Non-Hodgkin lymphoma risk in adults living with HIV across five continents.
Non-Hodgkin lymphoma risk in adults living with HIV across five continents.
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DOI：
10.1097/qad.0000000000002003
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发表时间：
2018-11-28
期刊：
影响因子：
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通讯作者：
AIDS-defining Cancer Project Working Group of IeDEA, COHERE in EuroCoord
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文献类型：
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作者：
AIDS-defining Cancer Project Working Group of IeDEA, COHERE in EuroCoord
比较亚太地区、南非、欧洲、拉丁美洲和北美开始抗逆转录病毒治疗（ART）的成人非霍奇金淋巴瘤（NHL）发病率。我们纳入了1995年后在国际艾滋病流行病学评估数据库（IeDEA）和欧洲观察性艾滋病毒流行病学研究合作（COHERE）框架内开始抗逆转录病毒治疗的成年艾滋病毒感染者的队列数据。我们使用灵活的参数生存模型来比较ART开始后2年的区域NHL发病率，并确定NHL的危险因素。我们纳入了210,898名成年人，随访110万人年（pys）和1,552例NHL病例（原始总发病率为142/100,000 pys）。在调整ART开始时的年龄、一线ART治疗方案、ART开始的日历期，特别是当前CD4细胞计数后，大多数人群的NHL发病率在不同地区相似。然而，与欧洲女性相比，南非女性患NHL的风险仍然增加（调整后的风险比[aHR] 1.79, 95% CI 1.19-2.70）。在欧洲、拉丁美洲和北美，男男性行为者（MSM, aHR 1.30, 95% CI 1.14-1.48）的NHL风险最高，其次是异性恋男性（参考）和女性（aHR 0.66, 95% CI 0.57-0.78）。南非妇女罹患NHL的风险高于欧洲妇女，男男性行为者罹患NHL的风险高于异性恋男女。造成这些差异的原因尚不清楚。早期获得抗逆转录病毒治疗和定期监测患者以避免低CD4细胞计数仍然是NHL预防的关键。
To compare non-Hodgkin lymphoma (NHL) incidence rates in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. We included cohort data of adults living with HIV who started ART after 1995 within the framework of the International epidemiology Databases to Evaluate AIDS (IeDEA) and the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). We used flexible parametric survival models to compare regional NHL rates at 2 years after ART start and to identify risk factors for NHL. We included 210,898 adults with 1.1 million person-years (pys) of follow-up and 1,552 incident NHL cases (raw overall incidence rate 142/100,000 pys). After adjusting for age at ART start, first-line ART regimen, calendar period of ART start, and especially current CD4 cell count, NHL rates were similar across regions for most population groups. However, South African women remained at increased risk of developing NHL compared with their European counterparts (adjusted hazard ratio [aHR] 1.79, 95% CI 1.19–2.70). In Europe, Latin and North America, NHL risk was highest in men who have sex with men (MSM, aHR 1.30, 95% CI 1.14–1.48), followed by heterosexual men (referent), and women (aHR 0.66, 95% CI 0.57–0.78). The risk of developing NHL is higher in women in South Africa than in Europe and higher in MSM compared with heterosexual men and women. Reasons for these differences remain unclear. Early ART access and regular patient monitoring to avert low CD4 cell counts remain key for NHL prevention.