Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
Clin Infect Dis. 2021 Aug 2;73(3):e735-e744. doi: 10.1093/cid/ciab087.
We analyzed associations between immunodeficiency and cancer incidence in a nationwide cohort of people living with human immunodeficiency virus (HIV; PLWH) in South Africa.
We used data from the South African HIV Cancer Match Study built on HIV-related laboratory measurements from the National Health Laboratory Services and cancer records from the National Cancer Registry. We evaluated associations between time-updated CD4 cell count and cancer incidence rates using Cox proportional hazards models. We reported adjusted hazard ratios (aHRs) over a grid of CD4 values and estimated the aHR per 100 CD4 cells/µL decrease.
Of 3 532 266 PLWH, 15 078 developed cancer. The most common cancers were cervical cancer (4150 cases), Kaposi sarcoma (2262 cases), and non-Hodgkin lymphoma (1060 cases). The association between lower CD4 cell count and higher cancer incidence rates was strongest for conjunctival cancer (aHR per 100 CD4 cells/µL decrease: 1.46; 95% confidence interval [CI], 1.38-1.54), Kaposi sarcoma (aHR, 1.23; 95% CI, 1.20-1.26), and non-Hodgkin lymphoma (aHR, 1.18; 95% CI, 1.14-1.22). Among infection-unrelated cancers, lower CD4 cell counts were associated with higher incidence rates of esophageal cancer (aHR, 1.06; 95% CI, 1.00-1.11) but not breast, lung, or prostate cancer.
Lower CD4 cell counts were associated with an increased risk of developing various infection-related cancers among PLWH. Reducing HIV-induced immunodeficiency may be a potent cancer-prevention strategy among PLWH in sub-Saharan Africa, a region heavily burdened by cancers attributable to infections.
我们分析了在南非一个全国性的艾滋病毒感染者队列中，免疫缺陷与癌症发病率之间的关联。
我们使用了南非艾滋病毒癌症匹配研究的数据，该研究基于国家卫生实验室服务的艾滋病毒相关实验室测量值和国家癌症登记处的癌症记录。我们使用 Cox 比例风险模型评估了时间更新的 CD4 细胞计数与癌症发病率之间的关联。我们报告了在 CD4 值网格上的调整后风险比 (aHR)，并估计了每降低 100 CD4 细胞/µL 的 aHR。
在 3532266 名艾滋病毒感染者中，有 15078 人患上了癌症。最常见的癌症是宫颈癌 (4150 例)、卡波西肉瘤 (2262 例) 和非霍奇金淋巴瘤 (1060 例)。较低的 CD4 细胞计数与较高的癌症发病率之间的关联最强的是结膜癌 (每降低 100 CD4 细胞/µL 的 aHR：1.46；95%置信区间 [CI]，1.38-1.54)、卡波西肉瘤 (aHR，1.23；95% CI，1.20-1.26) 和非霍奇金淋巴瘤 (aHR，1.18；95% CI，1.14-1.22)。在与感染无关的癌症中，较低的 CD4 细胞计数与食管癌发病率升高相关 (aHR，1.06；95% CI，1.00-1.11)，但与乳腺癌、肺癌或前列腺癌无关。
在艾滋病毒感染者中，较低的 CD4 细胞计数与各种感染相关癌症的发病风险增加相关。在撒哈拉以南非洲这一感染相关癌症负担沉重的地区，降低艾滋病毒引起的免疫缺陷可能是艾滋病毒感染者的一种有效的癌症预防策略。
