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

Dhokotera, Tafadzwa; Bohlius, Julia; Egger, Matthias; Spoerri, Adrian; Ncayiyana, Jabulani Ronnie; Naidu, Gita; Olago, Victor; Zwahlen, Marcel; Singh, Elvira; Muchengeti, Mazvita (2021). Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study. BMJ open, 11(10), e043941. BMJ Publishing Group 10.1136/bmjopen-2020-043941

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OBJECTIVE

To determine the spectrum of cancers in adolescents and young adults (AYAs) living with and without HIV in South Africa.

DESIGN

Cross-sectional study with cancer records provided by the National Cancer Registry (NCR) and HIV records from the National Health Laboratory Service (NHLS).

SETTING AND PARTICIPANTS

The NHLS is the largest provider of pathology services in the South African public sector. 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=8479). HIV status was obtained through record linkages and text mining.

PRIMARY AND SECONDARY OUTCOMES

We determined the spectrum of cancers by HIV status in AYAs. We used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex, ethnicity and calendar period. We imputed (post hoc) the HIV status for AYA with unknown HIV status.

RESULTS

8479 AYAs were diagnosed with cancer, HIV status was known for 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 OR (aOR) 218, 95% CI 89.9 to 530), cervical cancer (aOR 2.18, 95% CI 1.23 to 3.89), non-Hodgkin's lymphoma (aOR 2.12, 95% CI 1.69 to 2.66) and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27 to 5.86) than AYAs without HIV. About 44% (n=1062) of AYAs with HIV-related cancers had not been tested for HIV.

CONCLUSIONS

Targeted HIV testing for AYAs diagnosed with cancer, followed by immediate start of antiretroviral therapy, screening for cervical precancer and vaccination against human papilloma virus is needed to decrease cancer burden in AYAs living with HIV in South Africa.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Dhokotera, Tafadzwa Gladys; Bohlius, Julia Friederike; Egger, Matthias; Spörri, Adrian and Zwahlen, Marcel

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2044-6055

Publisher:

BMJ Publishing Group

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Beatrice Minder Wyssmann

Date Deposited:

20 Oct 2021 16:15

Last Modified:

22 Oct 2021 15:59

Publisher DOI:

10.1136/bmjopen-2020-043941

PubMed ID:

34663647

Uncontrolled Keywords:

HIV & AIDS adolescents epidemiology public health young adults

BORIS DOI:

10.48350/160223

URI:

https://boris.unibe.ch/id/eprint/160223

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