Cancer Incidence following Expansion of HIV Treatment in Botswana

Below:  Overall cancer age-adjusted incidence among HIV-infected (solid) and HIV-uninfected (dotted) individuals.

Analyses utilized the IPW population.

Below:  Annual number of cancer diagnoses among HIV-infected and HIV-uninfected in Botswana

Below:  Trend in standardized incidence ratio (SIR) of cancer comparing HIV infected and HIV uninfected populations during ART expansion

Below:  Trends in incidence for leading cancers among HIV-infected population.

Estimates from IPW population accounting for changes in overall and age-specific HIV prevalence. Shaded 95% confidence bands from 1000 bootstrap samples. Note: NHL, non-Hodgkin’s lymphoma

During this period 61.6% of cancers were diagnosed in HIV-infected individuals and 45.4% of all cancers in men and 36.4% of all cancers in women were attributable to HIV. Age-adjusted cancer incidence decreased in the HIV infected population by 8.3% per year (95% CI -14.1 to -2.1%). However, with a progressively larger and older HIV population the annual number of cancers diagnosed remained constant (0.0% annually, 95% CI -4.3 to +4.6%). In the overall population, incidence of Kaposi’s sarcoma decreased (4.6% annually, 95% CI -6.9 to -2.2), but incidence of non-Hodgkin lymphoma (+11.5% annually, 95% CI +6.3 to +17.0%) and HPV-associated cancers increased (+3.9% annually, 95% CI +1.4 to +6.5%). Age-adjusted cancer incidence among individuals without HIV increased 7.5% per year (95% CI +1.4 to +15.2%).

Expansion of ART in Botswana was associated with decreased age-specific cancer risk. However, an expanding and aging population contributed to continued high numbers of incident cancers in the HIV population. Increased capacity for early detection and treatment of HIV-associated cancer needs to be a new priority for programs in Africa.

Read more at:   http://goo.gl/oKyRyJ HT @BrighamWomens