Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
University of North Carolina Project-Malawi, Lilongwe.
Clin Infect Dis. 2019 Aug 16;69(5):829-835. doi: 10.1093/cid/ciy960.
With antiretroviral therapy (ART), AIDS-defining cancer incidence has declined and non-AIDS-defining cancers (NADCs) are now more frequent among human immunodeficiency virus (HIV)-infected populations in high-income countries. In sub-Saharan Africa, limited epidemiological data describe cancer burden among ART users.
We used probabilistic algorithms to link cases from the population-based cancer registry with electronic medical records supporting ART delivery in Malawi's 2 largest HIV cohorts from 2000-2010. Age-adjusted cancer incidence rates (IRs) and 95% confidence intervals were estimated by cancer site, early vs late incidence periods (4-24 and >24 months after ART start), and World Health Organization (WHO) stage among naive ART initiators enrolled for at least 90 days.
We identified 4346 cancers among 28 576 persons. Most people initiated ART at advanced WHO stages 3 or 4 (60%); 12% of patients had prevalent malignancies at ART initiation, which were predominantly AIDS-defining eligibility criteria for initiating ART. Kaposi sarcoma (KS) had the highest IR (634.7 per 100 000 person-years) followed by cervical cancer (36.6). KS incidence was highest during the early period 4-24 months after ART initiation. NADCs accounted for 6% of new cancers.
Under historical ART guidelines, NADCs were observed at low rates and were eclipsed by high KS and cervical cancer burden. Cancer burden among Malawian ART users does not yet mirror that in high-income countries. Integrated cancer screening and management in HIV clinics, especially for KS and cervical cancer, remain important priorities in the current Malawi context.
随着抗逆转录病毒疗法（ART）的应用，艾滋病定义性癌症的发病率已经下降，而非艾滋病定义性癌症（NADC）在高收入国家的艾滋病毒（HIV）感染者中更为常见。在撒哈拉以南非洲，有限的流行病学数据描述了接受 ART 治疗的人群中的癌症负担。
我们使用概率算法将来自人群癌症登记处的病例与支持 2000-2010 年期间在马拉维最大的两个 HIV 队列中提供 ART 的电子病历相链接。通过癌症部位、早期与晚期发病期（ART 开始后 4-24 个月和>24 个月）以及初始接受 ART 至少 90 天的 WHO 分期，对年龄调整后的癌症发病率（IR）和 95%置信区间进行了估计。
我们在 28576 名患者中发现了 4346 例癌症。大多数患者在晚期 WHO 分期 3 或 4 期开始接受 ART（60%）；12%的患者在开始 ART 时存在已确诊的恶性肿瘤，这些肿瘤主要是艾滋病定义的开始 ART 的资格标准。卡波西肉瘤（KS）的发病率最高（634.7/10 万人年），其次是宫颈癌（36.6）。KS 的发病率在 ART 开始后 4-24 个月的早期阶段最高。NADC 占新发癌症的 6%。
在历史上的 ART 指导原则下，NADC 的发病率较低，且被高发的 KS 和宫颈癌负担所掩盖。马拉维接受 ART 治疗的患者的癌症负担尚未反映出高收入国家的情况。在当前的马拉维背景下，在 HIV 诊所中进行癌症筛查和管理，特别是针对 KS 和宫颈癌，仍然是重要的优先事项。
