Research Article: The Challenge of AIDS-Related Malignancies in Sub-Saharan Africa

Date Published: January 11, 2010

Publisher: Public Library of Science

Author(s): Annie J. Sasco, Antoine Jaquet, Emilie Boidin, Didier K. Ekouevi, Fabian Thouillot, Thomas LeMabec, Marie-Anna Forstin, Philippe Renaudier, Paul N’Dom, Denis Malvy, François Dabis, Gary Maartens.

Abstract: With the lengthening of life expectancy among HIV-positive subjects related to the use of highly active antiretroviral treatments, an increased risk of cancer has been described in industrialized countries. The question is to determine what occurs now and will happen in the future in the low income countries and particularly in sub-Saharan Africa where more than two-thirds of all HIV-positive people live in the world. The objective of our paper is to review the link between HIV and cancer in sub-Saharan Africa, putting it in perspective with what is already known in Western countries.

Partial Text: Infection with the human immunodeficiency virus (HIV) entails an increased risk of developing cancer [1]. Cancers such as Kaposi Sarcoma (KS), Non Hodgkin Lymphoma (NHL) and Invasive Cancer of the Cervix (ICC) have been recognized for a long time as associated with HIV infection and have been classified as AIDS-defining diseases. More recently, and concomitantly with the lengthening of life expectancy related to the use of Highly Active Antiretroviral Therapy (HAART), an increased risk of other cancers has been found among HIV-positive subjects; they are classified among the non-AIDS defining diseases. This association was originally described in Western countries, where cancer currently accounts for approximately one-third of the causes of death in the patients infected with HIV [2]. The question is now to determine what happens in the low incomes countries and particularly sub-Saharan Africa where more than two-thirds of all HIV-positive people live and where the HAART roll-out is now well under way [3].

Studies from Africa were identified from several bibliographical databases (Medline, Scopus, Cochrane library, Web of Science, Francis and Pascal), using keywords “HIV” (including MesH term “HIV infections”), “neoplasia” (including MesH term “neoplasms”) and “Africa” (621 references). We then selected all case-referent and observational cohort studies as well as reviews published between 1992 and April 2008 (139 references). For AIDS-defining and non AIDS-defining cancer trends in sub-Saharan Africa, we included data from population-based cancer registries and of course preferably selected studies linking these registries with AIDS registries.



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