南非艾滋病毒阳性儿童中艾滋病界定癌症和其他癌症的发病率：记录链接研究
Incidence of AIDS-defining and Other Cancers in HIV-positive Children in South Africa: Record Linkage Study.
作者信息
Bohlius Julia, Maxwell Nicola, Spoerri Adrian, Wainwright Rosalind, Sawry Shobna, Poole Janet, Eley Brian, Prozesky Hans, Rabie Helena, Garone Daniela, Technau Karl-Günter, Maskew Mhairi, Davies Mary-Ann, Davidson Alan, Stefan D Cristina, Egger Matthias
机构信息
From the *Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; †School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; ‡Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, South Africa; §Harriet Shezi Children's Clinic, University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa; ¶Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa; ‖Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital; **Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; ††Division of Infectious Diseases, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa; ‡‡Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Tygerberg, Cape Town, South Africa; §§Khayelitsha ART Program, Médecins Sans Frontières, Cape Town, South Africa; ¶¶Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa; ‖‖Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ***Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and the University of Cape Town; and †††South African Medical Research Council, Cape Town, South Africa.
出版信息
Pediatr Infect Dis J. 2016 Jun;35(6):e164-70. doi: 10.1097/INF.0000000000001117.
BACKGROUND
Little is known on the risk of cancer in HIV-positive children in sub-Saharan Africa. We examined incidence and risk factors of AIDS-defining and other cancers in pediatric antiretroviral therapy (ART) programs in South Africa.
METHODS
We linked the records of 5 ART programs in Johannesburg and Cape Town to those of pediatric oncology units, based on name and surname, date of birth, folder and civil identification numbers. We calculated incidence rates and obtained hazard ratios (HR) with 95% confidence intervals (CI) from Cox regression models including ART, sex, age and degree of immunodeficiency. Missing CD4 counts and CD4% were multiply imputed. Immunodeficiency was defined according to World Health Organization 2005 criteria.
RESULTS
Data of 11,707 HIV-positive children were included in the analysis. During 29,348 person-years of follow-up 24 cancers were diagnosed, for an incidence rate of 82 per 100,000 person-years (95% CI: 55-122). The most frequent cancers were Kaposi sarcoma (34 per 100,000 person-years) and non-Hodgkin Lymphoma (31 per 100,000 person-years). The incidence of non AIDS-defining malignancies was 17 per 100,000. The risk of developing cancer was lower on ART (HR: 0.29; 95% CI: 0.09-0.86), and increased with age at enrollment (>10 vs. <3 years: HR: 7.3; 95% CI: 2.2-24.6) and immunodeficiency at enrollment (advanced/severe versus no/mild: HR: 3.5; 95% CI: 1.1-12.0). The HR for the effect of ART from complete case analysis was similar but ceased to be statistically significant (P = 0.078).
CONCLUSIONS
Early HIV diagnosis and linkage to care, with start of ART before advanced immunodeficiency develops, may substantially reduce the burden of cancer in HIV-positive children in South Africa and elsewhere.
背景
关于撒哈拉以南非洲地区艾滋病毒呈阳性儿童患癌症的风险，人们了解甚少。我们调查了南非儿科抗逆转录病毒治疗（ART）项目中艾滋病界定癌症及其他癌症的发病率和风险因素。
方法
我们将约翰内斯堡和开普敦5个ART项目的记录与儿科肿瘤科室的记录进行关联，依据姓名、姓氏、出生日期、病历夹及身份证号码。我们计算发病率，并从包含ART、性别、年龄和免疫缺陷程度的Cox回归模型中获得风险比（HR）及95%置信区间（CI）。缺失的CD4细胞计数和CD4%通过多重填补法处理。免疫缺陷根据世界卫生组织2005年标准定义。
结果
11707名艾滋病毒呈阳性儿童的数据纳入分析。在29348人年的随访期间，诊断出24例癌症，发病率为每100000人年82例（95%CI：55 - 122）。最常见的癌症是卡波西肉瘤（每100000人年34例）和非霍奇金淋巴瘤（每100000人年31例）。非艾滋病界定恶性肿瘤的发病率为每100000人年17例。接受ART治疗后患癌风险较低（HR：0.29；95%CI：0.09 - 0.86），且随着入组年龄增加（>10岁对比<3岁：HR：7.3；95%CI：2.2 - 24.6）以及入组时免疫缺陷程度增加（重度/严重对比无/轻度：HR：3.5；95%CI：1.1 - 12.0）而增加。完全病例分析中ART效应的HR相似，但不再具有统计学意义（P = 0.078）。
结论
早期艾滋病毒诊断及与治疗的衔接，在严重免疫缺陷出现之前开始ART治疗，可能会大幅降低南非及其他地区艾滋病毒呈阳性儿童的癌症负担。
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