HIV-associated malignancies in Tunisia: a 30-year retrospective cohort study from a North African perspective.

IF 3.2 2区医学 Q3 IMMUNOLOGY

Infectious Agents and Cancer Pub Date : 2026-07-14 DOI:10.1186/s13027-026-00779-y

Sarra Yacoub, Manel Ben Selma, Souha Ghachem, Marien Ben Ticha, Hela Knani, Mariem Garma, Taghrid Tlili, Safouene Frini, Badreddine Sriha, Wissem Hachfi

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Abstract

Background: Despite major advances in antiretroviral therapy (ART), HIV-associated malignancies remain a significant cause of morbidity and mortality in low- and middle-income countries. In Tunisia, data on AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) among people living with HIV (PLWH) remain scarce.

Methods: We conducted a descriptive retrospective cohort study over a 30-year period (1994-2024) at Farhat Hached University Hospital, Sousse, Tunisia. All PLWH who developed at least one malignant neoplasm were included. Epidemiological, clinical, immunovirological, pathological, and outcome data were retrospectively collected and analyzed.

Results: Among 655 PLWH followed during the study period, 25 patients with a median age of 36 years developed malignancies, representing 3.8% of all PLWH. 27 malignancies were identified with 2 patients developing 2 distinct malignancies: a Kaposi sarcoma (KS) and a Non-AIDS-defining cancer (NADC). AIDS-defining cancers (ADC) predominated (81.5%), mainly KS (44.4%) and non-Hodgkin lymphoma (33.3%), while NADCs accounted for 18.5%. Cancer and HIV diagnoses were concomitant in 56% of patients (n = 14) and 92% of malignancies occurred within the first year following HIV diagnosis. Most patients presented with advanced immunodeficiency, with median CD4 counts at tumor diagnosis of 73 cells/mm³ for ADCs and 57 cells/mm³ for NADCs. Median overall survival was 1.9 years for ADCs and 3.7 years for NADCs.

Conclusions: In this North African cohort, HIV-associated malignancies were predominantly AIDS-defining and affected young adults with advanced immunosuppression, reflecting late HIV diagnosis for PLWH developing malignancies. Beyond strengthening early HIV testing and timely ART initiation, targeted patient education focusing on high-risk behaviors, along with efforts to reduce HIV-related stigma, are essential components to improve cancer prevention, early diagnosis, and outcomes among PLWH in resource-limited settings.

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突尼斯hiv相关恶性肿瘤：一项北非视角的30年回顾性队列研究

背景：尽管抗逆转录病毒疗法（ART）取得了重大进展，但艾滋病毒相关恶性肿瘤仍然是低收入和中等收入国家发病率和死亡率的重要原因。在突尼斯，关于艾滋病毒感染者中艾滋病定义癌症（adc）和非艾滋病定义癌症（NADCs）的数据仍然很少。方法：我们在突尼斯苏塞Farhat Hached大学医院进行了一项为期30年（1994-2024）的描述性回顾性队列研究。所有发生至少一种恶性肿瘤的PLWH均被纳入研究。回顾性收集和分析流行病学、临床、免疫病毒学、病理学和结局资料。结果：在研究期间随访的655例PLWH中，25例患者发生恶性肿瘤，中位年龄36岁，占所有PLWH的3.8%。27例恶性肿瘤被确定，2例患者发展为2种不同的恶性肿瘤：卡波西肉瘤（KS）和非艾滋病定义癌（NADC）。aids定义癌（ADC）占主导地位（81.5%），主要是KS（44.4%）和非霍奇金淋巴瘤（33.3%），NADCs占18.5%。56%的患者（n = 14）同时患有癌症和艾滋病毒，92%的恶性肿瘤发生在艾滋病毒诊断后的第一年。大多数患者表现为晚期免疫缺陷，adc的中位CD4计数为73个细胞/mm³，NADCs为57个细胞/mm³。adc的中位总生存期为1.9年，NADCs为3.7年。结论：在这个北非队列中，HIV相关的恶性肿瘤主要是艾滋病定义和影响晚期免疫抑制的年轻人，反映了PLWH发展为恶性肿瘤的HIV诊断较晚。除了加强早期艾滋病毒检测和及时启动抗逆转录病毒治疗外，有针对性地对患者进行高危行为教育，并努力减少与艾滋病毒相关的耻辱感，是在资源有限的环境中改善艾滋病预防、早期诊断和艾滋病毒感染者卫生服务结果的重要组成部分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infectious Agents and Cancer ONCOLOGY-IMMUNOLOGY

CiteScore

5.80

自引率

2.70%

发文量

期刊介绍： Infectious Agents and Cancer is an open access, peer-reviewed online journal that encompasses all aspects of basic, clinical, epidemiological and translational research providing an insight into the association between chronic infections and cancer. The journal welcomes submissions in the pathogen-related cancer areas and other related topics, in particular: • HPV and anogenital cancers, as well as head and neck cancers; • EBV and Burkitt lymphoma; • HCV/HBV and hepatocellular carcinoma as well as lymphoproliferative diseases; • HHV8 and Kaposi sarcoma; • HTLV and leukemia; • Cancers in Low- and Middle-income countries. The link between infection and cancer has become well established over the past 50 years, and infection-associated cancer contribute up to 16% of cancers in developed countries and 33% in less developed countries. Preventive vaccines have been developed for only two cancer-causing viruses, highlighting both the opportunity to prevent infection-associated cancers by vaccination and the gaps that remain before vaccines can be developed for other cancer-causing agents. These gaps are due to incomplete understanding of the basic biology, natural history, epidemiology of many of the pathogens that cause cancer, the mechanisms they exploit to cause cancer, and how to interrupt progression to cancer in human populations. Early diagnosis or identification of lesions at high risk of progression represent the current most critical research area of the field supported by recent advances in genomics and proteomics technologies.