Corneo-conjunctival carcinoma in Uganda

Since 1990, the incidence of conjunctival neoplasia has more than tripled in Uganda. It is known to be associated with exposure to solar ultraviolet radiation and to infection with the human immunodeficiency virus-1 (HIV). However, little is known about the most effective treatments. In this study, we report surgical outcomes among people with corneo-conjunctival squamous neoplasia in Uganda and investigate the role of HIV infection and other factors in the aetiology of the tumour.

Country-wide enrolment of participants; removal and histology of suspect lesions; HIV counselling and testing; home visiting of participants to determine outcomes.

In 67 months between 1995 and 2001, 476 participants were enrolled (262 female, 214 male, median age 32 years). A total of 463 (97%) had eye-conserving removal of the lesion and 13 had other surgery. For 414, the histology was squamous neoplasia (184 invasive carcinoma, 230 intraepithelial). The prevalence of HIV infection in cases was 64%. In all, 96% were followed up for a median period of 32 months (range 0-81) after eye-conserving surgery during which time 13 (3.2%) had a recurrence.

Surgery resulted in a low recurrence rate during the follow-up period and had minimal complications. The prevalence of HIV among cases was higher than expected on the basis of data from the general population, although about a third of cases were HIV-negative and had normal CD4 counts. No new cofactors were identified.