Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study

Abstract

Objective: To determine the spectrum of cancers in AYAs living with HIV in South Africa compared to their HIV negative peers. Design: Cross sectional study with cancer data provided by the National Cancer Registry and HIV data from the National Health Laboratory Service. Setting and participants: The NHLS is the largest provider of pathology services in the South African public sector with an estimated coverage of 80%. The NCR is a division of the NHLS. We included AYAs (aged 10-24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8 479). We included 3 672 in the complete case analysis. Primary and secondary outcomes: We used linked NCR and NHLS data to determine the spectrum of cancers by HIV status in AYAs. We also used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex (as appropriate), ethnicity, and calendar period. Due to the large proportion of unknown HIV status we also imputed (post-hoc) the missing HIV status. Results: From 2004-2014, 8 479 AYAs were diagnosed with cancer, HIV status was known for only 45% (n=3812); of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi's sarcoma (adjusted odds ratio (aOR) 218, 95% CI 89.9-530), cervical cancer (aOR 2.18, 95% CI 1.23-3.89), non-Hodgkin's lymphoma (aOR 2.12, 95% CI 1.69-2.66), and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27-5.86). About 44% (n=1 062) of AYAs with HIV related cancers had not been tested for HIV, though they were very likely to have the disease. Conclusions: Cancer burden in AYAs living with HIV in South Africa could be reduced by screening young women for cervical cancer and vaccinating them against human papilloma virus (HPV) infection.

Emerging Patterns and Current Trends of AIDS Defining and Non-AIDS Defining Malignancies in HIV Infected Individuals from a Tertiary Care Center in South India

“…Thus it is recommended that this unique cohort of young patients must be diagnosed at the earliest and started on ART therapy and that access to HPV and HBV vaccination as well as individualized cancer screening facilities should be provided in their multidisciplinary services. 22,23 None Authors' contributions Authors contributed to the manuscript in the following ways: study concept and design (CSP,SRS,RM); acquisition, analysis, and interpretation of the data (CSP,SRS,JTR,SR,RM); drafting the manuscript (CSP,SRS); critical revision of the manuscript for important intellectual content (all authors); statistical analysis (CSP,SRS); administrative, technical, or material support (all authors); and study supervision (all authors). All authors have read and approved the nal manuscript.…”