title: Cancer and HIV infection in referral hospitals from four West African countries.
abstract: The consequences of the HIV epidemic on cancer epidemiology are sparsely documented in Africa. We aimed to estimate the association between HIV infection and selected types of cancers among patients hospitalized for cancer in four West African countries. A case-referent study was conducted in referral hospitals of Benin, Côte d'Ivoire, Nigeria and Togo. Each participating clinical ward included all adult patients seeking care with a confirmed diagnosis of cancer. All patients were systematically screened for HIV infection. HIV prevalence of AIDS-defining and some non-AIDS defining cancers (Hodgkin lymphoma, leukemia, liver, lung, skin, pharynx, larynx, oral cavity and anogenital cancers) were compared to a referent group of cancers reported in the literature as not associated with HIV. Odds ratios adjusted on age, gender and lifetime number of sexual partners (aOR) and their 95% confidence intervals (CI) were estimated. Among the 1644 cancer patients enrolled, 184 (11.2%) were identified as HIV-infected. The HIV prevalence in the referent group (n=792) was 4.4% [CI 3.0-5.8]. HIV infection was associated with Kaposi sarcoma (aOR 34.6 [CI: 17.3-69.0]), non-Hodgkin lymphoma (aOR 3.6 [CI 1.9-6.8]), cervical cancer (aOR 4.3 [CI 2.2-8.3]), anogenital cancer (aOR 17.7 [CI 6.9-45.2]) and squamous cell skin carcinoma (aOR 5.2 [CI 2.0-14.4]). A strong association is now reported between HIV infection and Human Papillomavirus (HPV)-related cancers including cervical cancer and anogenital cancer. As these cancers are amenable to prevention strategies, screening of HPV-related cancers among HIV-infected persons is of paramount importance in this African context.
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France. Electronic address: antoine.jaquet@isped.u-bordeaux2.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Jaquet
authors.affiliation: Institute of Human Virology in Nigeria (IHVN), Abuja, Nigeria.
authors.forename: Michael
authors.initials: M
authors.lastname: Odutola
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France; Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.affiliation: Service de Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, Cote d'Ivoire.
authors.forename: Aristophane
authors.initials: A
authors.lastname: Tanon
authors.affiliation: Institute of Human Virology in Nigeria (IHVN), Abuja, Nigeria.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oga
authors.affiliation: Centre de Prise en Charge des Personnes vivant avec le VIH, CHNU de Cotonou, Cotonou, Bénin.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Akakpo
authors.affiliation: Institute of Human Virology in Nigeria (IHVN), Abuja, Nigeria.
authors.forename: Manhattan
authors.initials: M
authors.lastname: Charurat
authors.affiliation: Centre de Prise en Charge des Personnes vivant avec le VIH, CHNU de Cotonou, Cotonou, Bénin.
authors.forename: Marcel D
authors.initials: MD
authors.lastname: Zannou
authors.affiliation: Service de Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, Cote d'Ivoire.
authors.forename: Serge P
authors.initials: SP
authors.lastname: Eholie
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France.
authors.forename: Annie J
authors.initials: AJ
authors.lastname: Sasco
authors.affiliation: Service de Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, Cote d'Ivoire.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bissagnene
authors.affiliation: Institute of Human Virology in Nigeria (IHVN), Abuja, Nigeria.
authors.forename: Clement
authors.initials: C
authors.lastname: Adebamowo
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, F-33000 Bordeaux, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000473:pathology; D016017:Odds Ratio; D027383:Papillomaviridae / Q000302:isolation & purification*; D015995:Prevalence; D012017:Referral and Consultation
keywords: Africa; Anal cancer; Cancer; Cervical cancer; Epidemiology; HIV; Human papillomavirus; Skin cancer