Association Between HIV Infection and Cancer Stage at Presentation at the Uganda Cancer Institute

Area of Science:

• Oncology
• Infectious Diseases
• Public Health

Background:

• The human immunodeficiency virus (HIV) epidemic is linked to increased cancer incidence in sub-Saharan Africa.
• Most cancer patients in the region present with advanced-stage disease, often due to delayed diagnosis.
• Expanding access to HIV care and treatment centers offers a potential avenue for earlier cancer detection in HIV-positive individuals.

Purpose of the Study:

• To investigate the hypothesis that improved access to HIV care facilitates earlier cancer diagnosis in HIV-positive patients.
• To characterize the stage of cancer at presentation among patients in Uganda.
• To identify factors associated with advanced-stage cancer at presentation.

Main Methods:

• Retrospective analysis of 731 adult patients with cervical, breast, non-Hodgkin lymphoma, or Hodgkin lymphoma in Kampala, Uganda (2003-2010).
• Data abstraction included demographics, clinical information, and laboratory results.
• Advanced stage was defined as clinical stage III or IV; multivariate logistic regression was used to identify associated factors.

Main Results:

• Nearly 80% of all patients presented with advanced-stage cancer; 37% were HIV-positive.
• HIV-positive patients were less likely to present at an advanced stage compared to HIV-negative patients.
• Factors associated with reduced likelihood of advanced-stage presentation included HIV positivity, higher hemoglobin levels, and fewer symptoms.

Conclusions:

• Enhanced access to HIV clinical care infrastructure may contribute to earlier cancer diagnosis among HIV-positive individuals.
• Leveraging existing HIV care networks for cancer screening and referral is a promising strategy.
• Continued support for these integrated care approaches is crucial, given the poor survival rates for advanced cancer in HIV-positive populations globally.