南非艾滋病毒妇女的妇科和乳腺癌：一项创纪录的联系研究
Gynaecologic and breast cancers in women living with HIV in South Africa: A record linkage study
影响因子:4.70000
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
摘要
乳腺癌和妇科癌症约占南非妇女中被诊断出的所有癌症的一半，其中许多人也患有艾滋病毒。我们的目的是确定南非艾滋病毒（WLHIV）妇女中乳腺癌和妇科癌的发生率和危险因素的发生率和危险因素。这是对南非HIV癌症匹配研究的纵向分析，其中包括≥15岁的女性和两个或多个与HIV相关的实验室测试。我们使用COX比例危害模型来确定与患者和市政水平的特征相关的人乳头状瘤病毒（HPV）相关和激素相关的妇科癌的关联。从3个447 908名妇女和1050万年的随访中，我们确定了11个384事件和7612个普遍存在的妇科和乳腺癌。总体原油发病率为108/1 00 000人年（PYEARS）（95％置信区间[CI]：106-110），宫颈癌的发病率最高（70/1 00 000 PYEARS； 95％CI：68.5-71.7）。低CD4细胞计数和高HIV RNA病毒载量增加了宫颈和其他HPV相关癌症的风险。年龄与HPV相关和与激素有关的癌症均相关。与在SEP低城市中获得护理的妇女相比，可以诊断出具有HPV相关的癌症和乳腺癌的妇女更有可能被诊断出患有HPV相关的癌症和乳腺癌的妇女。作为WLHIV癌症预防策略的一部分，提高WLHIV的免疫学状态非常重要。预防癌症和早期检测计划应根据艾滋病毒衰老的妇女的需求量身定制。此外，必须解决癌症诊断服务中的SEP差异。
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.