HIV infection is associated with an increased risk for lung cancer, independent of smoking
HIV infection is associated with an increased risk for lung cancer, independent of smoking
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DOI：
10.1086/518606
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发表时间：
2007-07-01
影响因子：
11.8
通讯作者：
Engels, Eric A.
中科院分区：
文献类型：
--
作者：
Kirk, Gregory D.;Merlo, Christian;Engels, Eric A.
背景资料。人类免疫缺陷病毒(HIV)感染者患肺癌的风险增加，但这种增加是否仅仅反映了他们大量吸烟仍是一个悬而未决的问题。自1988年以来，获得性免疫缺陷综合征(AIDS)与静脉注射体验研究的联系使用两年一次的临床、实验室和行为数据收集，对马里兰州巴尔的摩的一群注射吸毒者进行了前瞻性观察。通过与国家死亡指数的关联来确定肺癌死亡人数。用COX比例风险回归分析HIV感染对肺癌风险的影响，控制吸烟状况、药物使用和临床变量。在2086名艾滋病与静脉注射经验研究参与者观察了19835人年中，确定了27人死于肺癌；其中14人死于艾滋病毒感染者。除1名(96%)肺癌患者外，其余患者均为吸烟者，平均每天吸烟1.2包。与高效抗逆转录病毒治疗前相比，肺癌死亡率在高效抗逆转录病毒治疗期间有所增加(死亡率比率为4.7；95%可信区间为1.7-16)。在调整了年龄、性别、吸烟状况和日历周期后，HIV感染与肺癌风险增加相关(风险比，3.6；95%可信区间，1.6-7.9)。既往存在的肺部疾病，特别是非传染性疾病和哮喘，显示出肺癌风险增加的趋势。非法药物使用与肺癌风险增加无关。在HIV感染者中，吸烟仍然是主要的危险因素；CD4细胞计数和HIV载量与肺癌风险的增加没有很强的相关性，使用高效抗逆转录病毒治疗的风险增加的趋势并不显著。艾滋病毒感染与患肺癌的风险显著增加有关，与吸烟状况无关。
Background. Human immunodeficiency virus ( HIV)-infected persons have an elevated risk for lung cancer, but whether the increase reflects solely their heavy tobacco use remains an open question.Methods. The Acquired Immunodeficiency Syndrome ( AIDS) Link to the Intravenous Experience Study has prospectively observed a cohort of injection drug users in Baltimore, Maryland, since 1988, using biannual collection of clinical, laboratory, and behavioral data. Lung cancer deaths were identified through linkage with the National Death Index. Cox proportional hazards regression was used to examine the effect of HIV infection on lung cancer risk, controlling for smoking status, drug use, and clinical variables.Results. Among 2086 AIDS Link to the Intravenous Experience Study participants observed for 19,835 person-years, 27 lung cancer deaths were identified; 14 of the deaths were among HIV-infected persons. All but 1 ( 96%) of the patients with lung cancer were smokers, smoking a mean of 1.2 packs per day. Lung cancer mortality increased during the highly active antiretroviral therapy era, compared with the pre-highly active antiretroviral therapy period ( mortality rate ratio, 4.7; 95% confidence interval, 1.7-16). After adjusting for age, sex, smoking status, and calendar period, HIV infection was associated with increased lung cancer risk ( hazard ratio, 3.6; 95% confidence interval, 1.6-7.9). Preexisting lung disease, particularly noninfectious diseases and asthma, displayed trends for increased lung cancer risk. Illicit drug use was not associated with increased lung cancer risk. Among HIV-infected persons, smoking remained the major risk factor; CD4 cell count and HIV load were not strongly associated with increased lung cancer risk, and trends for increased risk with use of highly active antiretroviral therapy were not significant.Conclusions. HIV infection is associated with significantly increased risk for developing lung cancer, independent of smoking status.