携带艾滋病毒将增强患宫颈癌的风险

Background: Human papillomavirus (HPV)-induced tumors can be enhanced by human immunodeficiency virus (HIV). However, the impact of HIV on cervical cancer has not yet been quantified. We aimed to investigate the risk of cervical cancer among HIV-infected women and estimate the global HIV-related cervical cancer burden.

Methods We conducted a systematic literature search and analysis of five databases (PubMed, Embase, Global Health [CABI.org], Web of Science, and Global Index Medicus) to identify studies analyzing the association between HIV infection and cervical cancer. We estimated the combined risk of cervical cancer among HIV-infected women from four continents: Africa, Asia, Europe, and North America. Risk ratios (RRs) were 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, as well as population-attributable fractions and age-standardized incidence rates (ASIRs) of HIV-attributable cervical cancer.

Findings: Twenty-four studies met our inclusion criteria, including 236,127 HIV-infected women. HIV-infected patients had an increased combined risk of cervical cancer (rr 6.07, 95% CI 4.40-8.37). Globally, 5.8% of new cervical cancer cases in 2018 were HIV-positive, and 4.9% were attributed to HIV infection (28,000 new cases, 20,000-36,000). The most affected regions are southern and eastern Africa. In Southern Africa, 63.8% of women with cervical cancer are HIV-positive, as is 27.4% of women in Eastern Africa. In six countries, HIV-caused cervical cancer ASIRs exceeded 20%, all in southern and eastern Africa.

Conclusion: HIV-infected women have a significantly increased risk of cervical cancer. HPV vaccination and cervical cancer screening for HIV-infected women are particularly important for countries in southern and eastern Africa, where a large HIV-caused cervical cancer burden adds to the existing cervical cancer burden.

Reference: Estimates of the global burden of cervical cancer associated with HIV