Association between HIV and Survival after Cancer Diagnosis

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DESCRIPTION (provided by applicant): Cancer is an increasingly common complication of HIV infection worldwide, with one of the highest burdens of HIV-associated cancer found in sub-Saharan Africa. Evidence exists for an association between HIV and increased incidence for both AIDS-defining (ADC) and non-AIDS-defining (NADC) cancers. Despite the link between HIV infection and cancer incidence, the question of whether HIV affects cancer progression in infected individuals has not been adequately addressed to date. Little is known about survival after a diagnosis of cancer, particularly in resource-limited settings; limited emerging data does suggest that the presence of HIV infection and its treatment play an important role. The goal of this research is to exmaine the role of HIV and its treatment on survival after a diagnosis of cancer. Specifically we will 1) determine the relationship between HIV serostatus and survival after diagnosis with common AIDS-defining (Kaposi's sarcoma (KS) and cervical) and non-AIDS-defining (breast and lung) cancers and 2) examine the relationship between HIV disease severity, its treatment, and survival in HIV- positive cancer patients. To accomplish these aims, we will study cases of cervical, KS, breast, and lung cancer presenting to the Uganda Cancer Institute (UCI), the sole cancer care facility in Uganda, from 2005- 2010 (n=7,488). Information on HIV serostatus, viral load, CD4 T-cell count, and highly active antiretroviral therapy (HAART) will be available from patient medical records. Follow up for the following outcomes at one year and for full study follow-up will be completed for all cases: overall mortality, cancer-specific mortality, and cancer progression-free survival. The setting of Uganda presents a unique opportunity for HIV-associated malignancy research; in addition to having a world class cancer care facility at UCI, Uganda experiences extremely high rates of HIV infection and increasing rates of cancer. To our knowledge, the proposed study will be the first to investigate the association of HIV and its treatment on survival after diagnosis with either AIDS-defining or non-AIDS defining cancers in a resource-poor setting. The proposed study will utilize extant medical records in a cost- efficient manner, and we anticipate that results from this study will provide insights into the etiology of HIV among cancer patients that can be followed up in future research. PUBLIC HEALTH RELEVANCE: Project Relevance: Effective HIV therapy (HAART) has prolonged the life expectancy of the HIV-positive population, and as a result, the number of HIV-positive individuals living with cancer has continued to increase. As such, the question of the effect of HIV infection on survival after a cancer diagnosis is an increasingly relevant one that remains largely unanswered for HIV-associated malignancies, particularly in HIV-endemic regions such as East Africa.