title: HIV infection and domestic smoke exposure, but not human papillomavirus, are risk factors for esophageal squamous cell carcinoma in Zambia: a case-control study.
abstract: There is emerging evidence that esophageal cancer occurs in younger adults in sub-Saharan Africa than in Europe or North America. The burden of human immunodeficiency virus (HIV) is also high in this region. We postulated that HIV and human papillomavirus (HPV) infections might contribute to esophageal squamous cell carcinoma (OSCC) risk. This was a case-control study based at the University Teaching Hospital in Lusaka, Zambia. Cases were patients with confirmed OSCC and controls had completely normal upper endoscopic evaluations. A total of 222 patients were included to analyze the influence of HIV infection; of these, 100 patients were used to analyze the influence of HPV infection, alcohol, smoking, and exposure to wood smoke. The presence of HIV infection was determined using antibody kits, and HPV infection was detected by polymerase chain reaction. HIV infection on its own conferred increased risk of developing OSCC (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.0-5.1; P = 0.03). The OR was stronger when only people under 60 years were included (OR 4.3; 95% CI 1.5-13.2; P = 0.003). Cooking with charcoal or firewood, and cigarette smoking, both increased the odds of developing OSCC ([OR 3.5; 95% CI 1.4-9.3; P = 0.004] and [OR 9.1; 95% CI 3.0-30.4; P < 0.001], respectively). There was no significant difference in HPV detection or alcohol intake between cases and controls. We conclude that HIV infection and exposure to domestic and cigarette smoke are risk factors for OSCC, and HPV immunization unlikely to reduce OSCC incidence in Zambia.
authors: Department of Internal Medicine, University of Zambia, Lusaka, Zambia.
authors: Violet
authors: V
authors: Kayamba
authors: Allen C
authors: AC
authors: Bateman
authors: Akwi W
authors: AW
authors: Asombang
authors: Aaron
authors: A
authors: Shibemba
authors: Kanekwa
authors: K
authors: Zyambo
authors: Themba
authors: T
authors: Banda
authors: Rose
authors: R
authors: Soko
authors: Paul
authors: P
authors: Kelly
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000209:etiology*; D016022:Case-Control Studies; D003296:Cooking; D004938:Esophageal Neoplasms / Q000209:etiology*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications*; D011446:Prospective Studies; D012307:Risk Factors; D012906:Smoke / Q000009:adverse effects*; D012907:Smoking / Q000009:adverse effects; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D015024:Zambia
chemical_list: D012906:Smoke; D014028:Tobacco Smoke Pollution
keywords: Charcoal; HIV; HPV; esophageal cancer; firewood
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