Non-AIDS definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era.
Non-AIDS definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era.
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DOI：
10.5501/wjv.v4.i3.209
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发表时间：
2015-08-12
期刊：
影响因子：
--
通讯作者：
Raise, Enzo
中科院分区：
文献类型：
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作者：
Brugnaro, Pierluigi;Morelli, Erika;Raise, Enzo
自1996年以来，在工业化国家广泛提供了治疗人类免疫缺陷病毒（HIV）感染的高效抗逆转录病毒疗法（HAART）；它的广泛使用决定了获得性免疫缺陷综合症（艾滋病）相关死亡率的急剧下降，因此，艾滋病定义癌症的显著减少。然而，艾滋病毒感染患者的平均年龄增加，长期暴露于环境和生活方式癌症风险因素，以及与致癌病毒的共同感染，导致了其他恶性肿瘤的出现，这些恶性肿瘤被认为是非艾滋病定义性癌症（NADCs），在采用HAART治疗20年后，艾滋病毒感染者的发病率和死亡率中占相关比例。免疫抑制在NADCs发病机制中的作用尚不明确，未来的研究应进一步探讨NADCs的病因。在过去几年中，越来越多的证据表明，在继续HAART治疗的同时，对艾滋病毒阳性患者可以安全地给予强化化疗方案和放疗。这需要多学科的方法和肿瘤学家和艾滋病毒医生的密切合作，以便最好地管理患者对治疗的依从性和面对药物相关的副作用。本文综述了肺癌、肝细胞癌、结直肠癌、肛门癌、霍奇金淋巴瘤和一些皮肤恶性肿瘤等常见NADCs的主要流行病学特征、危险因素和临床行为，并重点介绍了目前的治疗方法和预防筛查策略。
Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection has been widely available in industrialized countries since 1996; its widespread use determined a dramatic decline in acquired immunodeficiency syndrome (AIDS)-related mortality, and consequently, a significant decrease of AIDS-defining cancers. However the increased mean age of HIV-infected patients, prolonged exposure to environmental and lifestyle cancer risk factors, and coinfection with oncogenic viruses contributed to the emergence of other malignancies that are considered non-AIDS-defining cancers (NADCs) as a relevant fraction of morbidity and mortality among HIV-infected people twenty years after HAART introduction. The role of immunosuppression in the pathogenesis of NADCs is not well defined, and future researches should investigate the etiology of NADCs. In the last years there is a growing evidence that intensive chemotherapy regimens and radiotherapy could be safely administrated to HIV-positive patients while continuing HAART. This requires a multidisciplinary approach and a close co-operation of oncologists and HIV-physicians in order to best manage compliance of patients to treatment and to face drug-related side effects. Here we review the main epidemiological features, risk factors and clinical behavior of the more common NADCs, such as lung cancer, hepatocellular carcinoma, colorectal cancer and anal cancer, Hodgkin's lymphoma and some cutaneous malignancies, focusing also on the current therapeutic approaches and preventive screening strategies.