Tisler Anna, Toompere Karolin, Bardou Marc, Diaz Jose, Orumaa Madleen, Uusküla Anneli
Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
CIC-P INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, France.
Eur J Public Health. 2024 Dec 1;34(6):1199-1204. doi: 10.1093/eurpub/ckae152.
Cancers represent the primary cause of mortality among people living with HIV (PLWH). However, comprehensive nationwide data regarding cancer incidence remains limited. Our objective was to evaluate the incidence rates of cancers, particularly those associated with human papillomavirus (HPV), within a nationwide study cohort. Using data from the Estonian Health Insurance Fund and the National Cancer Registry from 2004 to 2021, we calculated standardized incidence ratios (SIRs) for various cancer types among PLWH to compare to the general population with special emphases on HPV-associated cancers. A total of 7011 individuals (65.7% men) diagnosed with HIV were identified. HPV-associated cancers accounted for 21.4% of all incident cancer cases among PLWH. SIRs for HPV-associated cancers were 3.7 [95% confidence interval (CI) 2.2-6.2] among men living with HIV (MLWH) and 5.7 (95% CI 4.0-7.9) among women living with HIV (WLWH). In MLWH, the highest SIRs were for penile 12.5 (95% CI 4.0-38.7), followed by oropharyngeal 3.6 (95% CI 1.7-7.6) and anal-rectal cancers 2.7 (95% CI 1.1-6.4) in comparison to the general population. In WLWH, an increased incidence of cervical (SIR = 5.8, 95% CI 3.9-8.5), oropharyngeal (SIR = 6.1, 95% CI 1.5-24.3), and anal-rectal (SIR = 3.6, 95% CI 1.2-11.2) cancers was observed. A significantly increased risk of AIDS-defining and non-AIDS-defining cancers is reported. We demonstrate a substantially heightened risk of HPV-associated cancers among PLWH compared to the general population, underscoring the imperative for intensified screening and scaled-up vaccination along with improvement in adherence to antiretroviral therapy.
癌症是人类免疫缺陷病毒（HIV）感染者（PLWH）死亡的主要原因。然而，全国范围内关于癌症发病率的全面数据仍然有限。我们的目标是在一项全国性研究队列中评估癌症的发病率，特别是与人类乳头瘤病毒（HPV）相关的癌症发病率。利用爱沙尼亚健康保险基金和国家癌症登记处2004年至2021年的数据，我们计算了PLWH中各种癌症类型的标准化发病率（SIR），以便与普通人群进行比较，并特别关注与HPV相关的癌症。共确定了7011名被诊断感染HIV的个体（65.7%为男性）。在PLWH中，与HPV相关的癌症占所有新发癌症病例的21.4%。感染HIV的男性（MLWH）中与HPV相关癌症的SIR为3.7[95%置信区间（CI）2.2 - 6.2]，感染HIV的女性（WLWH）中为5.7（95%CI 4.0 - 7.9）。在MLWH中，与普通人群相比，阴茎癌的SIR最高，为12.5（95%CI 4.0 - 38.7），其次是口咽癌3.6（95%CI 1.7 - 7.6）和肛管直肠癌2.7（95%CI 1.1 - 6.4）。在WLWH中，观察到宫颈癌（SIR = 5.8，95%CI 3.9 - 8.5）、口咽癌（SIR = 6.1，95%CI 1.5 - 24.3）和肛管直肠癌（SIR = 3.6，95%CI 1.2 - 11.2）的发病率增加。据报告，定义艾滋病和非艾滋病相关癌症的风险显著增加。我们证明，与普通人群相比，PLWH中与HPV相关癌症的风险大幅升高，这突出了加强筛查、扩大疫苗接种以及改善抗逆转录病毒治疗依从性的紧迫性。
