Mbatha Sikhumbuzo Z, Maphosho Tania, Ramali Dakalo, Damane Botle, Nevhungoni Portia, Mc-Cabe Michelle, Mosoane Benny, Hull Rodney, Dlamini Zodwa
Department of Surgery, Steve Biko Academic Hospital, University of Pretoria, Hatfield, Pretoria, South Africa.
South African Medical Research Council, Biostatistics Research Unit, Pretoria, South Africa.
Front Oncol. 2025 Aug 18;15:1634565. doi: 10.3389/fonc.2025.1634565. eCollection 2025.
Esophageal squamous cell carcinoma (ESCC) is a serious public health concern in South Africa, ranking among the most lethal malignancies. It has known risk factors including human papillomavirus (HPV). HPV is strongly linked to squamous cell cancers (i.e., cervix, anus, and oropharynx) with human immunodeficiency virus (HIV) shown to increase susceptibility to HPV-related malignancies. The extent to which co-infection with these two viruses contribute to ESCC in South African populations is unclear. This study aimed to determine the prevalence of HPV and HIV in ESCC patients.
A total of 78 ESCC patients were prospectively recruited between January 2022 and December 2024 at Steve Biko Academic Hospital, Pretoria, South Africa. Participants were assessed for HIV, and tumors biopsied by endoscopy. DNA was extracted from formalin-fixed paraffin-embedded (FFPE) tissue specimens and HPV detection and genotyping were performed. Statistical analyses were conducted using Stata 18, with chi-square tests and logistic regression applied to assess associations, using a significance threshold of p ≤ 0.05.
The study population was predominantly Black Africans (96%), 55% male and 45% female, and aged 34-86 years. HIV infection was present in 42.3% (n=33) of patients. High-risk HPV DNA was detected in 56.4% (n=44) of ESCC cases, with high-risk subtypes HPV16 and HPV18 being the most prevalent, found in 68% and 41% of HPV-positive cases, respectively. Co-infection with both HIV and HPV was observed in 23.1% (n=18) of patients. However, statistical analyses showed no significant association between HIV and HPV status in ESCC patients (p = 0.78). However, a trend towards correlation was noted between HIV status and HPV18 positivity (adjusted p = 0.051).
While no direct association between HIV and HPV in ESCC was found, the high prevalence of high-risk HPV, particularly HPV16 and HPV18, highlights the need for further research. Given South Africa's burden of HIV and HPV, larger multicenter studies are essential to better understand viral contributions to esophageal carcinogenesis.
食管鳞状细胞癌（ESCC）是南非一个严重的公共卫生问题，位列最致命的恶性肿瘤之一。已知其风险因素包括人乳头瘤病毒（HPV）。HPV与鳞状细胞癌（即子宫颈、肛门和口咽）密切相关，而人类免疫缺陷病毒（HIV）已被证明会增加对HPV相关恶性肿瘤的易感性。在南非人群中，这两种病毒的共同感染对ESCC的影响程度尚不清楚。本研究旨在确定ESCC患者中HPV和HIV的感染率。
2022年1月至2024年12月期间，在南非比勒陀利亚的史蒂夫·比科学术医院前瞻性招募了78例ESCC患者。对参与者进行HIV检测，并通过内窥镜检查对肿瘤进行活检。从福尔马林固定石蜡包埋（FFPE）组织标本中提取DNA，进行HPV检测和基因分型。使用Stata 18进行统计分析，应用卡方检验和逻辑回归评估相关性，显著性阈值为p≤0.05。
研究人群主要为非洲黑人（96%），男性占55%，女性占45%，年龄在34至86岁之间。42.3%（n = 33）的患者感染了HIV。56.4%（n = 44）的ESCC病例检测到高危HPV DNA，高危亚型HPV16和HPV18最为常见，分别在68%和41%的HPV阳性病例中发现。23.1%（n = 18）的患者同时感染了HIV和HPV。然而，统计分析显示ESCC患者的HIV和HPV状态之间无显著关联（p = 0.78）。不过，注意到HIV状态与HPV18阳性之间存在相关性趋势（校正p = 0.051）。
虽然未发现ESCC患者中HIV与HPV之间存在直接关联，但高危HPV，尤其是HPV16和HPV18的高感染率凸显了进一步研究的必要性。鉴于南非的HIV和HPV负担，开展更大规模的多中心研究对于更好地了解病毒对食管癌发生的影响至关重要。
