National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Int J Cancer. 2023 Jan 15;152(2):183-194. doi: 10.1002/ijc.34236. Epub 2022 Sep 2.
South Africa's HIV epidemic has evolved over time in terms of numbers of people living with HIV, access to antiretroviral treatment (ART) and age. These changes have profoundly influenced local cancer patterns. The Johannesburg Cancer Study has, over a period of 22 years (1995-2016), recruited over 20 000 incident black cancer patients who consented to provide answers to a questionnaire and blood samples (serum, DNA). This has presented a unique opportunity to examine the evolving association of HIV with cancer in Africa. We used logistic regression models to explore case-control associations between specific cancers and HIV, using participants with non-infection related cancers as controls. Using data of 20 835 cancer patients with confirmed HIV status, we found the following cancers to be associated with HIV: Kaposi's sarcoma (OR ; 95%CI): (99.1;72.6-135.1), non-Hodgkin lymphoma (11.3;9.3-13.6), cervical cancer (2.7;2.4-3.0), Hodgkin lymphoma (3.1;2.4-4.2), cancer of the eye/conjunctiva (18.7;10.1-34.7), anogenital cancers (anus [2.1;1.4-3.2], penis [5.4;2.7-10.5], vulva [4.8;3.5-6.4], vagina [5.5;3.0-10.2]), oropharyngeal cancer (1.6;1.3-1.9), squamous cell carcinoma of the skin (3.5;2.4-4.9), melanoma (2.0;1.2-3.5) and cancer of the larynx (1.7;1.3-2.4). Kaposi's sarcoma odds ratios increased from the pre-ART (1995-2004) to the early ART (2005-2009) period but declined in the late ART (2010-2016) period. Odds ratios for cancers of the eye/conjunctiva, cervix, penis and vulva continued to increase in recent ART periods. Our study confirms the spectrum of HIV-associated cancers found in other African settings. The odds ratios of conjunctival and HPV-related cancers continue to rise in the ART era as the HIV positive population ages.
南非的艾滋病毒流行情况在感染艾滋病毒的人数、获得抗逆转录病毒治疗 (ART) 和年龄方面随时间发生了变化。这些变化深刻地影响了当地的癌症模式。约翰内斯堡癌症研究在 22 年的时间里（1995-2016 年），招募了超过 20000 名新发病例的黑人癌症患者，他们同意回答问卷并提供血液样本（血清、DNA）。这为研究艾滋病毒与非洲癌症之间不断变化的关系提供了独特的机会。我们使用逻辑回归模型，使用与感染无关的癌症患者作为对照，探索特定癌症与艾滋病毒之间的病例对照关联。利用 20835 名确诊艾滋病毒感染癌症患者的数据，我们发现以下癌症与艾滋病毒相关：卡波西肉瘤（OR；95%CI）：（99.1；72.6-135.1），非霍奇金淋巴瘤（11.3；9.3-13.6），宫颈癌（2.7；2.4-3.0），霍奇金淋巴瘤（3.1；2.4-4.2），眼/结膜癌（18.7；10.1-34.7），肛门生殖器癌（肛门 [2.1；1.4-3.2]，阴茎 [5.4；2.7-10.5]，外阴 [4.8；3.5-6.4]，阴道 [5.5；3.0-10.2]），口咽癌（1.6；1.3-1.9），皮肤鳞状细胞癌（3.5；2.4-4.9），黑色素瘤（2.0；1.2-3.5）和喉癌（1.7；1.3-2.4）。卡波西肉瘤的优势比从抗逆转录病毒治疗前（1995-2004 年）到早期抗逆转录病毒治疗（2005-2009 年）期间增加，但在晚期抗逆转录病毒治疗（2010-2016 年）期间下降。最近的抗逆转录病毒治疗期间，眼/结膜、宫颈、阴茎和外阴癌症的优势比继续增加。我们的研究证实了在其他非洲环境中发现的艾滋病毒相关癌症的范围。随着艾滋病毒阳性人群年龄的增长，眼/结膜和 HPV 相关癌症的优势比在抗逆转录病毒治疗时代继续上升。
