Singh Elvira, Naidu Gita, Davies Mary-Ann, Bohlius Julia
aNational Cancer Registry, National Health Laboratory Service bPaediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa cCentre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa dInstitute of Social and Preventive Medicine, University of Bern, Switzerland.
Curr Opin HIV AIDS. 2017 Jan;12(1):77-83. doi: 10.1097/COH.0000000000000331.
HIV-infected children are at an increased risk of developing cancer. Many of the cancers in HIV-infected children are linked to immunosuppression and oncogenic coinfections. Worldwide most HIV-infected children live in sub-Saharan Africa, but cancer data for this population are scarce. In this article, we review the current literature on the epidemiology and prevention of cancer in HIV-infected children.
Combined antiretroviral therapy (cART) reduces the risk of developing cancer in HIV-infected children. Cancer risk remains increased in children who start cART at older ages or more advanced immunosuppression as compared with children who start cART at younger age and with mild immunosuppression. Starting cART before severe immunosuppression develops is key to prevent cancer in HIV-infected children but most children in low-income countries start cART at severe immunosuppression levels. Vaccination against high-risk variants of human papillomavirus may protect again human papillomavirus-associated cancer later in life. However, tailoring of human papillomavirus vaccination guidelines for HIV-infected children and young women awaits answers to determine the best vaccination strategies.
Better data on the short-term and long-term risks of developing cancer and the effects of preventive measures in HIV-infected children from regions with high burden of HIV/AIDS are urgently needed.
感染HIV的儿童患癌症的风险增加。许多感染HIV儿童的癌症与免疫抑制和致癌性合并感染有关。在全球范围内，大多数感染HIV的儿童生活在撒哈拉以南非洲地区，但该人群的癌症数据稀缺。在本文中，我们综述了目前关于感染HIV儿童癌症流行病学和预防的文献。
联合抗逆转录病毒疗法（cART）可降低感染HIV儿童患癌症的风险。与在较年轻时开始cART且免疫抑制较轻的儿童相比，在较大年龄或免疫抑制更严重时开始cART的儿童患癌症风险仍然较高。在严重免疫抑制出现之前开始cART是预防感染HIV儿童患癌症的关键，但低收入国家的大多数儿童在严重免疫抑制水平时才开始cART。接种针对高危型人乳头瘤病毒的疫苗可能会在日后预防人乳头瘤病毒相关癌症。然而，针对感染HIV儿童和年轻女性的人乳头瘤病毒疫苗接种指南的调整仍有待确定最佳接种策略。
迫切需要来自HIV/AIDS高负担地区的关于感染HIV儿童患癌症的短期和长期风险以及预防措施效果的更好数据。
