Age and Cancer Incidence in 5.2 Million People With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study

Abstract

Background Old age is an important risk factor for developing cancer, but few data exist on this association in people with HIV (PWH) in sub-Saharan Africa. Methods The South African HIV Cancer Match study is a nationwide cohort of PWH based on a linkage between HIV-related laboratory records from the National Health Laboratory Services and cancer diagnoses from the National Cancer Registry for 2004-2014. We included PWH who had HIV-related tests on separate days. Using natural splines, we modelled cancer incidence rates as a function of age. Results We included 5,222,827 PWH with 29,580 incident cancer diagnoses – most commonly cervical cancer (n = 7418), Kaposi sarcoma (n = 6380), and breast cancer (n = 2748). In young PWH, the incidence rates for infection-related cancers were substantially higher than for infection-unrelated cancers. At age 40 years, the most frequent cancer was cervical cancer in female and Kaposi sarcoma in male PWH. Thereafter, the rates of infection-unrelated cancers increased steeply, particularly among male PWH, where prostate cancer became the most frequent cancer type at older age. While Kaposi sarcoma rates peaked at 34 years (101/100,000 person-years) in male PWH, cervical cancer remained the most frequent cancer among older female PWH. Conclusions Infection-related cancers are common in PWH in South Africa, but rates of infection-unrelated cancers overtook those of infection-related cancers after age 54 years in the overall study population. As PWH in South Africa live longer, prevention and early detection of infection-unrelated cancers becomes increasingly important. Meanwhile, control strategies for infection-related cancers, especially cervical cancer, remain essential.

Global and regional estimates of cervical cancer burden associated with human immunodeficiency virus infection from 1990 to 2019

“…This is consistent with the findings of Stelzle et al, who reported that women accounted for the majority of cervical cancer cases associated with HIV in Eastern and Southern Africa in 2018 3 . Cervical cancer is categorized as an AIDS‐defining illness, and it is more prevalent in women living with HIV, particularly in South Africa 24 . Studies has reported that more than half of women infected with HIV live in the East and South Africa, 25 and a maximum HPV prevalence ~20% in Africa females 26 .…”

“…3 Cervical cancer is categorized as an AIDS-defining illness, and it is more prevalent women living with HIV, particularly in South Africa. 24 Studies has reported that more than half of women infected with HIV live in the East and South Africa, 25 and a maximum HPV prevalence ~20% in Africa females. 26 As a result, the Eastern and Southern Africa region was responsible for nearly 30% of all DALYs related to cervical cancer and attributable to HIV.…”

Global and Regional Estimate of HIV-Associated Stroke Burden: A Meta-Analysis and Population Attributable Modeling Study

“…32 Besides South Africa shouldering the heaviest burden of HIV-related stroke, the South African HIV Cancer Match study indicated that infection-related cancers (eg, cervical cancer, Kaposi sarcoma, and breast cancer) are common in PLWH. 33 Hence, the prevention and early detection of HIV-associated disease has become increasingly important in South Africa.…”

State of the science and future directions for research on HIV and cancer: Summary of a joint workshop sponsored by IARC and NCI

“…Populations of PLWH accessing ART worldwide are aging, and there is an increasing burden of a range of cancers among PLWH, even in the setting of declining cancer incidence rates 16,17 . Shifts toward aging‐associated cancers (eg, prostate, breast and colorectal cancers) have already been observed in countries with early introduction of ART, and the impact of aging on cancer risk in countries with younger populations of PLWH will become apparent in the coming years 18 …”

“…16,17 Shifts toward aging-associated cancers (eg, prostate, breast and colorectal cancers) have already been observed in countries with early introduction of ART, and the impact of aging on cancer risk in countries with younger populations of PLWH will become apparent in the coming years. 18 Large studies of PLWH followed over time are critical to quantify cancer incidence and mortality trends, and to understand what is driving cancer risks and outcomes to identify means of prevention and optimize treatment. Data linkages with records from data warehouses, disease registries, cohort studies and serial cross-sectional studies T A B L E 1 Cancer sites for which HIV is considered by IARC in 2009 to be a carcinogen with "sufficient" or "limited" evidence.…”