Wednesday, October 28, 2020

Botswana battles a deadly unholy trinity: HIV/AIDS, TB and cervical cancer

Botswana is fighting a life and death battle against a combined onslaught of three deadly diseases: cervical cancer, HIV/AIDS and Tuberculosis.

A Study by Journal of Global Oncology reveals that in Botswana, 60% of patients diagnosed with cervical cancer are also infected with HIV. Botswana has one of the highest TB prevalence rates in the world, and it is estimated that 60% to 75% of people diagnosed with TB are co infected with HIV.

Cervical cancer is the third most common malignancy in women worldwide and the leading cause of cancer-related death for women in developing countries. Globally, it is estimated that approximately half a million women are diagnosed with cervical cancer every year, and approximately 275,000 women die of the disease, 85% of whom live in low- and middle-income countries.

 In Botswana, cervical cancer is the most common gynecologic cancer and the leading cause of cancer death.

TB is the number one killer of people living with HIV in the world. Importantly, the impact of these pandemics is more severe in countries with more challenging health care systems, where TB and HIV are less controlled, and patients may have more advanced disease states compared with the developed world.

“Despite the magnitude of the cervical cancer, HIV, and TB epidemics coexisting in many resource-limited settings, their associations and the potential interactions among all three pandemics have not been documented previously, although, as previously mentioned, those between HIV and cervical cancer as well as between HIV and TB have been explored,” the study revealed.

Cervical cancer diagnosis and treatment in Botswana is centralised at Princess Marina Hospital, the largest referral hospital in the country.

The study says approximately 95% of all patients diagnosed with any cancer in public hospitals from all over the country are referred there for confirmation of diagnosis and treatment. In this study, consecutive patients referred to Princess Marina Hospital for the treatment of cervical cancer were enrolled between July 2013 and January 2015.

HIV testing was performed on all patients in accordance with Botswana’s national guidelines.

The study enrolled 180 women; during the study period, of whom 117 (65%) were infected with HIV at the time of their cervical cancer diagnosis. Overall, 18 (10%) patients with cervical cancer had a history of TB disease, and 16 (89%) of them were co infected with HIV. All patients with TB were treated for their disease. All HIV-positive patients were either already receiving antiretroviral treatment or had started on antiretroviral treatment at the time of cancer diagnosis.

However the study says there is limited information on the impact of TB or the combination of TB and HIV on cervical carcinomas.

The study examined the association between cervical cancer and a prior history of TB by HIV status in a prospective cohort of patients with cervical cancer in Botswana.

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