Alex Mremi1, Jackline Mswima2, Mathew G Mlay2, Henry Bartholomew2, Julius P Alloyce3, Blandina T Mmbaga4, John Bartlett5. 1. Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania. Electronic address: alex.mremi@kcmuco.ac.tz. 2. Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania. 3. Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, Tanzania. 4. Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Duke Global Health Institute, Duke University Medical Center, Durham, NC, United States of America. 5. Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Duke Global Health Institute, Duke University Medical Center, Durham, NC, United States of America; Department of Internal Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, United States of America.
Abstract
BACKGROUND: Although the burden of human immunodeficiency virus (HIV) infection in Tanzania is high, limited data are available on cancers in HIV-infected patients. We aimed to determine the spectrum and prevalence of cancers in HIV-infected patients attending care at a zonal hospital in Tanzania. MATERIALS AND METHODS: Clinical records of HIV-infected patients from 2009 to 2019 were identified and retrospectively reviewed. RESULTS: A total of 3398 HIV-infected patients were recruited with median age of 37 years. Cancer was diagnosed in 9% of the patients after enrollment into HIV clinical care, with an increasing prevalence from 7.2% between years 2009 and 2013 to 8.6% between years 2017 and 2019 (p-value <0.0001). Majority (89.2%) were on antiretroviral therapy (ART) during the time of cancer diagnosis. The proportions of acquired immunodeficiency syndrome (AIDS)-defining cancers and non-AIDS defining cancers were 28% and 72% respectively. Kaposi's sarcoma was the most common (13.2%) AIDS-defining cancer while esophageal cancer was the most common (11.1%) non-AIDS defining cancer. The median duration of time from HIV infection to cancer diagnosis was 715 days (IQR: 98-2570). The median CD4+T-cell count was 318(IQR 159-690) cells/µl at the time of cancer diagnosis and 40.7% of the patients had advanced immunosuppression with CD4 count less than 200 cells/µl at the time of cancer diagnosis. CONCLUSION: Non-AIDS defining cancers were much more common than AIDS-defining cancers suggesting increased longevity due to ART access. The prevalence of cancer among HIV-infected patients was 9% with an increasing trend over time; highlighting the importance of promoting cancer screening in this vulnerable population and implementation of vaccinations programs for liver and cervical cancers as well as tobacco control policies for smoking-related cancers.
BACKGROUND: Although the burden of human immunodeficiency virus (HIV) infection in Tanzania is high, limited data are available on cancers in HIV-infectedpatients. We aimed to determine the spectrum and prevalence of cancers in HIV-infectedpatients attending care at a zonal hospital in Tanzania. MATERIALS AND METHODS: Clinical records of HIV-infectedpatients from 2009 to 2019 were identified and retrospectively reviewed. RESULTS: A total of 3398 HIV-infectedpatients were recruited with median age of 37 years. Cancer was diagnosed in 9% of the patients after enrollment into HIV clinical care, with an increasing prevalence from 7.2% between years 2009 and 2013 to 8.6% between years 2017 and 2019 (p-value <0.0001). Majority (89.2%) were on antiretroviral therapy (ART) during the time of cancer diagnosis. The proportions of acquired immunodeficiency syndrome (AIDS)-defining cancers and non-AIDS defining cancers were 28% and 72% respectively. Kaposi's sarcoma was the most common (13.2%) AIDS-defining cancer while esophageal cancer was the most common (11.1%) non-AIDS defining cancer. The median duration of time from HIV infection to cancer diagnosis was 715 days (IQR: 98-2570). The median CD4+T-cell count was 318(IQR 159-690) cells/µl at the time of cancer diagnosis and 40.7% of the patients had advanced immunosuppression with CD4 count less than 200 cells/µl at the time of cancer diagnosis. CONCLUSION:Non-AIDS defining cancers were much more common than AIDS-defining cancers suggesting increased longevity due to ART access. The prevalence of cancer among HIV-infectedpatients was 9% with an increasing trend over time; highlighting the importance of promoting cancer screening in this vulnerable population and implementation of vaccinations programs for liver and cervical cancers as well as tobacco control policies for smoking-related cancers.