HIV infection and esophageal cancer in Sub-Saharan Africa: a comprehensive meta-analysis

Africa hosts the highest burden of esophageal cancer (49%) and HIV (60%) worldwide. It is imperative to investigate the synergistic impact of these two diseases on African populations. This study conducted an exhaustive computerized search of databases, including Medline/PubMed, Embase, Web of Science, Scopus, Cochrane library, and African Journals Online, to identify eligible studies up to October 2023. HIV infection was the exposure, esophageal cancer risk was the outcome, and healthy subjects with no cancer history served as comparators. Study quality was assessed using the Newcastle-Ottawa scale, and potential publication bias was evaluated through funnel plots and the Egger test. Meta-analyses were conducted using Stata 17.0 software and involved a thorough examination of 98,397 studies. Out of these, eight studies originating from Eastern and Southern Africa, recognized as esophageal cancer hotspots on the continent, met the eligibility criteria. The analysis revealed a non-significant association between HIV infection and esophageal cancer risk (odds ratio = 1.34 [95% confidence interval, 0.85-2.12]; with 0.26 as p-value of overall effects). The Egger test yielded a p-value of 0.2413, suggesting the absence of publication bias. In summary, this systematic review and meta-analysis indicate that there is no established causal link between HIV infection and esophageal cancer risk. However, further research is essential to delve into the potential mechanisms underlying this relationship.