Infectious Diseases Division, Hospital General Universitario de Elche, Elche, Spain.
Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
Cancer Med. 2023 Nov;12(21):20590-20603. doi: 10.1002/cam4.6585. Epub 2023 Oct 25.
Cancer is the leading cause of mortality in people living with HIV (PWH) and is expected to account for a growing fraction of deaths as PWH age.
In this literature review, we have compiled the most recent developments in cancer screening and screening performance in PWH, which are currently primarily implemented in well-resourced settings. This includes an assessment of the associated benefits, harms, and cost-effectiveness. The article also addresses unmet needs and potential strategies for tailored screening in the HIV population.
Incidence and mortality due to screenable cancer are higher in PWH than in the general population, and diagnosis is frequently made at younger ages and/or at more advanced stages, the latter amenable to improved screening. Adequate evidence on the benefits of screening is lacking for most cancers in the HIV population, in whom standard practice may be suboptimal. While cancer surveillance has helped reduce mortality in the general population, and interest in risk-based strategies is growing, implementation of screening programs in the HIV care settings remains low.
Given the devastating consequences of a late diagnosis, enhancing early detection of cancer is essential for improving patient outcomes. There is an urgent need to extend the investigation in cancer screening performance to PWH, evaluating whether personalized measures according to individual risk could result in higher efficiency and improve patient outcomes.
癌症是导致艾滋病毒感染者（PLWH）死亡的主要原因，随着 PLWH 年龄的增长，预计癌症死亡人数将占比越来越大。
在本次文献综述中，我们汇集了目前主要在资源充足环境中实施的 PLWH 癌症筛查和筛查性能的最新进展，评估了相关的获益、危害和成本效益。本文还探讨了未满足的需求和针对 HIV 人群的个性化筛查的潜在策略。
与一般人群相比，PLWH 的可筛查癌症发病率和死亡率更高，诊断通常发生在更年轻的年龄和/或更晚期，后者可通过更好的筛查来改善。在 HIV 人群中，大多数癌症的筛查获益证据不足，而标准实践可能并不理想。虽然癌症监测有助于降低一般人群的死亡率，且基于风险的策略的兴趣正在增加，但在 HIV 护理环境中实施筛查计划的情况仍然很少。
鉴于晚期诊断的后果严重，提高癌症的早期检测对于改善患者预后至关重要。迫切需要将癌症筛查性能的研究扩展到 PLWH，评估根据个体风险制定个性化措施是否可以提高效率并改善患者预后。
