The Spectrum of Cancers in West Africa: Associations with Human Immunodeficiency Virus.

Background: Canceris a growing co-morbidity among HIV-infected patients worldwide. With the scale-up of antiretroviral therapy (ART) in developing countries cancerwill contribute more and more to the HIV/AIDS disease burden. Our objective was to estimate the association between HIV infection and selected types of cancersamong patients hospitalized for diagnosis or treatment of cancerin West Africa. Methods: A case-referent study was conducted in referral hospitals in CA´te dIvoire and Benin. Each participating clinical ward enrolled all adult patients seeking care for a confirmed diagnosis of cancerand clinicians systematically proposed an HIV test. HIV prevalence was compared between AIDS-defining cancersand a subset of selected non-AIDS defining cancersto a referent groupof non-AIDS defining cancersnot reported in the literature to be positively or inversely associated with HIV. An unconditional logistic model was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of the risk of being HIV-infected for selected cancerssites compared to a referent groupof other cancers. Results: The HIV overall prevalence was 12.3% (CI 10.3-14.4) among the 1017 cancercases included. A total of 442 patients constituted the referent groupwith an HIV prevalence of 4.7% (CI 2.8-6.7). In multivariate analysis Kaposi sarcoma (OR 62.2 [CI 22.1-175.5]) non-Hodgkin lymphoma (4.0 [CI 2.0-8.0]) cervical cancer(OR 7.9 [CI 3.8-16.7]) anogenital cancer(OR 11.6 [CI 2.9-46.3]) and liver cancer(OR 2.7 [CI 1.1-7.7]) were all associated with HIV infection. Conclusions: In a time of expanding accessto ART AIDS-defining cancersremain highly associated with HIV infection. This is to our knowledge the first study reporting a significant association between HIV infection and liver cancerin sub-Saharan Africa.