Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study.
Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study.
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DOI：
10.1097/qai.0b013e31817aebfe
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发表时间：
2008-08-01
期刊：
影响因子：
--
通讯作者：
Jacobson LP
中科院分区：
文献类型：
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作者：
D'Souza G;Wiley DJ;Li X;Chmiel JS;Margolick JB;Cranston RD;Jacobson LP
在1984年至2006年（MACS）期间，对hiv阳性和阴性的男男性行为者进行多中心队列研究，研究肛门癌的发病率和危险因素。使用泊松回归和Cox比例风险模型进行前瞻性分析，并使用条件逻辑回归进行嵌套病例对照研究。在6972名接受评估的男性中，有28人患有肛门癌。hiv阳性男性的发病率明显高于hiv阴性男性（IR= 69 vs. 14 / 100000人年）。在hiv阳性男性中，HAART治疗期间肛门癌的发病率高于HAART治疗前（IR=137 vs. 30 / 100000人年）。在仅限于HAART时代的多变量分析中，肛门癌的风险随着HIV感染（RH=4.7, 95%CI= 1.3-17）和前三次研究访问中无保护的接受性肛交伴侣数量的增加而显著增加（p趋势=0.03）。在艾滋病毒阳性的男性中，目前使用HAART并没有降低肛门癌的风险。艾滋病毒阳性的男性患肛门癌的风险增加。在HAART开始后，hiv阳性个体的生存率提高，可能为人类乳头瘤病毒（HPV）相关的肛门发育不良发展为恶性肿瘤提供了足够的时间，从而解释了HAART时代肛门癌发病率增加的原因。
To examine the incidence and risk factors for anal cancer in a multicenter cohort of HIV-positive and negative men who have sex with men followed between 1984 and 2006 (MACS). Prospective analysis using Poisson regression and Cox proportional hazard models, and a nested case-control study using conditional logistic regression. There were 28 cases of anal cancer among the 6,972 men who were evaluated. The incidence rate was significantly higher in HIV-positive men than in HIV-negative men (IR= 69 vs. 14 per 100,000 person-years). Among HIV-positive men, anal cancer incidence was higher in the HAART era than the pre-HAART era (IR=137 vs. 30 per 100,000 person-years). In multivariate analysis restricted to the HAART era, anal cancer risk increased significantly with HIV infection (RH=4.7, 95%CI=1.3–17), and increasing number of unprotected receptive anal sex partners at the first three study visits (p-trend=0.03). Among HIV-positive men, current HAART use did not decrease anal cancer risk. HIV-positive men had increased risk of anal cancer. Improved survival of HIV-positive individuals following HAART initiation may allow for sufficient time for human papillomavirus (HPV) associated anal dysplasias to develop into malignancies, thus explaining the increased incidence of anal cancer in the HAART era.