The incidence of conjunctival squamous-cell carcinoma in Kampala, Uganda, was steady at around 6 per million per year from 1970 until 1988, but has increased six-fold since then to 35 per million per year in 1992. Among 48 patients with conjunctival tumours seen at the ophthalmology clinic of the New Mulago Hospital from 1990 to 1991, 75% were HIV seropositive, compared with a 19% seropositivity rate among 48 matched controls (relative risk 13.0, 95% CI 4.5-39.4, p < 0.0001). The recent epidemic of conjunctival tumours in Uganda (and in neighbouring countries) appears to be largely due to the epidemic of HIV infection. Other factors that may contribute to the high incidence of these tumours in equatorial Africa may be exposure to ultraviolet light and conjunctival papillomavirus infection.
PIP: The incidence of conjunctival squamous-cell carcinoma in Kampala, Uganda, was 6/million/year from 1970 until 1988, and it has increased to 35/million/year in 1992. Between February 1990 and February 1991, HIV tests were performed on all 48 patients who presented with conjunctival squamous cell carcinoma of the eye. A comparison was made with matched controls suffering from other eye diseases. 36 (75%) of the cancer patients were seropositive as compared with 9 (19%) of the controls. The cancerous tumors started as a whitish swelling in the limbus and rapidly increased in size. This study showed a relative risk for conjunctival tumors associated with HIV infection of 13:0. It appears from the scarcity of reports that these tumors are uncommon in HIV-infected subjects in the US and Europe. This would reflect the fact that before the AIDS epidemic, these tumors were more common in equatorial Africa than elsewhere, leading to the possibility that the combination of HIV-induced immunosuppression, conjunctival papilloma virus infections, and intense exposure to ultraviolet light may hasten the development of these tumors.