Cancer spectrum in HIV-infected patients: A zonal hospital experience in Tanzania.
Cancer spectrum in HIV-infected patients: A zonal hospital experience in Tanzania.
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DOI：
10.1016/j.ctarc.2020.100213
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发表时间：
2020
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尽管坦桑尼亚感染人类免疫缺陷病毒(HIV)的负担很重，但有关艾滋病毒感染患者癌症的数据有限。我们的目标是确定在坦桑尼亚一家地区性医院接受护理的艾滋病毒感染患者的癌症谱和患病率。对2009年至2019年艾滋病毒感染者和癌症患者的临床记录进行识别和回顾。共招募了3398名HIV感染患者，中位年龄为37岁(IQR为28-46岁)。9%的患者在参加艾滋病毒临床护理后被诊断为癌症，患病率从2009年至2013年的3.2%上升到2017年至2019年的17.3%(pValue<；0.0001)。大多数人(85.9%)在癌症诊断期间接受抗逆转录病毒治疗(ART)。艾滋病定义癌症的比例为28%，非艾滋病定义癌症的比例为72%。卡波西肉瘤是最常见的艾滋病定义癌症(13.2%)，食道癌是最常见的非艾滋病定义癌症(11.1%)。CD_4~+T细胞计数中位数为415(IQR197~680)Cells/μL；确诊时CD_4~+T细胞计数<200cell/μ的患者中有556例(25.7%)处于晚期免疫抑制状态。非艾滋病定义的癌症比艾滋病定义的癌症更常见，这表明由于接受抗逆转录病毒治疗，寿命延长。艾滋病毒感染患者的癌症患病率为9%，随着时间的推移有增加的趋势；强调在这一脆弱人群中促进癌症筛查的重要性。
Although the burden of human immunodeficiency virus (HIV) infection in Tanzania is high, limited data are available on cancers in HIV-infected patients. We aimed to determine the spectrum and prevalence of cancers in HIV-infected patients attending care at a zonal hospital in Tanzania. Clinical records of patients with HIV and cancer from 2009 to 2019 were identified and retrospectively reviewed. A total of 3398 HIV-infected patients were recruited with median age of 37 years (Inter quartile range (IQR) 28–46 years). Cancer was diagnosed in 9% of the patients after enrollment into HIV clinical care, with an increasing prevalence from 3.2% between years 2009 and 2013 to 17.3% between years 2017 and 2019 (p value <0.0001). Majority (85.9%) were on antiretroviral therapy (ART) during the time of cancer diagnosis. The proportions of acquired immunodeficiency syndrome (AIDS)-defining cancers and non-AIDS defining cancers were 28% and 72% respectively. Kaposi’s sarcoma was the most common (13.2%) AIDS-defining cancer while esophageal cancer was the most common (11.1%) non-AIDS defining cancer. The median CD4+ T-cell count was 415 (IQR 197–680) cells/μl; and 556 (25.7%) patients had advanced immunosuppression with CD4 count less than 200 cells/μl at the time of diagnosis. Non-AIDS defining cancers were much more common than AIDS-defining cancers suggesting increased longevity due to ART access. The prevalence of cancer among HIV-infected patients was 9% with an increasing trend over time; highlight the importance of promoting cancer screening in this vulnerable population.