Estimates of the global burden of cervical cancer associated with HIV.
Estimates of the global burden of cervical cancer associated with HIV.
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与艾滋病毒相关的宫颈癌全球负担估计数。
DOI：
10.1016/s2214-109x(20)30459-9
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Dalal S
中科院分区：
文献类型：
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作者：
Stelzle D;Tanaka LF;Lee KK;Ibrahim Khalil A;Baussano I;Shah ASV;McAllister DA;Gottlieb SL;Klug SJ;Winkler AS;Bray F;Baggaley R;Clifford GM;Broutet N;Dalal S
HIV增强人乳头瘤病毒（HPV）诱导的致癌作用。然而，艾滋病毒在人口一级对宫颈癌负担的贡献尚未量化。我们的目的是调查感染艾滋病毒的妇女患宫颈癌的风险，并估计与艾滋病毒相关的全球宫颈癌负担。我们对五个数据库（PubMed、Embase、Global Health [CABI.org]、Web of Science和Global Index Medicus）进行了系统的文献检索和荟萃分析，以确定分析HIV感染与宫颈癌之间关系的研究。我们估计了四大洲（非洲、亚洲、欧洲和北美）感染艾滋病毒的妇女患宫颈癌的合并风险。风险比（RR）与艾滋病规划署对艾滋病毒流行率的国别估计和GLOBOCAN 2018对宫颈癌的估计相结合，以计算宫颈癌妇女中感染艾滋病毒的妇女比例以及艾滋病毒所致宫颈癌的人口归因分数和年龄标准化发病率（ASIR）。24项研究符合我们的纳入标准，其中包括236127名女性艾滋病毒感染者。 感染HIV的女性宫颈癌合并风险增加（RR 6.07，95% CI 4.40 - 8.37）。在全球范围内，2018年5.8%（95%CI 4.6 - 7.3）的新发宫颈癌病例（33000例新发病例，95%CI 26000 - 42000）是在感染艾滋病毒的女性中诊断出来的，4.9%（95%CI 3.6 - 6.4）可归因于艾滋病毒感染（28000例新发病例，20000 - 36000）。 受影响最严重的地区是南部非洲和东部非洲。在南部非洲，63.8%（95%CI 58.9 - 68.1）的宫颈癌妇女（9200例新发病例，95%CI 8500-9800）感染了艾滋病毒，东非27.4%（23.7 - 31.7）的妇女也感染了艾滋病毒（14000例新发病例，12000 - 17000）。 在6个国家，艾滋病毒引起的宫颈癌的ASIR超过每10万人20人，这些国家都在南部非洲和东部非洲。感染艾滋病毒的妇女患宫颈癌的风险显著增加。对感染艾滋病毒的妇女进行HPV疫苗接种和宫颈癌筛查对南部非洲和东部非洲国家尤为重要，因为在这些国家，艾滋病毒引起的宫颈癌负担大大增加了现有的宫颈癌负担。世卫组织、美国国际开发署和美国总统艾滋病紧急救援计划。
HIV enhances human papillomavirus (HPV)-induced carcinogenesis. However, the contribution of HIV to cervical cancer burden at a population level has not been quantified. We aimed to investigate cervical cancer risk among women living with HIV and to estimate the global cervical cancer burden associated with HIV. We did a systematic literature search and meta-analysis of five databases (PubMed, Embase, Global Health [CABI.org], Web of Science, and Global Index Medicus) to identify studies analysing the association between HIV infection and cervical cancer. We estimated the pooled risk of cervical cancer among women living with HIV across four continents (Africa, Asia, Europe, and North America). The risk ratio (RR) was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer to calculate the proportion of women living with HIV among women with cervical cancer and population attributable fractions and age-standardised incidence rates (ASIRs) of HIV-attributable cervical cancer. 24 studies met our inclusion criteria, which included 236 127 women living with HIV. The pooled risk of cervical cancer was increased in women living with HIV (RR 6·07, 95% CI 4·40–8·37). Globally, 5·8% (95% CI 4·6–7·3) of new cervical cancer cases in 2018 (33 000 new cases, 95% CI 26 000–42 000) were diagnosed in women living with HIV and 4·9% (95% CI 3·6–6·4) were attributable to HIV infection (28 000 new cases, 20 000–36 000). The most affected regions were southern Africa and eastern Africa. In southern Africa, 63·8% (95% CI 58·9–68·1) of women with cervical cancer (9200 new cases, 95% CI 8500–9800) were living with HIV, as were 27·4% (23·7–31·7) of women in eastern Africa (14 000 new cases, 12 000–17 000). ASIRs of HIV-attributable cervical cancer were more than 20 per 100 000 in six countries, all in southern Africa and eastern Africa. Women living with HIV have a significantly increased risk of cervical cancer. HPV vaccination and cervical cancer screening for women living with HIV are especially important for countries in southern Africa and eastern Africa, where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden. WHO, US Agency for International Development, and US President's Emergency Plan for AIDS Relief.