Epidemiology of HIV Related Malignancies among cases seen at the Nyangabgwe Referral Hospital Dr. KN NTUMBA, MD,MPH October 2007

Introductory Remarks 1.Cancers: global concern Each year cancer is newly diagnosed in 9 million people worldwide and it causes approximately 5 million deaths. Each year cancer is newly diagnosed in 9 million people worldwide and it causes approximately 5 million deaths million deaths 80 million deaths 60 million deaths 80 million deaths 2/3 in developing countries 2/3 in developing countries 2.Cancers: National concern The trend of tumors in selected districts of Botswana such as Francistown, Gaborone, Lobatse and others is increasing. A marked sharp increase was notable after Francistown had the highest mean tumor attendance followed by Gaborone and Selebi-Phikwe (Lyaku’s 2004). This could be related to improvement in health care availability and HIV/AIDS. The trend of tumors in selected districts of Botswana such as Francistown, Gaborone, Lobatse and others is increasing. A marked sharp increase was notable after Francistown had the highest mean tumor attendance followed by Gaborone and Selebi-Phikwe (Lyaku’s 2004). This could be related to improvement in health care availability and HIV/AIDS.

Objectives of the Study 1.Overall Objective: To obtain sufficient and accurate data on HIV related malignancies at NRH. To obtain sufficient and accurate data on HIV related malignancies at NRH. 2. Specific Objectives: 1. To determine Socio-demographic factors associated with the distribution of malignancies among HIV infected subjects. 2. To determine the prevalence and mortality rate of HIV related malignancies 3. To determine the relationship between HIV and the commonest malignancies. 4. To contribute with basic information needed to establish strategies for reducing morbidity and mortality due to cancers amid HIV infected subjects.

Methodology Study Area: Nyangagbwe Referral Hospital (2000–2004) Study Design and Study Population: Limitations of the Study: 1. Hospital Data 2. Selection Bias 3. Confounding Factors

Research Findings When you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind. William Thompson (Lord Kelvin),

Socio-demographic consideration Distribution of Malignacies by Age group and Sex

Socio-demographic consideration Distribution of Malignacies by Age group and Sex

Socio-demographic consideration 65% 24% 0% 5% 6% Single Married Divorced Widow Unknown - Singles for marital status were 1.6 times more likely to have HIV related cancers than married (CI = 1.09 to 2.33; p = 0.001) Distribution of Malignacies by Marital Status

Socio-demographic consideration Distribution of Malignacies by Employment Status

Socio-demographic considerations Distribution of Malignacies by Residential Status

HIV Sero-status consideration Distribution of Malignacies by Age and HIV Status

HIV Sero-status consideration Distribution of Malignacies by HIV Status Percentage MALIGNANCIESMALIGNANCIES Of 25 malignancies assessed

Relationship HIV and Commonest cancers

Malignancies in Children

Prevalence of Malignancies in the Study Population

Mortality and Fatality Rates HIV Pos. subjects were 2.3 times at risk to die than HIV Neg.

PYLL before age 72 years ĀDeathCalculat.PYLL Age < 15 yrs74 (72-7)*4 260 Yrs 15 – (72-22)*8 400 Yrs 25 – (72-30)* Yrs 35 – (72-38)* Yrs 45 – (72-48)* Yrs 55 – (72–59)*9 117 Yrs ≥ 65 Yrs694 (72-69)*4 12 Yrs

Cancer deaths PYLL before age 72 years N0. HIV+ Death: KS=50, CC=17, Br=5, Ovary=3, Oes=2

Conclusion & Recommendations A landmark study on pre-AIDS cancer in Botswana was that of Macrae and Cook (1975). With the advent of HIV/AIDS, this preliminary study suggest that, the AIDS epidemic has dramatically change the natural history of cancers in our community. Cancer such as KS, previously unusual in the country has overtaken breast cancer to become the second commonest malignancy in our society. Similarly, findings of this study suggest that, persons with AIDS-related malignancies have an increased potential years of life lost. Individuals aged between 25 to 34 years are the most affected. As a result, many productive years and much investment in education and training are lost. Significant family consequences are also to be considered since most people in this particular age group are breadwinners. A landmark study on pre-AIDS cancer in Botswana was that of Macrae and Cook (1975). With the advent of HIV/AIDS, this preliminary study suggest that, the AIDS epidemic has dramatically change the natural history of cancers in our community. Cancer such as KS, previously unusual in the country has overtaken breast cancer to become the second commonest malignancy in our society. Similarly, findings of this study suggest that, persons with AIDS-related malignancies have an increased potential years of life lost. Individuals aged between 25 to 34 years are the most affected. As a result, many productive years and much investment in education and training are lost. Significant family consequences are also to be considered since most people in this particular age group are breadwinners.

Conclusion & Recommendations To implement cancer control programmes, we need to: - Establish a population-based cancer registry. - Promote multidisciplinary researches - Increase the awareness of the population - Health workers should be trained in screening of symptomatic and asymptomatic subjects. To implement cancer control programmes, we need to: - Establish a population-based cancer registry. - Promote multidisciplinary researches - Increase the awareness of the population - Health workers should be trained in screening of symptomatic and asymptomatic subjects.

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