HIV among cancer patients: prevalence and cancer description by HIV status

Background: Antiretroviral therapy (ART) has resulted in a higher life expectancy of persons living with Human Immunodeficiency Virus (PLHIV) leading to an aging population at risk for non-AIDS defining cancers (NADCs) rather than AIDS-defining cancers (ADCs). Identification of HIV-cancer comorbidity through diagnostic HIV testing of patients presenting for cancer care is not offered routinely. The HIV prevalence among cancer patients in Kenya is undefined. In addition, the spectrum of malignancies in PLHIV has not been well characterized outside of ADCs. Objective: Our primary objective was to determine the prevalence of HIV among patients with cancer. Secondary objectives were to determine the proportion of ADCs and NADCs in HIV positive patients and to describe the spectrum of malignancies seen among HIV-positive and negative patients with cancer. Methods: This was a cross sectional study done at the Aga Khan University Hospital, Nairobi between February and September 2021 where patients with a histological cancer diagnosis were enrolled and demographic data collected. HIV pre-test counselling and consent were done prior to testing. Diagnostic HIV testing was done using a rapid fourth generation HIV assay. Positive HIV results were confirmed with a rapid third generation assay. HIV and cancer related clinical variables were obtained from medical records including cancer stage, Eastern Cooperative Oncology Group status, CD4 count, HIV viral load, ART regime and history of defaulting on ART. Results: During our study period, 301 cancer patients were enrolled; 67.8% (204/301) were female; mean age was 50.7 ± 12.5 years. From our cohort 10.6% (32/301) patients were HIV positive. Of the HIV-positive patients, 59.4% (19/32) had a NADC. The commonest NADC among HIV positive patients was breast cancer (18.8%; 6/32). The most prevalent ADCs among HIV positive patients were non-Hodgkin’s lymphoma (18.8%; 6/32) and cervical cancer (18.8%; 6/32). Conclusion: The prevalence of HIV infection among patients with cancer was twice the Kenya national HIV prevalence. NADCs comprised a larger percentage of the cancer burden. Universal opt-out HIV testing of patients attending for cancer care regardless of cancer type may facilitate iv early recognition of HIV infected patients, aid in appropriate selection of ART and cancer therapies and preventive strategie