154 Responding to the challenge of AIDS Associated Cancers in Nigeria

The stabilization of the HIV epidemic in Africa has uncovered new epidemic of HIV associated comorbidities including cancers which the poorly developed health care system, poor infrastructure and lack of personnel is unable to cope with. In November 2012, international leaders in Cancer Research and Policy from 15 countries met at the NIH, Bethesda and made recommendations about the interventions needed to respond to the global cancer challenge in the world. These include (1) Creation of reliable, population-based registries that define the incidence, mortality, and survival rates of different types of cancers (2) Implementation of prevention measures to mitigate factors now known to promote cancer—tobacco, certain infectious agents, ultraviolet radiation, alcohol, obesity, lack of exercise, and diet, (3) Screening individuals for certain cancers (of the cervix, breast, prostate, and colorectum, in particular) and (4) Optimal cancer treatment. In this presentation, I will highlight how the Institute of Human Virology, University of Maryland (IHV) and the Institute of Human Virology Nigeria (IHVN) working with partners in Nigeria and internationally have implemented these recommendations and present data illustrating the outcome of our interventions. For example, Since 2010, 21 cancer registries have been developed or re-strengthened in Nigeria and 3 of these have met the WHO criteria for population based cancer registration (PBCR). These registries are now able to contribute data to the global cancer incidence database after more than 30 years during which there was no data from Nigeria. With mainstreaming of an additional 3 PBCR this year, we would have increased the proportion of Africa covered by PBCR from 11% to 32%. Our results also correct distortions in the estimates of cancer incidence and mortality in Nigeria which was previously based on projections derived from data from cancer registries of other African countries that had been used in the past. Cervical cancer is the commonest female cancer in Africa and in women living with HIV/AIDS. Implementation of screening programs has reduced incidence in developed countries by 80% in recent decades but incidence in developing countries remain stable or has been increasing. IHV implements an innovative “screen and treat” with immediate treatment with cold coagulation, digital cervicography for QA/QC and web based consultation for second opinion for early detection of cervical cancer. In collaboration with the Nigerian authorities and other partners, this program plans to reach 1,000,000 Nigerian women with at least 1 lifetime screening event over the next 10 years. This screening project laid the foundation for the NIH funded African Collaborative Center for Microbiome and Genomics Research (ACCME), part of the Wellcome Trust and NIH funded H3Africa initiative, which we set up at the IHVN and is currently engaged in integrative epidemiology of cervical cancer that is exploring the host and viral genomics and epigenomics, somatic cervical cancer genomics as part of NIH led Cancer Genome Atlas mapping project (TCGA), vaginal microenvironment—innate immunity and vaginal microbiota, as well as detailed risk factor characterization of prevalent and persistent HPV infection. Preliminary results from early studies conducted at this Center will be presented. Because of dearth of systematic information about the epidemiology of AIDS Associated Cancers in Africa, we have created a matched prospective cohort of persons living with HIV/AIDS and healthy volunteers who are being followed up every 2 years with detailed clinical evaluation and collection of data and biological samples in order to improve knowledge of the epidemiology of HIV Associated Comorbidities and provide high quality biological samples for molecular and omics studies. In my presentation, I will also mention some of the trainings that we have conducted, research into other cancer risk factors and the work we are doing to map the infrastructural needs for oncology treatment in Nigeria.