The impact of highly active antiretroviral therapy on non-AIDS-defining cancers among adults with AIDS
The impact of highly active antiretroviral therapy on non-AIDS-defining cancers among adults with AIDS
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DOI：
10.1093/aje/kwm017
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发表时间：
2007-05-15
影响因子：
5
通讯作者：
Scheer, Susan
中科院分区：
文献类型：
--
作者：
Hessol, Nancy A.;Pipkin, Sharon;Scheer, Susan
高效抗逆转录病毒疗法（HAART）显著降低了获得性免疫缺陷综合征（AIDS）的发病率，延长了艾滋病患者的生存时间，但对其对癌症的影响知之甚少。来自加州旧金山的成年人的数据，艾滋病监测登记处与加州癌症登记处进行了计算机匹配。计算年龄、性别和种族调整的标准化发病率比（SIRs），比例风险模型评估HAART使用对癌症发病率和癌症生存时间的影响。在1990年至2000年期间，14210名被诊断患有艾滋病的成年人中，有482名被诊断出患有非艾滋病定义的癌症。与普通人群相比，肛门癌（SIR = 13.4）、霍奇金淋巴瘤（SIR = 11.5）、肝脏癌（SIR = 3.6）、口腔和咽部癌（SIR = 2.6）、呼吸道癌（SIR = 2.6）、白血病（SIR = 2.4）、皮肤黑色素瘤（SIR = 2.4）和前列腺癌（SIR = 1.7）的发病率显著增加。使用HAART治疗肝癌的风险较低（相对危险度(RH) = 0.32）。1995年后肛门癌风险增加（RH = 2.9）。使用HAART治疗后，呼吸道肿瘤（RH = 0.40）和霍奇金淋巴瘤（RH = 0.17）的生存时间增加，而肛门肿瘤的生存时间可能略有下降（RH = 1.4）。HAART对非艾滋病定义的癌症发病率和生存率的影响并不统一，应进一步研究造成这些差异的机制。
Highly active antiretroviral therapy (HAART) has dramatically reduced the incidence of acquired immunodeficiency syndrome (AIDS) and increased AIDS survival time, but little is known about its impact on cancer. Data from adults in the San Francisco, California, AIDS surveillance registry were computer matched with the California Cancer Registry. Age-, sex-, and race-adjusted standardized incidence ratios (SIRs) were computed, and proportional hazards models evaluated the effect of HAART use on cancer incidence and cancer survival time. Among 14,210 adults with AIDS diagnosed in 1990-2000, 482 non-AIDS-defining cancers were diagnosed. Compared with rates for the general population, significantly increased cancer incidence rates were observed for anal (SIR = 13.4), Hodgkin's lymphoma (SIR = 11.5), liver (SIR = 3.6), oral cavity and pharynx (SIR = 2.6), respiratory (SIR = 2.6), leukemia (SIR = 2.4), skin melanoma (SIR = 2.4), and prostate (SIR = 1.7) cancers. Risk of liver cancer was lower with HAART use (relative hazard (RH) = 0.32). Risk of anal cancer increased after 1995 (RH = 2.9). Respiratory cancer (RH = 0.40) and Hodgkin's lymphoma (RH = 0.17) showed increased cancer survival time with HAART use, while anal cancer survival may have been slightly decreased (RH = 1.4). The impact of HAART on non-AIDS-defining cancer incidence rates and survival is not uniform, and the mechanism(s) responsible for these differences should be investigated further.