Changes in HIV-Related Cervical Cancer Over a Decade in Côte d'Ivoire.
Changes in HIV-Related Cervical Cancer Over a Decade in Côte d'Ivoire.
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DOI：
10.1200/go.21.00006
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发表时间：
2021-05
影响因子：
4.5
通讯作者：
Adoubi I
中科院分区：
文献类型：
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作者：
Jaquet A;Boni S;Tchounga B;Comoe K;Tanon A;Horo A;Diomandé I;Didi-Kouko Coulibaly J;Ekouevi DK;Adoubi I
在过去十年中，撒哈拉以南非洲感染艾滋病毒的妇女在获得浸润性宫颈癌筛查方面取得了重大进展。然而，关于人口一级与艾滋病毒有关的ICC负担变化的信息有限。我们的目标是比较十年来与艾滋病毒有关的ICC，并记录与科特迪瓦ICC妇女艾滋病毒感染相关的因素。2009-2011年和2018-2020年期间，在科特迪瓦阿比让的转诊医院进行了一项重复的横断面研究。被诊断患有ICC的妇女接受了系统的艾滋病毒检测。通过问卷调查收集人口统计学、ICC风险因素、癌症分期（国际妇产科联合会）和HIV特征。比较了这两个时期之间艾滋病毒相关ICC的特征，并通过多变量logistic模型记录了2018-2020年诊断为ICC的女性中与艾滋病毒相关的因素。在2009-2011年和2018-2020年期间，分别有147名和297名ICC妇女被诊断出艾滋病毒感染率估计为24.5%和21.9%（P = .53）。在感染艾滋病毒的妇女中，获得抗逆转录病毒治疗的比例从2.8%增加到73.8%（P < 10−4），CD 4细胞计数中位数从285（IQR，250-441）增加到492（IQR，377-833）个细胞/mm 3（P = 0.03）。在2018-2020年期间诊断为ICC的女性中，HIV感染与较晚的临床分期（国际妇产科联合会I期或II期）（调整后OR，2.2 [95%CI，1.1至4.4]）和通过系统筛查诊断的ICC相关（调整后OR，10.5 [95%CI，2.5至45.5]）。尽管在科特迪瓦，与艾滋病毒有关的ICC的比例一直很高，但艾滋病毒与ICC诊断时的临床分期较低有关。最近在艾滋病毒诊所的ICC筛查服务的改善可能解释这种关联，并支持其在非艾滋病毒卫生设施的实施。
Major improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire. A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model. During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% (P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% (P < 10−4) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm3 (P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]). Despite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities.