Carcinoma of the conjunctiva and HIV infection in Uganda and Malawi

K M Waddell, S Lewallen, S B Lucas, C Atenyi-Agaba, C S Herrington, G Liomba

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

AIM: To investigate the association of human immunodeficiency virus (HIV) infection and carcinoma of the conjunctiva in Africa, and the role of human papilloma virus type 16 (HPV-16).

METHODS: Patients in Uganda and Malawi presenting to eye clinics with lesions suspicious of carcinoma were studied. Pathological confirmation of eye lesions was sought. HIV testing of patients who were biopsied and, in Uganda, of matched case control subjects was carried out as was testing of a sample of fixed biopsies for HPV-16 by polymerase chain reaction (PCR). The HIV-1 serology, histopathology of conjunctival biopsies (conjunctival intraepithelial neoplasia (CIN), invasive carcinoma, other lesions), and prevalence of HPV-16 infection were determined.

RESULTS: Of Ugandan patients, 27/38 (71%) with carcinoma (27 invasive carcinoma, 11, CIN) were HIV positive compared with 12/76 (16%) of controls (odds ratio 13, 95% confidence interval 5-38). The calculated population aetiological fraction of carcinoma associated with HIV was 66%. Of 32 Malawian patients (20 invasive carcinoma, 12 CIN), 25/29 tested (86%) were HIV positive. HPV-16 infection was found in 7/20 (35%) of carcinoma samples, 0/9 pingueculae, and 2/6 conjunctivitis samples.

CONCLUSIONS: HIV infection is strongly associated with an apparent increase in the incidence of conjunctival carcinoma in Africa. While ultraviolet light is probably the prime risk factor and HPV-16 is implicated in a proportion of cases, the interactions of ultraviolet light, HIV, HPVs, and other factors are unclear in the pathogenesis of carcinoma. The disease represents another model of multifactorial epithelial carcinogenesis.

Original languageEnglish
Pages (from-to)503-8
Number of pages6
JournalBritish Journal of Ophthalmology
Issue number6
Publication statusPublished - Jun 1996

Keywords / Materials (for Non-textual outputs)

  • AIDS-Related Opportunistic Infections
  • Adolescent
  • Adult
  • Aged
  • Carcinoma, Squamous Cell
  • Case-Control Studies
  • Cervical Intraepithelial Neoplasia
  • Conjunctival Neoplasms
  • Female
  • HIV
  • HIV Infections
  • Humans
  • Malawi
  • Male
  • Middle Aged
  • Odds Ratio
  • Papillomaviridae
  • Papillomavirus Infections
  • Polymerase Chain Reaction
  • Tumor Virus Infections
  • Uganda


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