Uganda Cancer Institute, Kampala, Uganda.
Uganda Central Public Health Laboratory, Kampala, Uganda.
JCO Glob Oncol. 2023 Apr;9:e2200262. doi: 10.1200/GO.22.00262.
AIDS-related mortality declined markedly since the introduction of antiretroviral therapy (ART); however, cancer mortality in Africa was higher than its incidence in 2020. People living with HIV (PLWHIV) are at an increased risk of malignancy and death from malignancy compared with the general population. In Uganda, AIDS-defining malignancies (ADMs), including cervical cancer, Kaposi sarcoma, and non-Hodgkin lymphoma, are among the commonest malignancies. Virologic nonsuppression has been identified as an important predictor of mortality among PLWHIV diagnosed with cancer. This study aimed to determine the prevalence and to identify factors associated with virologic nonsuppression among PLWHIV newly diagnosed with cancer.
This was a cross-sectional study that was carried out between December 2018 and April 2019 at the Uganda Cancer Institute. PLWHIV who had been on ART for at least 6 months and were newly diagnosed with cancer were enrolled.
A total of 167 participants were enrolled. Cervical cancer was the commonest ADM (n = 45; 50.6%) of all ADMs, while esophageal and breast cancers were the commonest non-ADMs, accounting for 17.5% (n = 14) each of all non-ADMs. The prevalence of virologic nonsuppression was 15%. Having Kaposi sarcoma (odds ratio [OR], 8.15; = .003), being poorly adherent to ART (OR, 4.1; = .045), and being on second-line ART (OR, 5.68; = .011) were associated with virologic nonsuppression.
The prevalence of virologic nonsuppression is high among patients with HIV newly diagnosed with cancer. These findings emphasize the need for strengthening of adherence strategies, optimizing ART regimens, and prioritization of viral load testing among PLWHIV with newly diagnosed malignancy.
自抗逆转录病毒疗法（ART）问世以来，艾滋病相关死亡率显著下降；然而，非洲的癌症死亡率高于 2020 年的发病率。与普通人群相比，艾滋病毒感染者（PLWHIV）罹患恶性肿瘤和因恶性肿瘤死亡的风险增加。在乌干达，艾滋病定义的恶性肿瘤（ADM），包括宫颈癌、卡波西肉瘤和非霍奇金淋巴瘤，是最常见的恶性肿瘤之一。病毒学未抑制已被确定为诊断出患有癌症的 PLWHIV 死亡的重要预测因素。本研究旨在确定新诊断出患有癌症的 PLWHIV 中病毒学未抑制的流行率，并确定与病毒学未抑制相关的因素。
这是一项横断面研究，于 2018 年 12 月至 2019 年 4 月在乌干达癌症研究所进行。招募了至少接受了 6 个月 ART 治疗且新诊断出患有癌症的 PLWHIV。
共纳入 167 名参与者。宫颈癌是所有 ADM 中最常见的 ADM（n = 45；50.6%），而食管癌和乳腺癌是最常见的非 ADM，各占所有非 ADM 的 17.5%（n = 14）。病毒学未抑制的流行率为 15%。患有卡波西肉瘤（比值比 [OR]，8.15； =.003）、ART 治疗依从性差（OR，4.1； =.045）和使用二线 ART（OR，5.68； =.011）与病毒学未抑制相关。
新诊断出患有癌症的 HIV 患者中病毒学未抑制的流行率很高。这些发现强调需要加强依从性策略、优化 ART 方案，并优先对新诊断出恶性肿瘤的 PLWHIV 进行病毒载量检测。
