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PLoS One. 2015 Aug 12;10(8):e0135602. doi: 10.1371/journal.pone.0135602. eCollection 2015.

Cancer Incidence following Expansion of HIV Treatment in Botswana.

Author information

  • 1Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard School T.H Chan School of Public Health, Boston, Massachusetts, United States of America; Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
  • 2Department of Public Health, Botswana Ministry of Health, Gaborone, Botswana.
  • 3Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
  • 4Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America.
  • 5National Health Laboratory, Botswana Ministry of Health, Gaborone, Botswana.
  • 6Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
  • 7Department of Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
  • 8Department of Immunology and Infectious Diseases, Harvard School T.H Chan School of Public Health, Boston, Massachusetts, United States of America.

Abstract

BACKGROUND:

The expansion of combination antiretroviral treatment (ART) in southern Africa has dramatically reduced mortality due to AIDS-related infections, but the impact of ART on cancer incidence in the region is unknown. We sought to describe trends in cancer incidence in Botswana during implementation of the first public ART program in Africa.

METHODS:

We included 8479 incident cases from the Botswana National Cancer Registry during a period of significant ART expansion in Botswana, 2003-2008, when ART coverage increased from 7.3% to 82.3%. We fit Poisson models of age-adjusted cancer incidence and counts in the total population, and in an inverse probability weighted population with known HIV status, over time and estimated ART coverage.

FINDINGS:

During this period 61.6% of cancers were diagnosed in HIV-infected individuals and 45.4% of all cancers in men and 36.4% of all cancers in women were attributable to HIV. Age-adjusted cancer incidence decreased in the HIV infected population by 8.3% per year (95% CI -14.1 to -2.1%). However, with a progressively larger and older HIV population the annual number of cancers diagnosed remained constant (0.0% annually, 95% CI -4.3 to +4.6%). In the overall population, incidence of Kaposi's sarcoma decreased (4.6% annually, 95% CI -6.9 to -2.2), but incidence of non-Hodgkin lymphoma (+11.5% annually, 95% CI +6.3 to +17.0%) and HPV-associated cancers increased (+3.9% annually, 95% CI +1.4 to +6.5%). Age-adjusted cancer incidence among individuals without HIV increased 7.5% per year (95% CI +1.4 to +15.2%).

INTERPRETATION:

Expansion of ART in Botswana was associated with decreased age-specific cancer risk. However, an expanding and aging population contributed to continued high numbers of incident cancers in the HIV population. Increased capacity for early detection and treatment of HIV-associated cancer needs to be a new priority for programs in Africa.

PMID:
26267867
PMCID:
PMC4534370
DOI:
10.1371/journal.pone.0135602
[PubMed - indexed for MEDLINE]
Free PMC Article
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