The burden of cancers associated with HIV in the South African Public Health Sector, 2004-2014
Date
2019
Authors
Dhokotera Tafadzwa
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Abstract
The impact of South Africa's high human immunodeficiency virus (HIV) burden on cancer
risk is not fully understood, particularly in the context of antiretroviral treatment (ART). We
examined national cancer trends and excess cancer risk in people living with HIV (PLHIV)
compared to those who are HIV-negative. We used probabilistic record linkage to match cancer
records provided by the National Cancer Registry to HIV data provided by the National Health
Laboratory Service (NHLS). We also used a text search of specific HIV terms from the clinical
section of pathology reports to determine the HIV status of cancer patients. We used logistics and
Joinpoint regression models to evaluate the risk and trends in cancers in PLHIV compared to
HIV-negative patients from 2004-2014. In sensitivity analysis, we used inverse probability
weighting (IPW) to correct for possible selection bias. A total of 329 208 cancer cases from
public sector laboratories were reported to the NCR from 2004-2014 with the HIV status
known for 95 279 (28.9%) cancer cases. About 50% of all female cancer cases (n=30 486)
with a known status were HIV-positive. PLHIV were at higher risk of AIDS-defining cancers
(Kaposi sarcoma [adjusted OR:134.01, 95% CI:111-162], non-Hodgkin lymphoma [adjusted
OR:2.73, 95% CI:2.56-2.91] and, cervix [ adjusted OR:1.7, 95% CI:1.63-1.77], conjunctival
cancer [adjusted OR:21.5, 95% CI:16.3-28.4] and human papillomavirus (HPV) related
cancers (including; penis [adjusted OR:2.35, 95% CI: 1.85-2.99]), and vulva [ adjusted OR: 1.94,
95% CI: 1.67-2.25] compared to HIV-negative patients. Analysis using the Inverse Probability
Weighting yielded comparable results. There is a need for improved awareness and screening of
conjunctiva! cancer and HPV-associated cancers at HIV care centers. Further research and
discussion are warranted on inclusive HPV vaccination in PLHIV.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the
degree of Master of Science in Epidemiology: Epidemiology and Biostatistics.