High Cancer Burden Among Antiretroviral Therapy Users in Malawi: A Record Linkage Study of Observational Human Immunodeficiency Virus Cohorts and Cancer Registry Data.
- Horner MJ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
- Chasimpha S Malawi Cancer Registry, Blantyre, Malawi.
- Spoerri A Institute of Social and Preventive Medicine, University of Bern, Switzerland.
- Edwards J Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
- Bohlius J Institute of Social and Preventive Medicine, University of Bern, Switzerland.
- Tweya H Lighthouse Trust, Kamuzu Central Hospital, Lilongwe.
- Tembo P Lighthouse Trust, Kamuzu Central Hospital, Lilongwe.
- Nkhambule F Queen Elizabeth Central Hospital HIV Clinic, Blantyre, Malawi.
- Phiri EM Queen Elizabeth Central Hospital HIV Clinic, Blantyre, Malawi.
- Miller WC Department of Epidemiology, College of Public Health, Ohio State University, Columbus.
- Malisita K Queen Elizabeth Central Hospital HIV Clinic, Blantyre, Malawi.
- Phiri S Lighthouse Trust, Kamuzu Central Hospital, Lilongwe.
- Dzamalala C Malawi Cancer Registry, Blantyre, Malawi.
- Olshan AF Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
- Gopal S Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
- 2018-11-20
Published in:
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. - 2019
Africa
HIV
antiretroviral therapy
cancer
Adolescent
Adult
Algorithms
Anti-HIV Agents
Cohort Studies
Cost of Illness
Electronic Health Records
Female
HIV Infections
Humans
Incidence
Malawi
Male
Middle Aged
Neoplasms
Prevalence
Registries
Risk Factors
Sarcoma, Kaposi
Uterine Cervical Neoplasms
Young Adult
English
BACKGROUND
With antiretroviral therapy (ART), AIDS-defining cancer incidence has declined and non-AIDS-defining cancers (NADCs) are now more frequent among human immunodeficiency virus (HIV)-infected populations in high-income countries. In sub-Saharan Africa, limited epidemiological data describe cancer burden among ART users.
METHODS
We used probabilistic algorithms to link cases from the population-based cancer registry with electronic medical records supporting ART delivery in Malawi's 2 largest HIV cohorts from 2000-2010. Age-adjusted cancer incidence rates (IRs) and 95% confidence intervals were estimated by cancer site, early vs late incidence periods (4-24 and >24 months after ART start), and World Health Organization (WHO) stage among naive ART initiators enrolled for at least 90 days.
RESULTS
We identified 4346 cancers among 28 576 persons. Most people initiated ART at advanced WHO stages 3 or 4 (60%); 12% of patients had prevalent malignancies at ART initiation, which were predominantly AIDS-defining eligibility criteria for initiating ART. Kaposi sarcoma (KS) had the highest IR (634.7 per 100 000 person-years) followed by cervical cancer (36.6). KS incidence was highest during the early period 4-24 months after ART initiation. NADCs accounted for 6% of new cancers.
CONCLUSIONS
Under historical ART guidelines, NADCs were observed at low rates and were eclipsed by high KS and cervical cancer burden. Cancer burden among Malawian ART users does not yet mirror that in high-income countries. Integrated cancer screening and management in HIV clinics, especially for KS and cervical cancer, remain important priorities in the current Malawi context.
With antiretroviral therapy (ART), AIDS-defining cancer incidence has declined and non-AIDS-defining cancers (NADCs) are now more frequent among human immunodeficiency virus (HIV)-infected populations in high-income countries. In sub-Saharan Africa, limited epidemiological data describe cancer burden among ART users.
METHODS
We used probabilistic algorithms to link cases from the population-based cancer registry with electronic medical records supporting ART delivery in Malawi's 2 largest HIV cohorts from 2000-2010. Age-adjusted cancer incidence rates (IRs) and 95% confidence intervals were estimated by cancer site, early vs late incidence periods (4-24 and >24 months after ART start), and World Health Organization (WHO) stage among naive ART initiators enrolled for at least 90 days.
RESULTS
We identified 4346 cancers among 28 576 persons. Most people initiated ART at advanced WHO stages 3 or 4 (60%); 12% of patients had prevalent malignancies at ART initiation, which were predominantly AIDS-defining eligibility criteria for initiating ART. Kaposi sarcoma (KS) had the highest IR (634.7 per 100 000 person-years) followed by cervical cancer (36.6). KS incidence was highest during the early period 4-24 months after ART initiation. NADCs accounted for 6% of new cancers.
CONCLUSIONS
Under historical ART guidelines, NADCs were observed at low rates and were eclipsed by high KS and cervical cancer burden. Cancer burden among Malawian ART users does not yet mirror that in high-income countries. Integrated cancer screening and management in HIV clinics, especially for KS and cervical cancer, remain important priorities in the current Malawi context.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1093/cid/ciy960
- PMID 30452634
- Persistent URL
- https://sonar.ch/global/documents/164453
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