Combination antiretroviral therapy and cancer risk.
Combination antiretroviral therapy and cancer risk.
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联合抗逆转录病毒治疗和癌症风险。
DOI：
10.1097/coh.0000000000000334
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发表时间：
2017-01
影响因子：
4.1
通讯作者：
Borges ÁH
中科院分区：
文献类型：
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作者：
Borges ÁH
综述抗逆转录病毒联合治疗（cART）对癌症风险影响的最新研究进展。由于由病毒和细菌共同感染驱动的恶性肿瘤的这种风险更高，因此将恶性肿瘤分为感染相关和感染无关已成为一种新兴趋势。研究发现，在免疫抑制的HIV+患者中，cART启动后，卡波西肉瘤（KS）和非霍奇金淋巴瘤（NHL）的发病率显著降低。然而，最近的随机数据表明，在明显的免疫抑制发生之前，cART也可以降低早期HIV感染期间KS和NHL的风险。cART暴露对癌症风险的长期影响尚未得到很好的界定；根据基础和流行病学研究，每种cART类型可能与不同的癌症风险模式有特定的关联。cART暴露与癌症风险之间的关系是复杂而微妙的。一个有趣的事实是，无论是否在严重免疫抑制期间开始，cART都可以降低KS和NHL的风险。进一步的研究应确定立即启动cART降低癌症风险的介质，了解长期暴露于cART与癌症发病率之间的关系，并评估辅助抗炎治疗是否可以降低接受治疗的HIV感染期间的癌症风险。
to review the newest research about the effects of combination antiretroviral therapy (cART) on cancer risk HIV+ persons are at increased risk of cancer. As this risk is higher for malignancies driven by viral and bacterial co-infections, classifying malignancies into infection-related and infection-unrelated has been an emerging trend. Cohorts have detected major reductions in the incidence of Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) following cART initiation among immunosuppressed HIV+ persons. However, recent randomized data indicate that cART reduces risk of KS and NHL also during early HIV infection before overt immunosuppression occurs. Long term effects of cART exposure on cancer risk are not well defined; according to basic and epidemiological research, there might be specific associations of each cART class with distinct patterns of cancer risk. The relationship between cART exposure and cancer risk is complex and nuanced. It is an intriguing fact that, whether initiated during severe immunosuppression or not, cART reduces risk of KS and NHL. Further research should identify mediators of the benefit of immediate cART initiation in reducing cancer risk, understand the relationship between long term cART exposure and cancer incidence, and assess whether adjuvant anti-inflammatory therapies can reduce cancer risk during treated HIV infection.