Carcinoma of the conjunctiva and HIV infection in Uganda and Malawi.
OBJECTIVE
To investigate the association of human immunodeficiency virus (HIV) infection and carcinoma of the conjunctiva in Africa, and the role of human papilloma virus type 16 (HPV-16).


METHODS
Patients in Uganda and Malawi presenting to eye clinics with lesions suspicious of carcinoma were studied. Pathological confirmation of eye lesions was sought. HIV testing of patients who were biopsied and, in Uganda, of matched case control subjects was carried out as was testing of a sample of fixed biopsies for HPV-16 by polymerase chain reaction (PCR). The HIV-1 serology, histopathology of conjunctival biopsies (conjunctival intraepithelial neoplasia (CIN), invasive carcinoma, other lesions), and prevalence of HPV-16 infection were determined.


RESULTS
Of Ugandan patients, 27/38 (71%) with carcinoma (27 invasive carcinoma, 11, CIN) were HIV positive compared with 12/76 (16%) of controls (odds ratio 13, 95% confidence interval 5-38). The calculated population aetiological fraction of carcinoma associated with HIV was 66%. Of 32 Malawian patients (20 invasive carcinoma, 12 CIN), 25/29 tested (86%) were HIV positive. HPV-16 infection was found in 7/20 (35%) of carcinoma samples, 0/9 pingueculae, and 2/6 conjunctivitis samples.


CONCLUSIONS
HIV infection is strongly associated with an apparent increase in the incidence of conjunctival carcinoma in Africa. While ultraviolet light is probably the prime risk factor and HPV-16 is implicated in a proportion of cases, the interactions of ultraviolet light, HIV, HPVs, and other factors are unclear in the pathogenesis of carcinoma. The disease represents another model of multifactorial epithelial carcinogenesis.
Waddell
K M
KM
Uganda Eye Project, Kampala, Uganda.
Lewallen
S
S
Lucas
S B
SB
Atenyi-Agaba
C
C
Herrington
C S
CS
Liomba
G
G
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000821:virology*; D016022:Case-Control Studies; D003230:Conjunctival Neoplasms / Q000453:epidemiology / Q000821:virology*; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D014412:Tumor Virus Infections / Q000150:complications / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000821:virology*