Background:

The introduction of antiretroviral therapy (ART) in the United States and Europe has led to changes in the incidence of cancers among HIV-infected persons, including dramatic decreases in Kaposi sarcoma and non-Hodgkin lymphoma, and increases in Hodgkin lymphoma, liver, and anogenital malignancies. We sought to evaluate whether increasing availability of ART is associated with changing cancer incidence in Uganda.

Methods:

Incident cases of 10 malignancies were identified from Kampala Cancer Registry from 1999 to 2008. ART coverage rates for Uganda were abstracted from the Joint United Nations Program on HIV/AIDS reports. Negative binomial and Poisson regression modeled the association between ART coverage and age-adjusted cancer incidence.

Results:

ART coverage in Uganda increased from 0% to 43% from 1999 to 2008. With each 10% increase in ART coverage, incidence of Kaposi sarcoma decreased by 5%[incidence rate ratio (IRR)= 0.95, 95% confidence interval: 0.91 to 0.99, P= 0.02] and stomach cancer decreased by 13%[IRR= 0.87 (95% CI: 0.80 to 0.95), P= 0.002]. Conversely, incidence of non-Hodgkin lymphoma increased by 6%[IRR= 1.06 (95% CI: 1 to 1.12), P= 0.05], liver cancer by 12%[IRR= 1.12 (95% CI: 1.04 to 1.21), P= 0.002], prostate cancer by 5%[IRR= 1.05 (95% CI: 1 to 1.10), P= 0.05], and breast cancer by 5%[IRR= 1.05 (95% CI: 1 to 1.11), P= 0.05]. ART coverage was not associated with incidence of invasive cervical cancer, lung, colon, and Hodgkin disease. These findings were similar when restricted to histologically confirmed cases.

Conclusions:

Our findings suggest that AIDS-defining malignancies and other malignancies are likely to remain significant public health burdens in sub-Saharan Africa even as ART availability increases.