Elvira Singh1, Gita Naidu, Mary-Ann Davies, Julia Bohlius. 1. aNational Cancer Registry, National Health Laboratory Service bPaediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa cCentre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa dInstitute of Social and Preventive Medicine, University of Bern, Switzerland.
Abstract
PURPOSE OF REVIEW: HIV-infected children are at an increased risk of developing cancer. Many of the cancers in HIV-infected children are linked to immunosuppression and oncogenic coinfections. Worldwide most HIV-infected children live in sub-Saharan Africa, but cancer data for this population are scarce. In this article, we review the current literature on the epidemiology and prevention of cancer in HIV-infected children. RECENT FINDINGS: Combined antiretroviral therapy (cART) reduces the risk of developing cancer in HIV-infected children. Cancer risk remains increased in children who start cART at older ages or more advanced immunosuppression as compared with children who start cART at younger age and with mild immunosuppression. Starting cART before severe immunosuppression develops is key to prevent cancer in HIV-infected children but most children in low-income countries start cART at severe immunosuppression levels. Vaccination against high-risk variants of human papillomavirus may protect again human papillomavirus-associated cancer later in life. However, tailoring of human papillomavirus vaccination guidelines for HIV-infected children and young women awaits answers to determine the best vaccination strategies. SUMMARY: Better data on the short-term and long-term risks of developing cancer and the effects of preventive measures in HIV-infected children from regions with high burden of HIV/AIDS are urgently needed.
PURPOSE OF REVIEW: HIV-infectedchildren are at an increased risk of developing cancer. Many of the cancers in HIV-infectedchildren are linked to immunosuppression and oncogenic coinfections. Worldwide most HIV-infectedchildren live in sub-Saharan Africa, but cancer data for this population are scarce. In this article, we review the current literature on the epidemiology and prevention of cancer in HIV-infectedchildren. RECENT FINDINGS: Combined antiretroviral therapy (cART) reduces the risk of developing cancer in HIV-infectedchildren. Cancer risk remains increased in children who start cART at older ages or more advanced immunosuppression as compared with children who start cART at younger age and with mild immunosuppression. Starting cART before severe immunosuppression develops is key to prevent cancer in HIV-infectedchildren but most children in low-income countries start cART at severe immunosuppression levels. Vaccination against high-risk variants of human papillomavirus may protect again human papillomavirus-associated cancer later in life. However, tailoring of human papillomavirus vaccination guidelines for HIV-infectedchildren and young women awaits answers to determine the best vaccination strategies. SUMMARY: Better data on the short-term and long-term risks of developing cancer and the effects of preventive measures in HIV-infectedchildren from regions with high burden of HIV/AIDS are urgently needed.
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