AIDS-related Cancers in Africa: maturation of the epidemic in Uganda

ABSTRACT

The AIDS epidemic has passed its peak in Uganda; with possible consequences for the risk of cancers related to infectious agents. Objective: To compare the incidence of cancers linked to infections with HIV; before the AIDS epidemic (the 1960s); at its high point (the early 1990s) when HIV - seroprevalence and AIDS notifications peaked; and after the onset of its decline in the later 1990s. Methods: Analysis of incidence rates of infection-associated cancers in the population of Kyadondo county; in 1960-1971; 1991-1994; and 1995-1997. Comparison with data on prevalence of HIV infection; and notifications of AIDS. Results: The incidence of Kaposi's sarcoma has increased enormously since the 1960s; with a shift to earlier age at onset; and more generalised and nodal disease; there has been little change in the profile during the 1990s. There was a large increase in incidence of squamous cell carcinomas of the conjunctiva; which has continued through the 1990s. Non-Hodgkin's lymphomas showed little increase in incidence until the most recent period; in which the incidence has increased both in children (particularly Burkitt's lymphomas) and adults. Although the incidence of cervical cancer was higher in the 1990s than the 1960s; it seems doubtful that this is related to HIV infection. Certain other cancers which have been linked to AIDS in western populations (Hodgkin's disease; anal carcinoma; childhood leiomyosarcoma) show no changes in risk. Conclusion: The AIDS epidemic has dramatically changed the profile of cancer in Uganda. Trends in the AIDS-related cancers are consistent with current knowledge concerning the mechanisms behind the increased risk. The incidence of certain cancers with a viral aetiology (liver; cervix; penis; Hodgkin's disease) appears not to have been influenced by AIDS