Cancer overtakes TB as leading cause of death in HIV+ patients

It’s now official: cancer is the country’s top silent killer in HIV+ patients. Scientists gathered in Gaborone recently for the Botswana Harvard AIDS Institute Partnership (BHP) 20 years’ anniversary celebration, have confirmed.

A doctor at the Harvard AIDS Initiative (HAI), Dr. Scott Dryden-Peterson, said that although antiretroviral therapy has extended the lives of people with HIV, cancer remains the biggest challenge and has even overtaken Tuberculosis to become the leading cause of death in HIV+ patients in Botswana.

“We know that HIV patients are at increased risk of developing cancer, heart attacks, and strokes,” said Dr Dryden-Peterson further noting, “We have found that the risk of some cancers, such as anal, colorectal and liver cancers, are increasing over time mainly because HIV patients are living longer. If they survive for longer, they have more time to develop these illnesses.”

Dr Dryden-Peterson has done research to explore the interaction of HIV and cancer in resource-limited settings, particularly sub-Saharan Africa, where over 20 million people are living with HIV. He is currently the Principal Investigator of a pilot study, HIV and Malignancy in Botswana. Though the study is still in progress, there have already been major findings. Of the patients with cancer in Botswana, two-thirds of them have HIV. “It was surprising,” said Dr Dryden-Peterson. “I didn’t think it would be nearly that high.”

In 2010, he established the Botswana Prospective Cancer Cohort, which enrolls all cancer patients at Princess Marina, Nyangabwe Hospital and Gaborone Private Hospital. The project has enrolled over 2000 participants. Over the years, Dr. Dryden-Peterson said the cancer situation has been worsening, as many patients remain unscreened and undiagnosed. He emphasised that increased capacity for early detection and treatment of HIV-associated cancer needs to be a new priority for programmes. Not only that but, also improved quality of oncology care, particularly, he noted chemotherapy medication, which he said, was not always available.

Public Health Specialist and Head of National NCD Programme at the Ministry of Health and Wellness, Dr Neo Tapela concurred. While discussing the Potlako study, a two-year study designed to speed up patient diagnoses and treatment for patients with cancer related symptoms, she reiterated the “urgent need to turn around the disturbing trend”. She said the study, which is conducted in the Kweneng East district has so far yielded positive results. 

To date, 117 primary care clinicians have been trained on identifying cancer related signs and symptoms, how to evaluate patients with these and link to treatment, a process that has been taking years resulting in patients only receiving treatment when it was already too late. 200 patients have already been enrolled to date.

Meanwhile on Saturday, the Cancer Association of Botswana (CAB) will join the rest of the world in commemorating World Cancer Day. This year’s theme is, ‘We Can. I can’. A statement from the organisation said, “The main aim of commemorating this day, is to take part in the global effort to show support to all those affected by cancer and to remember those we have lost to the fight”.

Within Botswana, cervical cancer is the leading cause of cancer death. More than two-thirds of cases occur in HIV-infected women, with a national HIV prevalence of 17–24 percent in 2013. Between 2003 and 2011, cervical cancer accounted for 14 percent of all cancers in Botswana and 26 percent of all the cancers in women.