Background

Literature on cancer in adolescents and young adults (AYA; aged 15–24 years) living with HIV is scarce. We studied cancer incidence in AYA living with HIV in South Africa between 2004 and 2014.

Methods

In this nationwide cohort study, we included individuals between 15 and 24 years old who had at least two HIV-related laboratory measurements on separate days between Jan 1, 2004, and Dec 31, 2014, recorded in the National Health Laboratory Service database. We used privacy-preserving probabilistic record linkage methods to identify HIV-related laboratory records that most likely belonged to the same individual and to then link these individuals to cancer diagnoses from the National Cancer Registry. We computed incidence rates for the most common cancers in AYA living with HIV, and we assessed associations between these cancers and sex, age, calendar year, and CD4 cell count using Cox proportional hazards models and adjusted hazard ratios (aHRs).

Findings

We included 782 454 AYA living with HIV (698 066 [89·2%] women) with 1 428 114 person-years of follow-up. Of those, 867 developed incident cancer (incidence rate 60·7 per 100 000 person-years), including 429 who developed Kaposi sarcoma (30·0 per 100 000 person-years), 107 non-Hodgkin lymphoma (7·5 per 100 000 person-years), 48 Hodgkin lymphoma (3·4 per 100 000 person-years), 45 cervical cancer (3·4 per 100 000 woman-years), and 32 leukaemia (2·2 per 100 000 person-years). Kaposi sarcoma was more common in the 20–24 year age group than the 15–19 year age group (aHR 1·39, 95% CI 1·03–1·86). Male sex was associated with higher rates of Kaposi sarcoma (2·06, 1·61–2·63), non-Hodgkin lymphoma (3·17, 2·06–4·89), Hodgkin lymphoma (4·83, 2·61–8·93), and leukaemia (unadjusted HR 5·90, 95% CI 2·87–12·12). Cancer rates decreased over the study period, driven by declining Kaposi sarcoma rates. Lower baseline CD4 cell counts were associated with higher rates of Kaposi sarcoma, cervical cancer, non-Hodgkin lymphoma, and Hodgkin lymphoma, but not leukaemia.

Interpretation

Infection-related cancers were the most common cancer types in AYA living with HIV in South Africa, and their incidence rates increased with lower CD4 cell counts. Therefore, innovative strategies to maintaining high CD4 cell counts are needed to reduce the cancer burden in this vulnerable population.

Funding

US National Institutes of Health and Swiss National Science Foundation.

中文翻译：

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南非感染艾滋病毒的青少年和年轻人的癌症风险：一项全国性队列研究

背景

关于感染 HIV 的青少年和年轻成人（AYA；15-24 岁）癌症的文献很少。我们研究了 2004 年至 2014 年间南非艾滋病病毒感染者 AYA 的癌症发病率。

方法

在这项全国性队列研究中，我们纳入了在 2004 年 1 月 1 日至 2014 年 12 月 31 日期间分别进行了至少两次 HIV 相关实验室测量的 15 至 24 岁个体，并记录在国家健康实验室服务数据库中。我们使用保护隐私的概率记录链接方法来识别最有可能属于同一个人的 HIV 相关实验室记录，然后将这些个人与国家癌症登记处的癌症诊断联系起来。我们计算了携带 HIV 的 AYA 中最常见癌症的发病率，并使用 Cox 比例风险模型和调整后的风险比 (aHRs) 评估了这些癌症与性别、年龄、日历年和 CD4 细胞计数之间的关联。

发现

我们纳入了 782 454 名 AYA 艾滋病病毒感染者（698 066 [89·2%] 名女性），随访时间为 1 428 114 人年。其中，867 人发生癌症（发病率为 60·7/10 万人年），其中 429 人发生卡波西肉瘤（30·0/10 万人年），107 人发生非霍奇金淋巴瘤（7·5/100 000 人年）、48 例霍奇金淋巴瘤（每 10 万人年 3·4 例）、45 例宫颈癌（每 10 万人年 3·4 例）和 32 例白血病（每 10 万人年 2·2 例） . 卡波西肉瘤在 20-24 岁年龄组比 15-19 岁年龄组更常见（aHR 1·39，95% CI 1·03-1·86）。男性与卡波西肉瘤 (2·06, 1·61–2·63)、非霍奇金淋巴瘤 (3·17, 2·06–4·89)、霍奇金淋巴瘤 (4·83, 2 ·61–8·93）和白血病（未经调整的 HR 5·90，95% CI 2·87–12·12）。癌症发病率在研究期间下降，受到卡波西肉瘤发病率下降的推动。较低的基线 CD4 细胞计数与较高的卡波西肉瘤、宫颈癌、非霍奇金淋巴瘤和霍奇金淋巴瘤的发病率相关，但与白血病无关。

解释

感染相关癌症是南非艾滋病病毒感染者 AYA 中最常见的癌症类型，其发病率随着 CD4 细胞计数的降低而增加。因此，需要创新策略来维持高 CD4 细胞计数，以减轻这一弱势群体的癌症负担。

资金

美国国立卫生研究院和瑞士国家科学基金会。