THE OCCURRENCE AND PATTERN OF SQUAMOUS CELL CARCINOMA OF CONJUNCTIVA IN HIV/AIDS PATIENTS WITH CONJUNCTIVAL GROWTHS SEEN AT TWO TERTIARY HOSPITALS IN ZAMBIA

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Aims and objectives: To determine the prevalence, clinical and histological pattern of SCCC in HIV/AIDS patients with suspicious conjunctival growths attending the University Teaching Hospital, Lusaka and Kitwe Central Hospital in Zambia.

Methods: This was a hospital based cross sectional study which was conducted over a period of five months at the University Teaching Hospital, Lusaka and Kitwe Central Hospital. The study population was HIV positive patients with suspicious conjunctival growths presenting to the two eye clinics. Only those who consented to participate in the study were included. We also collected 2mls of blood for HIV testing and CD4+ count from patients who did not know their status. All HIV positive patients with conjunctival growths were assessed and counseled on the excision of the growth and the specimens were sent for histopathology examination. Those without HIV test results and Histology results were excluded from the study

Data Analysis: Data was analysed using SPSS version 11.5. A p‐value of less than 0.05 was considered significant.

Ethical approval: Was obtained from UNZA Biomedical research and ethics committee.

Results: On a total of 101 conjunctival lesions from HIV positive patients, excisional/ incisional biopsy was done and tissue sent for histopathological examination; 68 at UTH and 33 at KCH. Out of 101 HIV positive patients with suspicious conjunctival growths, 70 had confirmed histological diagnosis of SCCC. This gave a prevalence of 70%. The mean age was 37.6 years and age range was 17 to 61 years. The male to female was 1:3. The mean duration of the growth at presentation was 12.9 months. Recurrence of conjunctival growth was reported in 24 (34.3%) patients.  Out of 24 patients, 15 (62.5%) reported fast growing lesions. Only 5(7%) had bilateral conjunctival lesions. Majority of patients had one conjunctional lesion which tended to be more nasal and were rare in the fornix. Regional lymph node enlargement was noted in 5 (7.1%) patients. Of the 70 patients with SCCC, 17 (24.3%) developed the conjunctival growth while already on HAART. There was no statistical significance between rates of growth and being on antiretroviral therapy. The mean CD4 Count was 247.17, median 209, the range was 10 – 620. There was no statistical significance between the rates of growth and mean CD4+ counts.

Conclusion: SCCC is a highly significant and prevalent condition in HIV positive patients with conjunctival growths in Zambia. It is common in young adults, often affecting women. The lesions are aggressive and fast growing. Cases of recurrences are also high. SCCC bears no correlation with CD4+ counts. It does not seem to regress with HAART. SCCC can now be considered as a marker for HIV infection, a view which is held by many Ophthalmologists in Africa