The association of certain cancers with immunosuppression, and more recently with the Acquired Immune Deficiency Syndrome (AIDS), is well known. The incidence of Kaposi's Sarcoma in US AIDS patients is higher in gay men than in hemophiliacs and intra-venous drug users, while lymphoma shows no predilection for a particular high-risk group. Squamous cell tumors are also more common in immunosupressed patients, occurring more often in groups at high risk of pre-existing infection with oncogenic viruses such as human papillomavirus (HPV). The AIDS epidemic in Africa affects adult men and women equally. Urban adults are also at high risk for other sexually transmitted disease. We postulate that genital HPV is common in urban women, and that in the setting of HIV infection is associated with a high incidence and rapid progression of CIN. We propose to examine the incidence and natural history of HPV infection and CIN in two cohorts of urban sexually active women in Kigali. Rwanda: 500 HIV seropositive women and 1000 seronegatives will be followed yearly and cervical samples for detection of HPV and CIN taken. The prevalence of HPV infection and associated disease will be determined at baseline, and the relationship of persistence or progression of CIN to HIV and HPV type will analysed. The incidence of HPV infection and its relationship to HIV serostatus, intensity of exposure, and condom or spermicide use will also be addressed The incidence of Kaposi's Sarcoma and non- Hodgkins lymphoma in African AIDS patients is unknown, but the prevalence of associated co-factors (CMV) and EBV, respectively) is high. We will document the incidence of malignancy in these two cohorts of urban women and test the hypothesis that HIV infected adults in central Africa are more likely to develop these and other cancers than uninfected controls. Using case-control analyses of tumors diagnoses at the Pathology laboratory in Kigali (which receives specimens from the northern half of Rwanda), we will also compare cancers in HIV infected patients with similar cancers in seronegatives with respect to age, sex, stage at diagnosis, and histology.
| Palefsky, J (1991) Human papillomavirus infection among HIV-infected individuals. Implications for development of malignant tumors. Hematol Oncol Clin North Am 5:357-70 |
