Risk of cancers during interrupted antiretroviral therapy in the SMART study
Risk of cancers during interrupted antiretroviral therapy in the SMART study
复制标题
DOI：
10.1097/qad.0b013e3282ed6338
复制
发表时间：
2007-09-12
期刊：
影响因子：
3.8
通讯作者：
Abrams, Donald I.
中科院分区：
文献类型：
--
作者：
Silverberg, Michael J.;Neuhaus, Jacqueline;Abrams, Donald I.
目的：比较接受CD 4 T细胞引导的抗逆转录病毒治疗（ART）策略和连续ART的患者的AIDS定义和非AIDS定义恶性肿瘤的发生率。设计：一项随机临床试验。比较了药物保守组之间的抗逆转录病毒治疗率，其中如果CD 4 T细胞计数超过350个细胞/μ l，则停止ART，如果低于250个细胞/μ l，则（重新）开始ART。考克斯模型用于检查基线特征，包括年龄、性别、种族、吸烟、既往恶性肿瘤、CD 4 T细胞和HIV-RNA水平、B或丙型肝炎以及ART持续时间。13例艾滋病定义的恶性肿瘤和58例非艾滋病定义的恶性肿瘤（1例患者两者兼有）。每1000人-年的艾滋病定义恶性肿瘤发生率在药物保护组中更高（3.0对0.5）。近端CD 4 T细胞和HIV RNA水平介导了这种增加的风险。药物保护组的卡波西肉瘤（1.9比0.3）和淋巴瘤（霍奇金和非霍奇金; 1.1比0.3）的发病率也较高。药物保守治疗组和病毒抑制治疗组的非AIDS定义恶性肿瘤发生率相似（8.8 vs 7.1）。最常见的非艾滋病定义的恶性肿瘤是皮肤癌（n = 16），肺癌（n = 8）和前列腺癌（n = 6）cancer.Conclusion：非艾滋病定义的恶性肿瘤是更常见的，在这个队列比艾滋病定义的恶性肿瘤。这项分析提供了反对使用CD 4 T细胞引导的ART的进一步证据，因为除了机会性感染和死亡外，AIDS定义的恶性肿瘤的风险更高。(C)2007年利平科特威廉姆斯&威尔金斯。
Objective: To compare rates of AIDS-defining and non-AIDS-defining malignancies between patients on a CD4 T-cell-guided antiretroviral therapy (ART) strategy and continuous ART.Design: A randomized clinical trial.Methods: Malignancy rates were compared between the drug conservation arm in which ART was stopped if the CD4 T-cell count exceeded 350 cells/mu l and (re)started if it fell to less than 250 cells/mu l and the viral suppression arm utilizing continuous ART. Cox models were used to examine baseline characteristics including age, sex, race, cigarette use, previous malignancies, CD4 T-cell and HIV-RNA levels, hepatitis B or C, and ART duration.Results: A total of 5472 participants were randomly assigned to treatment groups, of whom 70 developed cancer: 13 AIDS-defining malignancies and 58 non-AIDS-defining malignancies (one patient had both). The AIDS-defining malignancy rate per 1000 person-years was higher in the drug conservation arm (3.0 versus 0.5). Proximal CD4 T-cell and HIV RNA levels mediated much of this increased risk. The drug conservation arm also had higher rates of Kaposi's sarcoma (1.9 versus 0.3) and lymphoma (Hodgkin's and non-Hodgkin's; 1.1 versus 0.3). The non-AIDS-defining malignancy rate was similar between the drug conservation and viral suppression arms (8.8 versus 7.1). The most common non-AIDS-defining malignancies were skin (n = 16), lung (n = 8) and prostate (n = 6) cancers.Conclusion: Non-AIDS-defining malignancies were more common in this cohort than AIDS-defining malignancies. This analysis provides further evidence against the use of CD4 T-cell-guided ART because of a higher risk of AIDS-defining malignancies in addition to opportunistic infections and deaths. (C) 2007 Lippincott Williams & Wilkins.