School of Mathematics and Statistics, UNSW Sydney, Kensington, Australia.
Cancer Research Division, Cancer Council NSW, Woolloomooloo, Australia.
PLoS One. 2020 May 6;15(5):e0231388. doi: 10.1371/journal.pone.0231388. eCollection 2020.
Women with HIV have an elevated risk of HPV infection, and eventually, cervical cancer. Tanzania has a high burden of both HIV and cervical cancer, with an HIV prevalence of 5.5% in women in 2018, and a cervical cancer incidence rate among the highest globally, at 59.1 per 100,000 per year, and an estimated 9,772 cervical cancers diagnosed in 2018. We aimed to quantify the impact that interventions intended to control HIV have had and will have on cervical cancer in Tanzania over a period from 1995 to 2070.
A deterministic transmission-dynamic compartment model of HIV and HPV infection and natural history was used to simulate the impact of voluntary medical male circumcision (VMMC), anti-retroviral therapy (ART), and targeted pre-exposure prophylaxis (PrEP) on cervical cancer incidence and mortality from 1995-2070.
We estimate that VMMC has prevented 2,843 cervical cancer cases and 1,039 cervical cancer deaths from 1995-2020; by 2070 we predict that VMMC will have lowered cervical cancer incidence and mortality rates by 28% (55.11 cases per 100,000 women in 2070 without VMMC, compared to 39.93 with VMMC only) and 26% (37.31 deaths per 100,000 women in 2070 without VMMC compared to 27.72 with VMMC), respectively. We predict that ART will temporarily increase cervical cancer diagnoses and deaths, due to the removal of HIV death as a competing risk, but will ultimately further lower cervical cancer incidence and mortality rates by 7% (to 37.31 cases per 100,000 women in 2070) and 5% (to 26.44 deaths per 100,000 women in 2070), respectively, relative to a scenario with VMMC but no ART. A combination of ART and targeted PrEP use is anticipated to lower cervical cancer incidence and mortality rates to 35.82 and 25.35 cases and deaths, respectively, per 100,000 women in 2070.
HIV treatment and control measures in Tanzania will result in long-term reductions in cervical cancer incidence and mortality. Although, in the near term, the life-extending capability of ART will result in a temporary increase in cervical cancer rates, continued efforts towards HIV prevention will reduce cervical cancer incidence and mortality over the longer term. These findings are critical background to understanding the longer-term impact of achieving cervical cancer elimination targets in Tanzania.
感染 HIV 的女性 HPV 感染风险增加，最终可能导致宫颈癌。坦桑尼亚 HIV 和宫颈癌负担都很高，2018 年女性 HIV 感染率为 5.5%，宫颈癌发病率在全球处于较高水平，每年每 10 万人中有 59.1 例，估计 2018 年诊断出 9772 例宫颈癌。我们旨在量化控制 HIV 的干预措施在 1995 年至 2070 年期间对坦桑尼亚宫颈癌的影响。
使用 HIV 和 HPV 感染和自然史的确定性传播动力学模型来模拟自愿男性包皮环切术 (VMMC)、抗逆转录病毒疗法 (ART) 和靶向性暴露前预防 (PrEP) 对宫颈癌发病率和死亡率的影响。
我们估计 VMMC 已预防了 1995 年至 2020 年期间的 2843 例宫颈癌病例和 1039 例宫颈癌死亡；到 2070 年，我们预计 VMMC 将使宫颈癌发病率和死亡率降低 28%（2070 年无 VMMC 的情况下，每 10 万妇女中有 55.11 例宫颈癌，而只有 VMMC 的情况下有 39.93 例）和 26%（无 VMMC 的情况下，每 10 万妇女中有 37.31 例宫颈癌死亡，而只有 VMMC 的情况下有 27.72 例）。我们预测，由于 HIV 死亡不再是竞争风险，ART 将暂时增加宫颈癌的诊断和死亡，但最终将通过 7%（2070 年每 10 万妇女中有 37.31 例宫颈癌）和 5%（2070 年每 10 万妇女中有 26.44 例宫颈癌死亡）进一步降低宫颈癌的发病率和死亡率，与 VMMC 但无 ART 的情况相比。预计 ART 和靶向 PrEP 的联合使用将使宫颈癌的发病率和死亡率分别降低至每 10 万妇女 35.82 例和 25.35 例死亡。
坦桑尼亚的 HIV 治疗和控制措施将导致宫颈癌发病率和死亡率的长期下降。尽管在短期内，ART 的延长生命能力将导致宫颈癌发病率的暂时增加，但持续努力预防 HIV 将在长期内降低宫颈癌的发病率和死亡率。这些发现是了解在坦桑尼亚实现宫颈癌消除目标的长期影响的重要背景。
