Mortality among people living with HIV/AIDS with non-small-cell lung cancer in the modern HAART Era
Mortality among people living with HIV/AIDS with non-small-cell lung cancer in the modern HAART Era
复制标题
现代HAART时代HIV/AIDS合并非小细胞肺癌患者的死亡率
作者：
Danielle M. Smith;K. Salters;Oghenowede Eyawo;Conrado Franco‐Villalobos;S. Jabbari;S. Wiseman;N. Press;J. Montaner;S. F. Man;M. Hull;R. Hogg
摘要艾滋病毒携带者(PLWHA)有足够的机会接受现代联合抗逆转录病毒治疗(CART)，他们的寿命更长，艾滋病相关的发病率和死亡率也更低。然而，随着时间的推移，与艾滋病无关的疾病(如某些癌症)的增加伴随着这些治疗进展。因此，我们的研究目标是在确诊为非小细胞肺癌(NSCLC)和HIV阴性的非小细胞肺癌患者中，确定HIV对全因死亡率和肺癌特异性死亡率的影响。这项分析包括19岁以上儿童上车和下车后的PLWHA，以及13年(2000年至2013年)BC人口≥19年10%的比较样本。Kaplan-Meier估计、Cox PH模型和对全原因死亡率和特定原因死亡率的竞争风险分析(分别)将PLWHA与HIV阴性个体进行了比较，控制了年龄、性别、癌症阶段、合并症；以及用于HIV阳性特异性分析的最低CD4计数、病毒载量和注射药物使用。我们确定了2000至2013年间71名PLWHA和2463名HIV阴性的非小细胞肺癌患者。患有非小细胞肺癌的PLWHA患者的确诊年龄明显低于艾滋病毒阴性者(中位年龄57岁对71岁，p <； 0.01)。我们发现肺癌特异性死亡率没有显著差异。然而，在多变量分析中，HIV与更高的全原因死亡率相关(调整后的危险比[AHR]：1.44；95%可信区间[CI]：1.08-1.90)，PLWHA的中位生存期为4个月，而HIV阴性的中位生存期为10个月。在多因素分析中，在PLWHA中，较高的最低值CD4计数对死亡率(AHR：0.33，95%CI：0.17-0.64)具有保护作用。我们的分析表明，与普通BC非小细胞肺癌患者相比，现代CART时代的PLWHA经历了类似的肺癌生存结果。然而，我们也观察到患有非小细胞肺癌的PLWHA患者的全因死亡率显著升高，这可能值得进一步探讨HIV在PLWHA合并癌症患者中加剧死亡率的作用。
ABSTRACT People living with HIV (PLWHA) with adequate access to modern combination antiretroviral therapy (cART) are living longer and experiencing reduced AIDS-related morbidity and mortality. However, increases in non-AIDS related conditions, such as certain cancers, have accompanied these therapeutic advances over time. As such, our study objective was to determine the impact of HIV on all-cause and lung cancer-specific mortality amongst PLWHA with diagnoses of non-small-cell lung cancer (NSCLC) and HIV-negative individuals with NSCLC. This analysis was inclusive of PLWHA on and off cART over the age of 19 years and a 10% comparison sample from the BC population ≥19 years, over a 13-year period (2000–2013). Kaplan-Meier estimates, Cox PH models, and competing risk analysis for all-cause and cause-specific mortality (respectively) compared PLWHA to HIV-negative individuals, controlling for age, gender, cancer stage, co-morbidities; and nadir CD4 count, viral load, and injection drug use for a HIV-positive specific analysis. We identified 71 PLWHA and 2463 HIV-negative individuals diagnosed with NSCLC between 2000 and 2013. PLWHA with NSCLC were diagnosed at a significantly younger age than HIV-negative individuals (median age 57 vs 71 years, p < 0.01). We found no significant difference in lung cancer-specific mortality. However, in multivariate analysis, HIV was associated with greater all-cause mortality (adjusted hazard ratio [aHR]:1.44; 95% confidence interval [CI]: 1.08–1.90), with median survival of 4 months for PLWHA, and 10 months for HIV-negative. Higher nadir CD4 count was protective against mortality (aHR: 0.33, 95% CI: 0.17–0.64) amongst PLWHA in multivariate analysis. Our analysis suggests that PLWHA in the modern cART era experience similar lung cancer survival outcomes compared to the general BC population with NSCLC. However, we also observed significantly higher all-cause mortality among PLWHA with NSCLC, which may warrant further inquiry into the role of HIV in exacerbating mortality among PLWHA with comorbidities and cancer.
影响因子：
11.8
作者：
Kirk, Gregory D.;Merlo, Christian;Engels, Eric A.
通讯作者：
Engels, Eric A.
影响因子：
45.3
作者：
Engels, EA;Brock, MV;Moore, RD
通讯作者：
Moore, RD