Skip to main content
NCBI home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1996 Jun;80(6):503–508. doi: 10.1136/bjo.80.6.503

Carcinoma of the conjunctiva and HIV infection in Uganda and Malawi.

K M Waddell 1, S Lewallen 1, S B Lucas 1, C Atenyi-Agaba 1, C S Herrington 1, G Liomba 1
PMCID: PMC505520  PMID: 8759259

Abstract

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.

Full text

PDF
503

Images in this article

505Image
on p.505
505Image
on p.505
506Image
on p.506
506Image
on p.506
506Image
on p.506

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adami J., Frisch M., Yuen J., Glimelius B., Melbye M. Evidence of an association between non-Hodgkin's lymphoma and skin cancer. BMJ. 1995 Jun 10;310(6993):1491–1495. doi: 10.1136/bmj.310.6993.1491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ateenyi-Agaba C. Conjunctival squamous-cell carcinoma associated with HIV infection in Kampala, Uganda. Lancet. 1995 Mar 18;345(8951):695–696. doi: 10.1016/s0140-6736(95)90870-6. [DOI] [PubMed] [Google Scholar]
  3. Buchbinder A., Friedman-Kien A. E. Clinical aspects of epidemic Kaposi's sarcoma. Cancer Surv. 1991;10:39–52. [PubMed] [Google Scholar]
  4. Chang Y., Cesarman E., Pessin M. S., Lee F., Culpepper J., Knowles D. M., Moore P. S. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma. Science. 1994 Dec 16;266(5192):1865–1869. doi: 10.1126/science.7997879. [DOI] [PubMed] [Google Scholar]
  5. Clear A. S., Chirambo M. C., Hutt M. S. Solar keratosis, pterygium, and squamous cell carcinoma of the conjunctiva in Malawi. Br J Ophthalmol. 1979 Feb;63(2):102–109. doi: 10.1136/bjo.63.2.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cooper K., Herrington C. S., Graham A. K., Evans M. F., McGee J. O. In situ human papillomavirus (HPV) genotyping of cervical intraepithelial neoplasia in South African and British patients: evidence for putative HPV integration in vivo. J Clin Pathol. 1991 May;44(5):400–405. doi: 10.1136/jcp.44.5.400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Denis P., Charpentier D., Roudier M., Lemaire J. C., Levin N., Nguyen-Khoa J. L. Carcinome épidermoïde conjonctival et virus de l'immunodéficience humaine. J Fr Ophtalmol. 1994;17(5):366–369. [PubMed] [Google Scholar]
  8. Goyal J. L., Rao V. A., Srinivasan R., Agrawal K. Oculocutaneous manifestations in xeroderma pigmentosa. Br J Ophthalmol. 1994 Apr;78(4):295–297. doi: 10.1136/bjo.78.4.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Herrington C. S., Evans M. F., Hallam N. F., Charnock F. M., Gray W., McGee J. D. Human papillomavirus status in the prediction of high-grade cervical intraepithelial neoplasia in patients with persistent low-grade cervical cytological abnormalities. Br J Cancer. 1995 Jan;71(1):206–209. doi: 10.1038/bjc.1995.42. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kestelyn P., Stevens A. M., Ndayambaje A., Hanssens M., van de Perre P. HIV and conjunctival malignancies. Lancet. 1990 Jul 7;336(8706):51–52. doi: 10.1016/0140-6736(90)91562-o. [DOI] [PubMed] [Google Scholar]
  11. Kestelyn P., Van de Perre P., Rouvroy D., Lepage P., Bogaerts J., Nzaramba D., Clumeck N. A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome in Africa. Am J Ophthalmol. 1985 Aug 15;100(2):230–238. doi: 10.1016/0002-9394(85)90787-1. [DOI] [PubMed] [Google Scholar]
  12. Kim R. Y., Seiff S. R., Howes E. L., Jr, O'Donnell J. J. Necrotizing scleritis secondary to conjunctival squamous cell carcinoma in acquired immunodeficiency syndrome. Am J Ophthalmol. 1990 Feb 15;109(2):231–233. doi: 10.1016/s0002-9394(14)75997-5. [DOI] [PubMed] [Google Scholar]
  13. Lauer S. A., Malter J. S., Meier J. R. Human papillomavirus type 18 in conjunctival intraepithelial neoplasia. Am J Ophthalmol. 1990 Jul 15;110(1):23–27. doi: 10.1016/s0002-9394(14)76932-6. [DOI] [PubMed] [Google Scholar]
  14. Lee G. A., Hirst L. W. Ocular surface squamous neoplasia. Surv Ophthalmol. 1995 May-Jun;39(6):429–450. doi: 10.1016/s0039-6257(05)80054-2. [DOI] [PubMed] [Google Scholar]
  15. Lucas S. B., Hounnou A., Peacock C., Beaumel A., Djomand G., N'Gbichi J. M., Yeboue K., Hondé M., Diomande M., Giordano C. The mortality and pathology of HIV infection in a west African city. AIDS. 1993 Dec;7(12):1569–1579. doi: 10.1097/00002030-199312000-00005. [DOI] [PubMed] [Google Scholar]
  16. Madreperla S. A., Green W. R., Daniel R., Shah K. V. Human papillomavirus in primary epithelial tumors of the lacrimal sac. Ophthalmology. 1993 Apr;100(4):569–573. doi: 10.1016/s0161-6420(93)31629-5. [DOI] [PubMed] [Google Scholar]
  17. Maiman M., Fruchter R. G., Guy L., Cuthill S., Levine P., Serur E. Human immunodeficiency virus infection and invasive cervical carcinoma. Cancer. 1993 Jan 15;71(2):402–406. doi: 10.1002/1097-0142(19930115)71:2<402::aid-cncr2820710222>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  18. McDonnell J. M., McDonnell P. J., Sun Y. Y. Human papillomavirus DNA in tissues and ocular surface swabs of patients with conjunctival epithelial neoplasia. Invest Ophthalmol Vis Sci. 1992 Jan;33(1):184–189. [PubMed] [Google Scholar]
  19. McDonnell P. J., McDonnell J. M., Kessis T., Green W. R., Shah K. V. Detection of human papillomavirus type 6/11 DNA in conjunctival papillomas by in situ hybridization with radioactive probes. Hum Pathol. 1987 Nov;18(11):1115–1119. doi: 10.1016/s0046-8177(87)80378-7. [DOI] [PubMed] [Google Scholar]
  20. Napora C., Cohen E. J., Genvert G. I., Presson A. C., Arentsen J. J., Eagle R. C., Laibson P. R. Factors associated with conjunctival intraepithelial neoplasia: a case control study. Ophthalmic Surg. 1990 Jan;21(1):27–30. [PubMed] [Google Scholar]
  21. Odrich M. G., Jakobiec F. A., Lancaster W. D., Kenyon K. R., Kelly L. D., Kornmehl E. W., Steinert R. F., Grove A. S., Jr, Shore J. W., Gregoire L. A spectrum of bilateral squamous conjunctival tumors associated with human papillomavirus type 16. Ophthalmology. 1991 May;98(5):628–635. doi: 10.1016/s0161-6420(91)32218-8. [DOI] [PubMed] [Google Scholar]
  22. Palefsky J. M. Anal human papillomavirus infection and anal cancer in HIV-positive individuals: an emerging problem. AIDS. 1994 Mar;8(3):283–295. doi: 10.1097/00002030-199403000-00001. [DOI] [PubMed] [Google Scholar]
  23. Rady P. L., Yen A., Rollefson J. L., Orengo I., Bruce S., Hughes T. K., Tyring S. K. Herpesvirus-like DNA sequences in non-Kaposi's sarcoma skin lesions of transplant patients. Lancet. 1995 May 27;345(8961):1339–1340. doi: 10.1016/s0140-6736(95)92538-4. [DOI] [PubMed] [Google Scholar]
  24. Templeton A. C. Tumours of the eye and adnexa. Recent Results Cancer Res. 1973;41:203–214. doi: 10.1007/978-3-642-80725-1_12. [DOI] [PubMed] [Google Scholar]
  25. Tuppurainen K., Raninen A., Kosunen O., Kankkunen J. P., Kellokoski J., Syrjänen S., Mäntyjärvi M., Syrjänen K. Squamous cell carcinoma of the conjunctiva. Failure to demonstrate HPV DNA by in situ hybridization and polymerase chain reaction. Acta Ophthalmol (Copenh) 1992 Apr;70(2):248–254. doi: 10.1111/j.1755-3768.1992.tb04132.x. [DOI] [PubMed] [Google Scholar]
  26. Wawer M. J., Serwadda D., Musgrave S. D., Konde-Lule J. K., Musagara M., Sewankambo N. K. Dynamics of spread of HIV-I infection in a rural district of Uganda. BMJ. 1991 Nov 23;303(6813):1303–1306. doi: 10.1136/bmj.303.6813.1303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Winward K. E., Curtin V. T. Conjunctival squamous cell carcinoma in a patient with human immunodeficiency virus infection. Am J Ophthalmol. 1989 May 15;107(5):554–555. doi: 10.1016/0002-9394(89)90508-4. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES