南非HIV感染女性中妇科及乳腺癌的记录关联研究

Gynaecologic and breast cancers in women living with HIV in South Africa: A record linkage study

INTERNATIONAL JOURNAL OF CANCER

影响因子:4.7

分区:医学2区 / 肿瘤学2区

发表日期:2024 Jan 15

作者: Tafadzwa G Dhokotera, Mazvita Muchengeti, Maša Davidović, Eliane Rohner, Victor Olago, Matthias Egger, Julia Bohlius

DOI: 10.1002/ijc.34712

摘要

乳腺癌和妇科癌症约占南非女性所有癌症的半数，其中许多女性同时感染HIV。我们旨在确定南非HIV感染女性中乳腺癌及妇科癌症的发生率及其危险因素。本研究为南非HIV癌症匹配研究的纵向分析，包括≥15岁、接受两次及以上HIV相关实验室检测的女性。我们采用Cox比例风险模型分析人乳头瘤病毒（HPV）相关及激素相关妇科癌症与患者及市政级特征的关联。在3,447,908名女性和超过1050万年的随访中，发现11,384例新发和7,612例既存妇科及乳腺癌病例。总体粗发病率为每100,000人年108例（95% CI：106-110），宫颈癌的发病率最高，为每100,000人年70例（95% CI：68.5-71.7）。低CD4细胞计数和高HIV RNA载量增加宫颈癌及其他HPV相关癌症的风险。年龄与HPV及激素相关癌症均相关。高社会经济地位（SEP）市政地区的妇女更可能被诊断为HPV相关癌症和乳腺癌。加强HIV感染妇女的免疫状态是癌症预防的重要措施。癌症预防和早期筛查方案应根据妇女的HIV伴随年龄特点进行调整。此外，必须解决癌症诊断服务中的SEP差异问题。

Abstract

Breast and gynaecologic cancers account for approximately half of all cancers diagnosed amongst women in South Africa, many of whom also live with HIV. We aimed to determine the incidence of and risk factors for developing breast and gynaecologic cancers in women living with HIV (WLHIV) in South Africa. This is a longitudinal analysis of the South African HIV Cancer Match study including women aged ≥15 years with two or more HIV-related laboratory tests. We used Cox proportional hazard models to determine the association of Human Papilloma Virus (HPV)-related and hormone-related gynaecologic cancer with patient- and municipal-level characteristics. From 3 447 908 women and 10.5 million years of follow-up, we identified 11 384 incident and 7612 prevalent gynaecologic and breast cancers. The overall crude incidence rate was 108/1 00 000 person-years (pyears) (95% confidence interval [CI]: 106-110), with the highest incidence observed for cervical cancer (70/1 00 000 pyears; 95% CI: 68.5-71.7). Low CD4 cell counts and high HIV RNA viral loads increased the risk of cervical and other HPV-related cancers. Age was associated with both HPV-related and hormone-related cancers. Women accessing health facilities in high socioeconomic position (SEP) municipalities were more likely to be diagnosed with HPV-related cancers and breast cancer than women accessing care in low SEP municipalities. It is important to improve the immunologic status of WLHIV as part of cancer prevention strategies in WLHIV. Cancer prevention and early detection programmes should be tailored to the needs of women ageing with HIV. In addition, SEP disparities in cancer diagnostic services have to be addressed.