Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study.
Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study.
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DOI：
10.1016/s2352-3018(17)30125-x
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Engels EA
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文献类型：
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作者：
Hernández-Ramírez RU;Shiels MS;Dubrow R;Engels EA
在现代抗逆转录病毒疗法(ART)时代，监测艾滋病毒感染者的癌症风险至关重要，因为他们患多种癌症的风险增加，而且由于免疫抑制、ART暴露和衰老而延长了生存时间。我们的研究描述了美国艾滋病毒感染者相对于普通人群的癌症风险。利用关联的基于人群的艾滋病毒和癌症登记处(9个地区；1996-2012年)的数据，我们计算了标准化发病率比(SIRS)。我们使用泊松回归检验了SIR在艾滋病状态和随时间变化方面的差异。在448,258名HIV感染者中，总体癌症(SIR 1·69；95%CI：1·67-1·72)、艾滋病定义癌症(卡波西肉瘤[498；478-519]、非霍奇金淋巴瘤[11·5；11·1-11·9]和宫颈癌[3·24；2·94-3·56])、大多数其他与病毒有关的癌症(例如，肛门[19·1；18·1-20·0]、肝脏[3·21；3·02-3·41]和霍奇金淋巴瘤[7·70；7·20-8·23])，以及一些与病毒无关的癌症(如肺癌[1·97；1·89-2·05])，但不包括其他常见癌症。在艾滋病发作后，患几种癌症的风险较高，并在不同日历时期呈下降趋势。在多变量调整后，6种癌症(Kaposi肉瘤、两种非霍奇金淋巴瘤亚型、肛门、肝脏和肺癌)的SIR在1996-2012年间显著下降，但在最近一段时间保持升高。对于任何癌症，SIRS没有随着时间的推移而增加。在艾滋病毒感染者中，几种与病毒相关的癌症和肺癌的风险下降，这可能反映了自1996年以来抗逆转录病毒治疗的扩大。尽管有所下降，但在现代治疗时代，许多癌症的风险仍然很高。美国国家癌症研究所。
Monitoring cancer risk among HIV-infected people in the modern antiretroviral therapy (ART) era is critical given their elevated risk for many cancers and prolonged survival with immunosuppression, ART exposure, and aging. Our study described cancer risk in HIV-infected people in the United States relative to the general population. Utilizing data from linked population-based HIV and cancer registries (nine areas; 1996–2012), we calculated standardized incidence ratios (SIRs). We tested SIR differences by AIDS status and over time using Poisson regression. Among 448,258 HIV-infected people, risk was elevated (p<0·0001) for cancer overall (SIR 1·69; 95%CI: 1·67–1·72), AIDS-defining cancers (Kaposi sarcoma [498; 478–519], non-Hodgkin lymphoma [11·5; 11·1–11·9], and cervix [3·24; 2·94–3·56]), most other virus-related cancers (e.g., anus [19·1; 18·1–20·0], liver [3·21; 3·02–3·41], and Hodgkin lymphoma [7·70; 7·20–8·23]), and some virus-unrelated cancers (e.g., lung [1·97; 1·89–2·05]), but not for other common cancers. Risk for several cancers was higher after AIDS onset and declined across calendar periods. After multivariable adjustment, SIRs decreased significantly across 1996–2012 for six cancers (Kaposi sarcoma, two non-Hodgkin lymphoma subtypes, anus, liver, and lung) but remained elevated in the latest period. SIRs did not increase over time for any cancer. Risks for several virus-related cancers and lung cancer declined among HIV-infected people, likely reflecting ART expansion since 1996. Despite declines, risk for many cancers remain elevated in the modern treatment era. National Cancer Institute.