CANCER BURDEN AMONG HIV-INFECTED PERSONS ON ANTIRETROVIRAL THERAPY IN MALAWI: A RECORD LINKAGE STUDY

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  • March 22, 2019
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  • Horner, Marie-Josephe
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Sub-Saharan Africa represents 70% of the global number of people living with HIV. The regional HIV epidemic is reflected in the cancer burden, where AIDS-defining cancers are among the most common malignancies in the region. Early access and continued adherence to antiretroviral therapy (ART) may reduce the risk of certain cancers among the HIV population. Local epidemiological data are needed to characterize the cancer burden among African HIV populations during the ART era. In the Malawi HIV-Cancer Match Study, we used algorithms to link cancer cases from the population-based cancer registry of Malawi with electronic medical records from two high volume HIV clinics. We constructed a clinical cohort of 29,000 people who initiated ART from 2000 to 2010 at Lighthouse Trust and Queen Elizabeth Central Hospital. We described implementation of a healthcare data linkage in a resource-constrained setting, common analytical barriers, and solutions. We used Poisson regression to estimate cancer incidence rates and describe the timing of new cancer diagnoses after starting ART. Missing data and misreporting of patient identifiers resulted in a substantial proportion of potential cancer cases being discarded from analysis. Consequently, missing data on potential cancer cases may have diminished sensitivity of the linkage algorithms. Sensitivity analysis of incidence rates was used to address scenarios of uncertainty in the linkage process. Two AIDS-defining malignancies, Kaposi sarcoma (KS) and cervical cancer, were the most common cancers in this young population of ART users who tend to present to care with severe immunosuppression. Most incident KS occurred within the first two years of starting ART, and elevated incidence rates persisted over the course of follow-up in spite of therapy. AIDS-associated non-Hodgkin lymphomas and a heterogeneous spectrum of NADC were also observed, but at low incidence rates. Our study is a baseline against which to monitor the contemporary burden of cancer among people who are now starting ART at earlier stages of HIV, when therapy likely to have a substantial impact on cancer incidence. Descriptive epidemiological data on people living with HIV is important for public health decision makers in Malawi to develop evidence-based cancer control plans targeting high-risk HIV populations.
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  • Cole, Stephen
  • Edwards, Jessie
  • Gopal, Satish
  • Olshan, Andrew
  • Miller, William
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2018
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