were documented as HIV infected (51% of those with documented status) compared with 14% (108 of 776 patients) of those with NADCs (21% of those with documented status). In multivariable analysis, HIV infection was associated with ADC diagnosis (adjusted prevalence ratio [aPR] compared with NADC, 2.2; 95% CI, 1.5 to 3.0), younger age (aPR, 0.9 per decade increase; 95% CI, 0.8 to 1.0), and worse performance status scores (aPR, 1.2 per point ECOG increase; 95% CI, 1.0 to 1.5). When sensitivity analysis accounted for undocumented HIV status, the expected prevalence of HIV infection was 29% (range, 23% to 32%), and almost one fourth of expected HIV cases were undiagnosed or unrecorded.ConclusionThe prevalence of HIV infection among Ugandan patients with cancer is substantially higher than in the general population. Patients with cancer and HIV tend to be younger and have poorer performance status. Greater awareness of the dual burden of cancer and HIV in Uganda and universal testing of patients with cancer may improve outcomes of HIV-associated malignancies.

Patterns of Care of Cancers and Radiotherapy in Ethiopia

“…The prevalence of HIV in our cohort was 3-fold higher than that of the general Ethiopian population (4.6% v 1.5%, respectively), which has also been observed in Uganda. 19,20 A majority of patients in the study were female. Females have a higher prevalence of HIV than males; in addition, HIV is an independent risk factor for cervical cancer, which is preferentially treated by RT.…”

Engagement in HIV Care and Access to Cancer Treatment Among Patients With HIV-Associated Malignancies in Uganda

“…To address these challenges, cancer centers could be better positioned to care for and treat PLWH. We previously estimated that approximately one in 10 Ugandan patients with cancer, or one third of those who are HIV infected, have undiagnosed HIV 10 ; therefore, cancer centers can improve efforts at universal screening and treatment of HIV. On-site provision of ART could help limit challenges of transportation, cost, and overlapping appointments, in addition to minimizing drug-drug interactions, adverse events, and gaps in ART during inpatient care or intensive outpatient treatment.…”

“…We did not include a comparator arm of HIV-negative patients, because this study was designed as preparation for implementation studies in HIVAM care. Because we selected only patients who were aware of their HIV diagnosis and who ultimately initiated cancer care, our study is not representative of all persons with HIVAM, especially those with undiagnosed HIV during cancer treatment (up to 10% of patients with cancer 10 ) or those who never entered cancer care. Although the UCI serves an international catchment within eastern Africa, a majority of our patients lived relatively close to Kampala, were receiving ART, were engaged in HIV care, and had access to a cellphone.…”

“…The enrollment target of 100 was based on feasibility with available resources. We capped enrollment of patients with Kaposi sarcoma (KS) or cervical cancer based on prevalence of these cancers at the UCI to allow sufficient representation of NADC 10 ; enrollment was continuous until caps were reached. Participants completed informed consent in English or Luganda.…”

“…In Uganda, approximately 29% of all patients with cancer are HIV positive, despite a general population prevalence of 7.5%, 10 and the risk of death resulting from cancer is more than two-fold higher in patients with cancer who are HIV infected. 11 Factors that may contribute to poor outcomes in patients with HIVAM include late stage at presentation and inability to obtain or negotiate complex treatments.…”