Background: With a high human immunodeficiency virus (HIV) adult prevalence, people living with HIV (PLHIV) in Botswana continue to experience a high burden of comorbid HIV and cancer. We sought to investigate the trends of acquired immunodeficiency syndrome (AIDS) defining cancers (ADCs), non-AIDS defining cancers (NADCs), and associated risk factors in PLHIV compared with those without HIV.Methods: We analyzed data from adults aged ≥18 years reported in Botswana National Cancer Registry and National Data Warehouse. The crude, age-standardized incidence rate (ASIR), standardized incidence ratios (SIRs) of cancers and time trends were computed. Risk factors were determined using the Cox-regression model.Results: Over a 30-year period, 27,726 cases of cancer were documented. Of these, 13,737 (49.5%) were PLHIV and 3505 (12.6%) were people without HIV and 10,484 (37.8%) had an unknown HIV status. Compared to the HIV-uninfected, the PLHIV had higher and increasing trends in the cancer incidence overall during the study period (from 44.2 to 1047.6 per 100,000;p-trend < 0.001) versus (from 1.4 to 27.2 per 100,000;p-trend < 0.001). The ASIRs also increased in PLHIV for overall ADCs, NADCs and other sub-types like cervical, lung, breast, and conjunctiva cancers (p-trend < 0.001). Further, PLHIV had elevated SIRs for cervical cancer, Kaposi sarcoma in males and some NADCs. The most common risk factors were HIV infection and female sex for ADCs incidence and advanced age and being HIV-uninfected for NADCs incidence.Conclusions:Increasing trends of ADCs and NADCs during ART expansion were observed among PLHIV compared to those without HIV highlighting a greater need for targeted effective prevention and screening strategies including the provision of access to timely HIV and cancer treatment.
背景：博茨瓦纳成人艾滋病病毒感染率较高，艾滋病病毒感染者（PLHIV）持续面临艾滋病与癌症共病的沉重负担。本研究旨在比较艾滋病病毒感染者与非感染者中艾滋病定义性癌症（ADCs）、非艾滋病定义性癌症（NADCs）的流行趋势及相关风险因素。 方法：我们分析了博茨瓦纳国家癌症登记处和国家数据仓库中记录的18岁及以上成年人的数据。计算了癌症的粗发病率、年龄标准化发病率（ASIR）、标准化发病比（SIRs）及时间趋势。使用Cox回归模型确定风险因素。 结果：在30年期间，共记录了27,726例癌症病例。其中，13,737例（49.5%）为艾滋病病毒感染者，3,505例（12.6%）为非感染者，10,484例（37.8%）的艾滋病病毒感染状况未知。与非感染者相比，研究期间艾滋病病毒感染者的总体癌症发病率更高且呈上升趋势（从44.2/10万增至1047.6/10万；趋势p值<0.001），而非感染者则从1.4/10万增至27.2/10万（趋势p值<0.001）。在艾滋病病毒感染者中，总体ADCs、NADCs以及宫颈癌、肺癌、乳腺癌和结膜癌等亚型的ASIR均有所上升（趋势p值<0.001）。此外，艾滋病病毒感染者的宫颈癌、男性卡波西肉瘤以及部分NADCs的SIRs升高。最常见的风险因素是：对于ADCs发病为艾滋病病毒感染和女性性别；对于NADCs发病为高龄和非艾滋病病毒感染状态。 结论：在抗逆转录病毒治疗推广期间，与非感染者相比，艾滋病病毒感染者的ADCs和NADCs均呈上升趋势，这凸显了更有针对性的有效预防和筛查策略的迫切需求，包括提供及时的艾滋病和癌症治疗机会。
肿瘤(癌症)患者之家