Mortality after cancer diagnosis in HIV-infected individuals treated with antiretroviral therapy.
Mortality after cancer diagnosis in HIV-infected individuals treated with antiretroviral therapy.
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DOI：
10.1097/qad.0b013e3283437f77
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发表时间：
2011-03-13
期刊：
影响因子：
--
通讯作者：
Saag MS
中科院分区：
文献类型：
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作者：
Achenbach CJ;Cole SR;Kitahata MM;Casper C;Willig JH;Mugavero MJ;Saag MS
评估接受联合抗逆转录病毒治疗 (cART) 的 HIV 感染者癌症诊断后的生存率和死亡率预测因素。多地点队列研究。我们检查了 1996 年至 2009 年间在美国八个地点接受 cART 常规护理并诊断出患有癌症的 HIV 感染患者的全因死亡率，并使用 Cox 比例风险回归模型进行了死亡率预测。非艾滋病定义的癌症（NADC）被分为与病毒合并感染相关和无关的癌症。在艾滋病研究中心综合临床系统队列的 20,677 人中，有 650 人接受了 cART 治疗，患上了侵袭性癌症。其中，305 人在 1480 人年的随访期间死亡；粗死亡率为每 100 人年 20.6 例 [95% 置信区间 (CI) 18.4, 23.1]，总体 2 年生存率为 58% (95% CI 54, 62)。原发性中枢神经系统非霍奇金淋巴瘤、肝癌和肺癌死亡率最高，分别为每 100 人年 90.6 例、84.3 例和 68.1 例。年龄较大且患有 IV 期癌症的人的调整后死亡风险较高。与感染无关的 NADC 相比，癌症诊断时 CD4 细胞计数较高、通过 cART 实现 HIV-RNA 抑制（≤ 400 拷贝/ml）、接受过任何癌症治疗、患有艾滋病定义癌症或感染相关 NADC 的患者的调整后死亡风险较低。 HIV 感染者癌症诊断后死亡率的独立预测因素包括免疫状态不佳、cART 未能抑制 HIV-RNA、癌症分期以及缺乏癌症治疗。需要通过改进艾滋病毒和艾滋病毒相关恶性肿瘤的预防和治疗策略来改变这些因素。
To evaluate survival and predictors of mortality after cancer diagnosis among HIV-infected persons receiving combination antiretroviral therapy (cART). Multisite cohort study. We examined all-cause mortality among HIV-infected patients treated with cART in routine care at eight US sites and diagnosed with cancer between 1996 and 2009, and predictors of mortality using Cox proportional hazards regression models. Non-AIDS-defining cancers (NADCs) were classified as related and unrelated to viral coinfections. Out of 20 677 persons in the Centers for AIDS Research Network of Integrated Clinical Systems cohort, 650 cART-treated individuals developed invasive cancer. Of these, 305 died during 1480 person-years of follow-up; crude mortality rate was 20.6 per 100 person-years [95% confidence interval (CI) 18.4, 23.1] and overall 2-year survival was 58% (95% CI 54, 62). Highest mortality was seen in primary central nervous system non-Hodgkin’s lymphoma, liver, and lung cancer with rates of 90.6, 84.3, and 68.1 per 100 person-years, respectively. Adjusted hazard of death was higher among those who were older and had stage IV cancer. Adjusted hazard of death was lower among those with higher CD4 cell counts at cancer diagnosis, who achieved HIV-RNA suppression (≤400 copies/ml) on cART, received any cancer treatment, and had AIDS-defining cancer or infection-related NADCs compared to infection-unrelated NADCs. Independent predictors of mortality after cancer diagnosis among HIV-infected persons include poor immune status, failure to suppress HIV-RNA on cART, cancer stage, and lack of cancer treatment. Modification of these factors with improved strategies for the prevention and treatment of HIV and HIV-associated malignancies are needed.