Elevated incidence of lung cancer among HIV-infected individuals
Elevated incidence of lung cancer among HIV-infected individuals
复制标题
DOI：
10.1200/jco.2005.03.4413
复制
发表时间：
2006-03-20
影响因子：
45.3
通讯作者：
Moore, RD
中科院分区：
文献类型：
--
作者：
Engels, EA;Brock, MV;Moore, RD
在美国，艾滋病病毒感染者经常吸烟。我们试图描述艾滋病病毒感染者之间的肺癌发病率，研究癌症的风险是否与艾滋病病毒诱导的免疫抑制，并评估是否吸烟的高患病率解释risk.Methods升高，我们进行了一项回顾性队列研究，在艾滋病病毒专科诊所在巴尔的摩，MID（1989-2003年）。肺癌的发病率是通过医院记录确定的。我们使用负二项回归来比较由人口统计学、高效抗逆转录病毒治疗（HAART）的使用和HIV标志物定义的亚组之间的发病率。标准化发病率比（SIR）与城市参考人群（底特律，MI）的发病率进行比较。我们使用从部分队列和一般人群中估计的吸烟患病率，调整了吸烟影响的SIR。结果在5，238例HIV感染者中观察到33例肺癌（发病率：170/100，000人年）。发病率随年龄增加而增加（P <0.0001），但性别、种族或CD 4计数无差异。发病率随日历年（P = 0.09）和HAART使用（P = 0.10）而增加，与HIV病毒载量呈负相关（P = 0.03），但这些相关性随年龄调整而减弱。与一般人群相比，SIR为4.7（95% CI，3.2 - 6.5）。28名肺癌患者（85%）和69%的队列是吸烟者。吸烟调整后，风险仍然升高（SIR，2.5; 95%CI，1.6至3.5）。结论肺癌的风险显着增加，在HIV感染者。发病率与HIV诱导的免疫抑制无关。值得注意的是，在调整吸烟因素后，发病率仍然很高，表明涉及其他因素。
Purpose People with HIV infection in the United States frequently smoke tobacco. We sought to characterize lung cancer incidence among HIV-infected individuals, examine whether cancer risk was related to HIV-induced immunosuppression, and assess whether the high prevalence of smoking explained elevated risk.Methods We conducted a retrospective cohort study at an HIV specialty clinic in Baltimore, MID (1989-2003). Incident lung cancers were identified using hospital records. We used negative binomial regression to compare incidence across subgroups defined by demographics, use of highly active antiretroviral therapy (HAART), and HIV markers. Standardized incidence ratios (SIRs) compared incidence with an urban reference population (Detroit, MI). We adjusted SIRs for the effect of smoking, using smoking prevalences estimated from part of the cohort and the general population. 95% CIs and P values were two sided.Results Thirty-three lung cancers were observed among 5,238 HIV-infected patients (incidence: 170 per 100,000 person-years). Incidence increased with age (P < .0001), but did not differ by sex, race, or CD4 count, Incidence tended to increase with calendar year (P = .09) and HAART use (P = .10), and was inversely related to HIV viral load (P = .03), but these associations were attenuated with age adjustment. The SIR was 4.7 (95% CI, 3.2 to 6.5) versus the general population. Twenty-eight lung cancer patients (85%) and 69% of the cohort were smokers. After smoking adjustment, risk remained elevated (SIR, 2.5; 95% CI, 1.6 to 3.5).Conclusion Lung cancer risk was substantially elevated in HIV-infected individuals. Incidence was unrelated to HIV-induced immunosuppression. Notably, incidence remained high after adjustment for smoking, suggesting the involvement of additional factors.