Page 333 - HIVMED_v21_i1.indb

Page 4 of 5 Original Research

TABLE 3: Distribution of malignancies amongst elderly patients receiving increased morbidity and mortality. Screening and optimal
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antiretroviral therapy at Newlands Clinic in March 2020, by sex. management of hypertension must become part of the
Malignancy type Female Male Frequency
n = 113 % n = 17 % n = 130 % comprehensive care of elderly PLWH.
CIN 3 77 68 - - 77 59
Cancer of the cervix 14 12 - - 14 11 The prevalence of CKD was high. Numerous risk factors
Kaposi sarcoma 4 4 7 41 11 9 are involved in renal disease in PLWH, such as age, black
VIN 3 10 9 - - 10 8 race, DM, hypertension, low CD4 counts and certain
Lymphomas† 3 3 4 24 7 5 ART medicines like tenofovir disoproxil fumarate. All
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Penile cancer - 4 24 4 3 HIV-positive patients especially the elderly must have annual
Vulvar cancer 3 3 - - 3 2 measurements of their renal function. Diabetes mellitus was
Multiple myeloma 1 1 1 6 2 2 far less common than hypertension. As has been previously
Anal cancer 1 1 0 - 1 1
Cancer of eye 1 1 0 - 1 1 reported, the risk of developing DM in PLWH is not well-
Cancer of rectum 1 1 0 - 1 1 established, and studies have not consistently shown a
CIN, cervical intra-epithelial neoplasia; VIN, vulvar intra-epithelial neoplasia. relationship between DM and HIV. 20,21 However, some
†, Lymphomas, four non-Hodgkin’s, one central nervous system, one Hodgkin’s, and one studies have shown that the risk of DM increases amongst
immunoblastic.
patients receiving ART. 22
Discussion A large number of elderly patients suffered from different
forms of malignancies, which were differently distributed by
We found that a quarter of PLWH receiving care at NC were sex. Human papilloma virus (HPV)-related malignancies
older than 50 years. The majority of these elderly patients were the leading diagnosed cancers. Almost 70% of the
had received ART for over 10 years. Most men were married; women with malignancies had HPV-related CIN3. The
the majority of women were widowed. This cohort of HPV-related anogenital malignancies will remain a challenge
elderly patients had well-controlled HIV infection with amongst HIV-infected men and women even in the era of
evidence of good immunological status. A high prevalence effective ART. Screening for high-risk HPV infection
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of overweight or obesity was reported, particularly amongst should become part of the care of HIV-positive women. The
women. Comorbidities were common, notably hypertension, estimated cumulative incidence for other cancers such as
malignancies (far higher in women than in men) and CKD non-Hodgkin’s B-cell lymphoma, lung cancer, liver cancer
(higher in men than in women). Nearly 20% of patients had and Hodgkin’s lymphoma increased amongst HIV-infected
at least two chronic comorbidities, and 5.6% had three. patients. Routine screening for common cancers should be
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part of the comprehensive care of HIV-infected elderly
The goal of ART is sustained suppression of HIV replication. patients.
Our results show that elderly patients with HIV achieve high
rates of viral suppression. This finding is consistent with the Our study was strengthened by very high levels of data
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results from other studies. Older patients receiving ART completeness. However, our study was limited as we used
have demonstrated good medication adherence and this data from a single clinic only. Frailty, cognitive impairment
plays a key role in achieving high rates of viral suppression. 14,15 and other geriatric syndromes that are common and
important in HIV were not included in comorbidities as
Although only half of our patients were married at the time data on these are not routinely collected. Furthermore,
of enrolment into care, over 80% of men were married. The assessing cancers cross sectionally as we did, without
higher proportion of marriage amongst men may be because consideration of those who have died of cancer prior to
of the fact that men are more likely to remarry after the loss the data pull, underestimates the true cancer burden.
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of a spouse or after divorce. Older patients with HIV face a We assessed all cancers ever diagnosed (historical). We
number of challenges that may affect their quality of life. acknowledge that although these data are interesting, they
Loss of partners and friends may lead to social isolation, are potentially misleading. Despite these limitations, we
depression and poor adherence to medicines. Additional believe that our results are important to healthcare providers
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stressors such as unemployment and poverty may further and policymakers.
worsen the quality of life. The high number of comorbidities
and pill burden may negatively affect medicine adherence. Conclusion
Interactions between ART and other medications are a major
consideration amongst the ageing population. Our data demonstrates that in Africa high rates of virological
suppression can be achieved amongst elderly patients on
The high prevalence of chronic non-AIDS diseases in this ART. However, the high rates of obesity (especially amongst
cohort is consistent with the findings from other studies women) and hypertension in this population need to
which have showed an increased number of comorbidities be addressed. The prevalence of pre-malignant cervical
in PLWH at all ages, but particularly as this population disease amongst elderly women is high; and hence, routine
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ages. Hypertension is now recognised as an important cervical cancer screening is essential for elderly women
chronic comorbid condition of PLWH and is associated with living with HIV.

http://www.sajhivmed.org.za 325 Open Access