Carcinoma of the conjunctiva and HIV infection in Uganda and Malawi

ABSTRACT

To investigae the association of human immunodeficiency virus (HIV) infection and carcinoma of the conjunctiva in Africa; and the role of human papilloma vius type 16 (HPV-16). Methods: Patients in Uganda nd Malawi presenting the 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 mached case control subjects was carried out as was testing of a sample of fixed biopsies for HPV-16 by plymease chain reaction (PCR). The HIV-1 serology; histopathology of conjunctival bipsies (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 ration 13;95confidence interval 5-38). The calculated population aetiological fraction 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 PHV-16 is implicated in a protection 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