Mutyaba Innocent, Phipps Warren, Krantz Elizabeth M, Goldman Jason D, Nambooze Sarah, Orem Jackson, Wabinga Henry R, Casper Corey
*Uganda Cancer Institute, Kampala, Uganda; †Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; ‡University of Washington, Seattle, WA; §Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; and ‖Kampala Cancer Registry, Kampala, Uganda.
J Acquir Immune Defic Syndr. 2015 Aug 1;69(4):481-6. doi: 10.1097/QAI.0000000000000620.
The introduction of antiretroviral therapy (ART) in the United States and Europe has led to changes in the incidence of cancers among HIV-infected persons, including dramatic decreases in Kaposi sarcoma and non-Hodgkin lymphoma, and increases in Hodgkin lymphoma, liver, and anogenital malignancies. We sought to evaluate whether increasing availability of ART is associated with changing cancer incidence in Uganda.
Incident cases of 10 malignancies were identified from Kampala Cancer Registry from 1999 to 2008. ART coverage rates for Uganda were abstracted from the Joint United Nations Program on HIV/AIDS reports. Negative binomial and Poisson regression modeled the association between ART coverage and age-adjusted cancer incidence.
ART coverage in Uganda increased from 0% to 43% from 1999 to 2008. With each 10% increase in ART coverage, incidence of Kaposi sarcoma decreased by 5% [incidence rate ratio (IRR) = 0.95, 95% confidence interval: 0.91 to 0.99, P = 0.02] and stomach cancer decreased by 13% [IRR = 0.87 (95% CI: 0.80 to 0.95), P = 0.002]. Conversely, incidence of non-Hodgkin lymphoma increased by 6% [IRR = 1.06 (95% CI: 1 to 1.12), P = 0.05], liver cancer by 12% [IRR = 1.12 (95% CI: 1.04 to 1.21), P = 0.002], prostate cancer by 5% [IRR = 1.05 (95% CI: 1 to 1.10), P = 0.05], and breast cancer by 5% [IRR = 1.05 (95% CI: 1 to 1.11), P = 0.05]. ART coverage was not associated with incidence of invasive cervical cancer, lung, colon, and Hodgkin disease. These findings were similar when restricted to histologically confirmed cases.
Our findings suggest that AIDS-defining malignancies and other malignancies are likely to remain significant public health burdens in sub-Saharan Africa even as ART availability increases.
美国和欧洲引入抗逆转录病毒疗法（ART）后，HIV感染者中癌症的发病率发生了变化，包括卡波西肉瘤和非霍奇金淋巴瘤的发病率大幅下降，以及霍奇金淋巴瘤、肝癌和肛门生殖器恶性肿瘤的发病率上升。我们试图评估ART可及性的提高是否与乌干达癌症发病率的变化有关。
从坎帕拉癌症登记处识别出1999年至2008年期间10种恶性肿瘤的发病病例。乌干达的ART覆盖率数据摘自联合国艾滋病规划署的报告。负二项式回归和泊松回归对ART覆盖率与年龄调整后的癌症发病率之间的关联进行建模。
1999年至2008年期间，乌干达的ART覆盖率从0%升至43%。ART覆盖率每增加10%，卡波西肉瘤的发病率下降5%[发病率比（IRR）=0.95，95%置信区间：0.91至0.99，P=0.02]，胃癌发病率下降13%[IRR=0.87（95%CI：0.80至0.95），P=0.002]。相反，非霍奇金淋巴瘤的发病率增加6%[IRR=1.06（95%CI：1至1.12），P=0.05]，肝癌增加12%[IRR=1.12（95%CI：1.04至1.21），P=0.002]，前列腺癌增加5%[IRR=1.05（95%CI：1至1.10），P=0.05]，乳腺癌增加5%[IRR=1.05（95%CI：1至1.11），P=0.05]。ART覆盖率与浸润性宫颈癌、肺癌、结肠癌和霍奇金病的发病率无关。这些结果在仅限于组织学确诊病例时相似。
我们的研究结果表明，即使ART的可及性增加，在撒哈拉以南非洲，定义艾滋病的恶性肿瘤和其他恶性肿瘤可能仍然是重大的公共卫生负担。
