title: A Population-Level Evaluation of the Effect of Antiretroviral Therapy on Cancer Incidence in Kyadondo County, Uganda, 1999-2008.
abstract: BACKGROUND
  The introduction of antiretroviral therapy (ART) in the United States and Europe has led to changes in the incidence of cancers among HIV-infected persons, including dramatic decreases in Kaposi sarcoma and non-Hodgkin lymphoma, and increases in Hodgkin lymphoma, liver, and anogenital malignancies. We sought to evaluate whether increasing availability of ART is associated with changing cancer incidence in Uganda.
  
  
  METHODS
  Incident cases of 10 malignancies were identified from Kampala Cancer Registry from 1999 to 2008. ART coverage rates for Uganda were abstracted from the Joint United Nations Program on HIV/AIDS reports. Negative binomial and Poisson regression modeled the association between ART coverage and age-adjusted cancer incidence.
  
  
  RESULTS
  ART coverage in Uganda increased from 0% to 43% from 1999 to 2008. With each 10% increase in ART coverage, incidence of Kaposi sarcoma decreased by 5% [incidence rate ratio (IRR) = 0.95, 95% confidence interval: 0.91 to 0.99, P = 0.02] and stomach cancer decreased by 13% [IRR = 0.87 (95% CI: 0.80 to 0.95), P = 0.002]. Conversely, incidence of non-Hodgkin lymphoma increased by 6% [IRR = 1.06 (95% CI: 1 to 1.12), P = 0.05], liver cancer by 12% [IRR = 1.12 (95% CI: 1.04 to 1.21), P = 0.002], prostate cancer by 5% [IRR = 1.05 (95% CI: 1 to 1.10), P = 0.05], and breast cancer by 5% [IRR = 1.05 (95% CI: 1 to 1.11), P = 0.05]. ART coverage was not associated with incidence of invasive cervical cancer, lung, colon, and Hodgkin disease. These findings were similar when restricted to histologically confirmed cases.
  
  
  CONCLUSIONS
  Our findings suggest that AIDS-defining malignancies and other malignancies are likely to remain significant public health burdens in sub-Saharan Africa even as ART availability increases.
authors.affiliation: *Uganda Cancer Institute, Kampala, Uganda; †Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; ‡University of Washington, Seattle, WA; §Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; and ‖Kampala Cancer Registry, Kampala, Uganda.
authors.forename: Innocent
authors.initials: I
authors.lastname: Mutyaba
authors.forename: Warren
authors.initials: W
authors.lastname: Phipps
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Krantz
authors.forename: Jason D
authors.initials: JD
authors.lastname: Goldman
authors.forename: Sarah
authors.initials: S
authors.lastname: Nambooze
authors.forename: Jackson
authors.initials: J
authors.lastname: Orem
authors.forename: Henry R
authors.initials: HR
authors.lastname: Wabinga
authors.forename: Corey
authors.initials: C
authors.lastname: Casper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
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