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Contribution of HIV infection to mortality among cancer patients in Uganda

Coghill, Anna E.a,b,c; Newcomb, Polly A.a,b; Madeleine, Margaret M.a,b; Richardson, Barbra A.a,b; Mutyaba, Innocentd; Okuku, Fredd; Phipps, Warrena,b,d; Wabinga, Henrye; Orem, Jacksona,d; Casper, Coreya,b,d

doi: 10.1097/01.aids.0000433236.55937.cb
Epidemiology and Social

Objective: HIV infection is associated with cancer risk. This relationship has resulted in a growing cancer burden, especially in resource-limited countries where HIV is highly prevalent. Little is known, however, about how HIV affects cancer survival in these settings. We therefore investigated the role of HIV in cancer survival in Uganda.

Design: Retrospective cohort (N = 802).

Methods: Eligible cancer patients were residents of Kyadondo County, at least 18 years of age at cancer diagnosis, and diagnosed between 2003 and 2010 with one of the following: breast cancer, cervical cancer, non-Hodgkin's lymphoma, Hodgkin's lymphoma, or esophageal cancer. Patients were classified as HIV-infected at cancer diagnosis based on a documented positive HIV antibody test, medical history indicating HIV infection, or an HIV clinic referral letter. The primary outcome, vital status at 1 year following cancer diagnosis, was abstracted from the medical record or determined through linkage to the national hospice database. The risk of death during the year after cancer diagnosis was compared between cancer patients with and without evidence of HIV infection using Cox proportional hazards regression.

Results: HIV-infected cancer patients in Uganda experienced a more than two-fold increased risk of death during the year following cancer diagnosis compared to HIV-uninfected cancer patients [hazard ratio 2.28; 95% confidence interval (CI) 1.61–3.23]. This association between HIV and 1-year cancer survival was observed for both cancers with (hazard ratio 1.56; 95% CI 1.04–2.34) and without (hazard ratio 2.68; 95% CI 1.20–5.99) an infectious cause.

Conclusion: This study demonstrates the role of HIV in cancer survival for both cancers with and without an infectious cause in a resource-limited, HIV-endemic setting.

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aFred Hutchinson Cancer Research Center

bUniversity of Washington, Seattle, Washington

cNational Cancer Institute, Bethesda, Maryland, USA

dUCI/Hutchinson Cancer Center Alliance

eKampala Cancer Registry, Kampala, Uganda.

Correspondence to Anna E. Coghill, Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Rockville, MD 20892, USA. Tel: +1 240 276 7184; e-mail:

Received 29 April, 2013

Revised 17 June, 2013

Accepted 4 July, 2013

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© 2013 Lippincott Williams & Wilkins, Inc.