Cancer risk among adolescents and young adults living with HIV in South Africa: a national cohort study

  1. Yann Ruffieux
  2. Tafadzwa Dhokotera
  3. Mazvita Muchengeti
  4. Lina Bartels
  5. Victor Olago
  6. Julia Bohlius
  7. Elvira Singh
  8. Matthias Egger
  9. Eliane Rohner

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Abstract

Background: We studied the incidence of and risk factors for various types of cancers in adolescents and young adults living with HIV (AYALWH) in South Africa between 2004 and 2014. Methods: We included individuals aged 15 to 24 years from the South African HIV Cancer Match study, a large cohort resulting from a linkage between HIV-related laboratory measurements from the National Health Laboratory Services and records from the National Cancer Registry. We computed incidence rates for the most common cancers. We assessed associations between these cancers and sex, age, calendar year, and CD4 cell count using Cox models and adjusted hazard ratios (aHR).Findings: We included 782,454 AYALWH (89% female). Of those, 867 developed incident cancer including 429 who developed Kaposi sarcoma, 107 non-Hodgkin lymphoma, 48 Hodgkin lymphoma, 45 cervical cancer, and 32 leukaemia. Kaposi sarcoma was more common in the 20-24 year age group than the 15-19 year age group (aHR 1.39, 95% CI 1.03-1.86). Male sex was associated with higher rates of Kaposi sarcoma (aHR 2.06, 95% CI 1.61-2.63), non-Hodgkin lymphoma (aHR 3.17, 95% CI 2.06-4.89), Hodgkin lymphoma (aHR 4.83, 95% 2.61-8.93), and leukaemia (aHR 5.90, 95% CI 2.87-12.1). Lower CD4 cell counts at baseline were associated with higher rates of Kaposi sarcoma, cervical cancer, non-Hodgkin and Hodgkin lymphoma.Interpretation: Infection-related cancers are the most common cancer types among AYALWH in South Africa. The burden of these cancers may be reduced through HPV vaccination, targeted HIV testing, early initiation of antiretroviral therapy, and improvement of treatment adherence.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/7145372.

    This full PREreview is the result of a live-streamed preprint journal club organized and hosted by AfricArXiv, Eider Africa, eLife, PREreview, and Training Center in Communication Africa as part of the Open Peer Reviewers in Africa workshop training.

    An important study has been conducted by the authors at a time when many developing countries face challenges in the medical field due to limited access to technologies. This was a study from the National Health Laboratory Services (NHLS) and the pathology-based national Cancer Registry (NCR) records for 2004-2014 carried out to investigate the incidence and risk factor of various types of cancer in adolescence and young adults living with HIV in South Africa (correlation between cancer and HIV). This study adopted the privacy-preserving probabilistic record linkage methods to first identify HIV-related laboratory records most likely belonged to the same individual. The researchers further linked these individuals to cancer diagnoses from the NCR. The primary aim of this study was to investigate the risk factor of cancer in HIV infected individuals within the ages of 15-24 years in South Africa. The study finds that Kaposi sarcoma was more prevalent in the age group 20-24 years than the 15- 19 years and the higher age groups have a higher prevalence of cervical cancer. The authors therefore concluded that infection - related cancers were the most common type of cancer occurring in adolescents. They recommend that innovative strategies are needed to encourage early ART initiation and enhance treatment adherence in adolescents and young adults living with HIV.

    Lists of major issues and feedback

    The reviewers believe that addressing the following major issues would significantly strengthen the conclusion of the study:

    • The data presented by this study might not reflect the actual situation. The reviewers are suggesting the possibility of the number of young people living with HIV might actually be much higher than reported due to the exclusion of individuals without information on sex and age from the study. We encourage authors to consider and possibly include the number of individuals without information on sex and age inorder to ascertain if it does not in any way skew the analysis of data reported. 

    •  The data used for this study are not recent and might not be appropriate to justify results in recent time. We recommend the authors to consider the data within the last 8 years.

    • We understand by the authors that age is the only predisposing factor to cancer in adolescents and young adults in South Africa between 2004-2014 from their study. We proposed that other factors should be mentioned such as the patient's lifestyle etc.

    • To further improve the manuscript, the authors could organize the writeup using the format that clearly outlines different sections accordingly; 'Abstract, Introduction, Methods, Results, Discussion and Acknowledgement' to make their write up readable and enjoyable.

    Lists of minor issues and feedback

    • Abbreviations of words were not consistent, for example ALYALWH instead of AYALWH. We recommend authors to proofread their write up and maintain abbreviations for easy understanding.

    • The introduction needs more background information.The introduction of this report will be more enlightening if more literature review is added.

    • The format for the presentation of figures was not followed. The title for figures should be below the figures not above.

    • Typographical errors such as the format of dating should be looked into. For example, 25th not 25th as the latter is used in positions but not dates.

    • The text in the figure wasn't clear enough. The figure should be made clear to understand the information in it.

    We thank the authors for sharing their work as a preprint. We hope our feedback above will be helpful as they consider any revisions to the manuscript or future lines of work.

    Competing interests

    The author declares that they have no competing interests.

  2. Version published to 10.31730/osf.io/xq6jh on OSF Preprints