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Challenges in the Detection, Prevention, and Treatment of HIV-Associated Malignancies in Low- and Middle-Income Countries in Africa

Adebamowo, Clement A. BM, ChB Hons, ScD*; Casper, Corey MD, MPH; Bhatia, Kishor PhD; Mbulaiteye, Sam M. MD, MPhil§; Sasco, Annie J. MD, DrPH; Phipps, Warren MD, MPH; Vermund, Sten H. MD, PhD; Krown, Susan E. MD#

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1st, 2014 - Volume 67 - Issue - p S17–S26
doi: 10.1097/QAI.0000000000000255
Supplement Article

Abstract: Cancers associated with immunosuppression and infections have long been recognized as a major complication of HIV/AIDS. More recently, persons living with HIV are increasingly diagnosed with a wider spectrum of HIV-associated malignancies (HIVAM) as they live longer on combination antiretroviral therapy. This has spurred research to characterize the epidemiology and determine the optimal management of HIVAM with a focus on low-and middle-income countries (LMICs). Given background coinfections, environmental exposures, host genetic profiles, antiretroviral therapy usage, and varying capacities for early diagnosis and treatment, one can expect the biology of cancers in HIV-infected persons in LMICs to have a significant impact on chronic HIV care, as is now the case in high-income countries. Thus, new strategies must be developed to effectively prevent, diagnose, and treat HIVAM in LMICs; provide physical/clinical infrastructures; train the cancer and HIV workforce; and expand research capacity—particularly given the challenges posed by the limitations on available transportation and financial resources and the population's general rural concentration. Opportunities exist to extend resources supported by the President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria to improve the health-care infrastructure and train the personnel required to prevent and manage cancers in persons living with HIV. These HIV chronic care infrastructures could also serve cancer patients regardless of their HIV status, facilitating long-term care and treatment for persons who do not live near cancer centers, so that they receive the same degree of care as those receiving chronic HIV care today.

*Office of Research and Training, Institute of Human Virology Nigeria, Abuja, Nigeria, and Department of Epidemiology and Public Health, Institute of Human Virology and Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD;

Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA;

AIDS Malignancy Program, Office of HIV and AIDS Malignancy, National Cancer Institute, National Institutes of Health, Bethesda, MD;

§Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD;

Centre INSERM U 897-Epidémiologie-Biostatistique, Université de Bordeaux, Inserm U 897- Epidémiologie et Biostatistiques, L'Institut de Santé Publique, d'Épidémiologie et de Développement de l'Université de Bordeaux, Bordeaux, France;

Institute of Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; and

#AIDS Malignancy Consortium and Memorial Sloan-Kettering Cancer Center (emerita), New York, NY.

Correspondence to: Clement A. Adebamowo, BM, ChB Hons, ScD, Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 725 West, Lombard Street, Suite 460, Baltimore, MD 21201 (e-mail:

Supported in part by the National Institutes of Health grants: D43 CA153792 (IHV-UM Capacity Development for Research into AIDS-Associated Malignancies) and 1U54HG006947 (African Collaborative Center for Microbiome and Genomics Research) (C.A.A.); D43 CA153720 (C.C. and W.P.), R24 TW007988 [Fogarty International Clinical Research Scholars Support Center at Vanderbilt (S.H.V.)], and U01 CA121947 [AIDS Malignancy Consortium (S.E.K. and C.C.)].

The views expressed in this article are those of the authors and do not reflect the official policy of the National Cancer Institute, the National Institutes of Health, or the US Government.

The authors have no conflicts of interest to disclose.

© 2014 by Lippincott Williams & Wilkins