Daniel Low, MDc


Nominated From: University of Washington

Research Site: Uganda

Research Area: HIV/AIDS; Cancer

Primary Mentor: Dr. Corey Casper

Research Project

HIV infection and cancer: assessing and addressing the unique challenges facing HIV-infected patients with cancer in Uganda

This research project is framed within a larger HIV/cancer study evaluating HIV prevalence and undiagnosed HIV infection in patients presenting to cancer centers in Sub-Saharan Africa (SSA). The study will provide a framework for the new HIV clinic at the Uganda Cancer Institute (UCI) by identifying unique challenges HIV-infected cancer patients face, and guide the delivery of care at the new UCI-hosted HIV clinic.

Specific Aims:
1. To quantitatively characterize the factors associated with failure to receive a diagnosis or appropriate treatment of HIV among cancer patients presenting for care in Uganda.

2. To qualitatively describe barriers to HIV treatment among newly-diagnosed cancer patients in Uganda.

Research Significance

There are limited recommendations for the treatment of cancer in patients with HIV co-infection. This is problematic, since 10% of HIV patients will develop cancer with routine care. In sub-Saharan Africa (SSA) alone, this amounts to over 2 million cases of HIV-associated malignancies. Recent studies have shown that early initiation of antiretroviral therapy (ART) when co-infected with opportunistic infections significantly reduces morbidity and mortality, implying early ART during cancer-directed therapy may similarly benefit
HIV-infected patients. In fact, a study of HIV-infected patients with Non-Hodgkin’s Lymphoma (NHL) in Uganda found a nearly 8-fold greater hazard of death for patients not on ART compared to those receiving ART. Yet, there are no clear recommendations for treatment of HIV in cancer patients (excluding Kaposi Sarcoma).
However, given the preliminary results with NHL, it is likely that early initiation of ART will benefit many HIV-infected cancer patients.

Due to the heterogeneity of cancers and the diverse risk factors associated with each however, it is likely that some HIV+ cancer patients will benefit more than others from early ART, while some may not benefit at all. Understanding these trends is critical to improving cancer care in Uganda, where it is estimated that 2/3 of presenting patients to the UCI are HIV+.

It is important to identify the unique barriers facing HIV+ cancer patients, as it is hypothesized that a disproportionate number of HIV+ cancer patients are not receiving ART. To date, there is no meaningful data examining why this may be; there is no data on the unique challenges HIV+ cancer patients face in Uganda. This is crucially important given the UCI/Hutchinson Center Cancer Alliance plans to open an HIV clinic in coordination with PEPFAR and the Uganda Ministry of Health this upcoming year, the first at any cancer center focusing on the unique needs of HIV-infected patients with cancer. As such, I propose to expand on the already proposed HIV/cancer medical records review and assessment being implemented this year, by exploring the unique challenges HIV+ cancer patients face.




Barriers to successful early infant diagnosis of HIV infection at primary care level in Malawi.
Impact of smear microscopy results and observed therapy on tuberculosis treatment in Mombasa, Kenya.