Kapambwe Sharon, Sahasrabuddhe Vikrant V, Blevins Meridith, Mwanahamuntu Mulindi H, Mudenda Victor, Shepherd Bryan E, Chibwesha Carla J, Pfaendler Krista S, Hicks Michael L, Vermund Sten H, Stringer Jeffrey S A, Parham Groesbeck P
*Center for Infectious Disease Research in Zambia, Lusaka, Zambia; †University of Zambia, Lusaka, Zambia; ‡Vanderbilt University, Nashville, TN; §University of North Carolina at Chapel Hill, Chapel Hill, NC; ‖University of Cincinnati, Cincinnati, OH; ¶Michigan Cancer Institute, Pontiac, MI.
J Acquir Immune Defic Syndr. 2015 Sep 1;70(1):e20-6. doi: 10.1097/QAI.0000000000000685.
Cervical cancer screening efforts linked to HIV/AIDS care programs are being expanded across sub-Saharan Africa. Evidence on the age distribution and determinants of invasive cervical cancer (ICC) cases detected in such programs is limited.
We analyzed program operations data from the Cervical Cancer Prevention Program in Zambia, the largest public sector programs of its kind in sub-Saharan Africa. We examined age distribution patterns by HIV serostatus of histologically confirmed ICC cases and used multivariable logistic regression to evaluate independent risk factors for ICC among younger (≤35 years) and older (>35 years) women.
Between January 2006 and April 2010, of 48,626 women undergoing screening, 571 (1.2%) were diagnosed with ICC, including 262 (46%) HIV seropositive (median age: 35 years), 131 (23%) HIV seronegative (median age: 40 years), and 178 (31%) of unknown HIV serostatus (median age: 38 years). Among younger (≤35 years) women, being HIV seropositive was associated with a 4-fold higher risk of ICC [adjusted odds ratio = 4.1 (95% confidence interval: 2.8, 5.9)] than being HIV seronegative. The risk of ICC increased with increasing age among HIV-seronegative women and women with unknown HIV serostatus, but among HIV-seropositive women, the risk peaked around age 35 and nonsignificantly declined with increasing ages. Other factors related to ICC included being married (vs. being unmarried/widowed) in both younger and older women, and with having 2+ (vs. ≤1) lifetime sexual partners among younger women.
HIV infection seems to have increased the risk of cervical cancer among younger women in Zambia, pointing to the urgent need for expanding targeted screening interventions.
撒哈拉以南非洲地区正不断扩大与艾滋病护理项目相关的宫颈癌筛查工作。关于在此类项目中检测出的浸润性宫颈癌（ICC）病例的年龄分布及决定因素的证据有限。
我们分析了赞比亚宫颈癌预防项目的项目运营数据，该项目是撒哈拉以南非洲地区同类最大的公共部门项目。我们按组织学确诊的ICC病例的HIV血清学状态检查了年龄分布模式，并使用多变量逻辑回归评估年轻（≤35岁）和年长（>35岁）女性中ICC的独立危险因素。
2006年1月至2010年4月期间，在接受筛查的48,626名女性中，571人（1.2%）被诊断为ICC，其中262人（46%）HIV血清学阳性（中位年龄：35岁），131人（23%）HIV血清学阴性（中位年龄：40岁），178人（31%）HIV血清学状态未知（中位年龄：38岁）。在年轻（≤35岁）女性中，HIV血清学阳性者患ICC的风险比HIV血清学阴性者高4倍[调整后的优势比 = 4.1（95%置信区间：2.8, 5.9）]。在HIV血清学阴性女性和HIV血清学状态未知的女性中，ICC风险随年龄增长而增加，但在HIV血清学阳性女性中，风险在35岁左右达到峰值，并随年龄增长而略有下降。与ICC相关的其他因素包括年轻和年长女性中已婚（相对于未婚/丧偶），以及年轻女性中有2个以上（相对于≤1个）终身性伴侣。
HIV感染似乎增加了赞比亚年轻女性患宫颈癌的风险，这表明迫切需要扩大有针对性的筛查干预措施。
