Burden, patterns, and challenges of HIV-associated malignancies in Nigeria: a narrative review

Nigeria bears one of the world's largest burdens of HIV, with ongoing expansion of antiretroviral therapy (ART) significantly improving the survival of people living with HIV (PLHIV). This epidemiologic shift has changed the pattern of morbidity and mortality toward chronic conditions, especially HIV-associated malignancies (HIVAMs), including both AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs). Despite their increasing significance, the national burden, patterns, and systemic challenges related to HIVAMs in Nigeria remain poorly understood and characterized.

We conducted a narrative review of peer-reviewed literature, cancer registry reports, and grey literature published between January 2000 and December 2024. Searches were carried out in PubMed/MEDLINE, Embase, African Journals Online, and Google Scholar, complemented by national reports from the National Agency for the Control of AIDS, the Federal Ministry of Health, and the National System of Cancer Registries. Eligible sources reported cancer occurrence among PLHIV or HIV prevalence among cancer patients in Nigeria. Findings were synthesized narratively due to significant heterogeneity across study designs and outcomes.

Seventy-three sources met the inclusion criteria, and these were primarily hospital-based and retrospective studies. ADMs remain the most common cancers among PLHIV, notably invasive cervical cancer, Kaposi sarcoma, and non-Hodgkin lymphoma, with notable regional differences. Expansion of ART has been linked to a decline in Kaposi sarcoma incidence, while the burden of cervical cancer remains high, driven by persistent oncogenic HPV infection and limited screening coverage among women living with HIV (WLWH). Emerging NADMs, such as hepatocellular carcinoma, Hodgkin lymphoma, breast cancer, and ocular surface squamous neoplasia, reflect improved survival, aging, chronic immune dysregulation, and co-infections like Hepatitis B and C. Across these cancers, late-stage presentation and poor outcomes are common, largely due to fragmented HIV-cancer surveillance, inadequate pathology and radiotherapy capacity, limited molecular diagnostics, high out-of-pocket treatment costs, and weak integration of HIV and oncology services.

HIV-associated cancers pose a major yet often overlooked public health issue in Nigeria. Enhancing integrated HIV-cancer surveillance, increasing prevention and early detection efforts through ART programs, upgrading diagnostic and treatment facilities, and utilizing digital and molecular innovations are essential for decreasing preventable cancer-related morbidity and mortality among PLHIV in Nigeria.