The burden of cancers associated with HIV in the South African public health sector, 2004–2014: a record linkage study

Abstract

Introduction The impact of South Africa’s high human immunodeficiency virus (HIV) burden on cancer risk is not fully understood, particularly in the context of antiretroviral treatment (ART) availability. We examined national cancer trends and excess cancer risk in people living with HIV (PLHIV) compared to those who are HIV-negative. Methods We used probabilistic record linkage to match cancer records provided by the National Cancer Registry to HIV data provided by the National Health Laboratory Service (NHLS). We also used text search of specific HIV terms from the clinical section of pathology reports to determine HIV status of cancer patients. We used logistic and Joinpoint regression models to evaluate the risk and trends in cancers in PLHIV compared to HIV-negative patients from 2004 to 2014. In sensitivity analysis, we used inverse probability weighting (IPW) to correct for possible selection bias. Results A total of 329,208 cancer cases from public sector laboratories were reported to the NCR from 2004 to 2014 with the HIV status known for 95,279 (28.9%) cancer cases. About 50% of all the female cancer cases ( n = 30,486) with a known status were HIV-positive. PLHIV were at higher risk of AIDS-defining cancers (Kaposi sarcoma [adjusted OR:134, 95% CI:111–162], non-Hodgkin lymphoma [adjusted OR:2.73, 95% CI:2.56–2.91] and, cervix [adjusted OR:1.70, 95% CI:1.63–1.77], conjunctival cancer [adjusted OR:21.5, 95% CI:16.3–28.4] and human papilloma virus (HPV) related cancers (including; penis [adjusted OR:2.35, 95% CI:1.85–2.99], and vulva [adjusted OR:1.94, 95% CI:1.67–2.25]) compared to HIV-negative patients. Analysis using the IPW population yielded comparable results. Conclusion There is need for improved awareness and screening of conjunctival cancer and HPV-associated cancers at HIV care centres. Further research and discussion is warranted on inclusive HPV vaccination in PLHIV.

An Analysis of Biopsies for Suspected Skin Cancer at a Tertiary Care Dermatology Clinic in the Western Cape Province of South Africa

“…When compared to data from sub-Saharan African, Nthumba et al reported KS to represent 25% of skin cancers diagnosed in Kenya in 2008 [24]. Although HIV status for subjects was not reported in the current study HIV infection remains the biggest risk factor for developing KS in South Africa [18].…”

“…e Odds Ratio for PLHIV to develop KS in SA was reported as 134 [18]. PLHIV are also at higher risk for developing NMSC with a 5-fold increased risk of SCC [18,19]. is may also explain the lower BCC to SCC ratio as mentioned.…”

“…A study investigating the burden of cancers associated with HIV in the South African public health sector between 2004 and 2014 also demonstrated that cancer proportions were highest between the ages of 25 and 49 with the greater proportion of cancers observed in the black population. e Odds Ratio for PLHIV to develop KS in SA was reported as 134 [18]. PLHIV are also at higher risk for developing NMSC with a 5-fold increased risk of SCC [18,19].…”

“…e prevalence of Human Immunodeficiency Virus (HIV) in South Africa was estimated at 12.7% in 2016 making the total number of people living with HIV (PLHIV) approximately 7.03 million [16,17]. Despite the rollout of the antiretroviral therapy (ART) programme in South Africa in 2004 the risk of KS amongst PLHIV remains elevated even in the ART era [18]. Omland et al also observed a 2-fold increased risk of BCC and a 5-fold increased risk of SCC in PLHIV compared with the background population [19].…”

Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

“…Other studies examined the management of mental health and substance use disorders [8], or the diagnostic and screening practices for (drug resistant) tuberculosis in adult and paediatric patients [9][10][11]. Furthermore, the routine data collected by participating sites have been enriched in some countries by linking the routine HIV databases to cancer registries [12,13], vital registries [14] or administrative databases [15].…”