Statin exposure and risk of cancer in people with and without HIV infection.
Statin exposure and risk of cancer in people with and without HIV infection.
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DOI：
10.1097/qad.0000000000002748
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发表时间：
2021-02-02
期刊：
影响因子：
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通讯作者：
Tate JP
中科院分区：
文献类型：
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作者：
Bedimo RJ;Park LS;Shebl FM;Sigel K;Rentsch CT;Crothers K;Rodriguez-Barradas MC;Goetz MB;Butt AA;Brown ST;Gibert C;Justice AC;Tate JP
确定他汀类药物暴露是否与艾滋病毒携带者(PWH)和非感染者中癌症和死亡风险的降低有关。他汀类药物似乎具有免疫调节和抗炎作用，并可能降低癌症风险，特别是在PWH患者，因为它们经历了慢性炎症和免疫激活。在退伍军人老龄化队列研究(VICS)中，倾向性得分与2002-2017年间他汀类药物暴露和未暴露患者的队列相匹配，这是一个与癌症登记联系和详细药房数据有关的大型队列。我们计算了所有癌症、微生物癌症(与细菌或肿瘤病毒混合感染相关)、非微生物癌症和死亡率与他汀类药物使用相关的Cox回归风险比(HR)和95%可信区间(CI)。倾向性评分匹配的样本(N=47,940)包括23,970个他汀类启动子(31%PWH)。在1160名威尔斯亲王医院和2116名未感染的患者中，确诊为偶发癌症。据报道，1667名接触他汀类药物的患者(7.0%)和2215名未接触他汀类药物的患者(9.2%)死亡。使用他汀类药物可使微生物相关癌症的风险降低24%(HR为0.76；95%CI为0.69-0.85)，但与非微生物癌症风险无关(HR为1.00；95%CI为0.92-1.09)。使用他汀类药物总体死亡风险降低33%(HR为0.67；95%CI为0.63-0.72)。在按艾滋病毒状况分层的分析中，结果是相似的，除了非霍奇金淋巴瘤，他汀类药物的使用与PWH风险的降低相关(HR0.56；95%CI0.38-0.83)，但与未感染的风险无关(p-交互作用=0.012)。在PWH和未感染的患者中，他汀类药物暴露与较低的微生物癌症发病率相关，但与非微生物癌症发病率无关，并与死亡率降低相关。
To determine whether statin exposure is associated with decreased cancer and mortality risk among persons with HIV (PWH) and uninfected persons. Statins appear to have immunomodulatory and anti-inflammatory effects and may reduce cancer risk, particularly among PWH as they experience chronic inflammation and immune activation. Propensity score matched cohort of statin-exposed and unexposed patients from 2002–2017 in the Veterans Aging Cohort Study (VACS), a large cohort with cancer registry linkage and detailed pharmacy data. We calculated Cox regression hazard ratios (HRs) and 95% confidence intervals (CI) associated with statin use for all cancers, microbial cancers (associated with bacterial or oncovirus coinfection), non-microbial cancers, and mortality. The propensity score-matched sample (N=47,940) included 23,970 statin initiators (31% PWH). Incident cancers were diagnosed in 1,160 PWH and 2,116 uninfected patients. Death was reported in 1,667 (7.0%) statin-exposed, and 2,215 (9.2%) unexposed patients. Statin use was associated with 24% decreased risk of microbial associated cancers (HR 0.76; 95% CI 0.69–0.85), but was not associated with non-microbial cancer risk (HR 1.00; 95% CI 0.92–1.09). Statin use was associated with 33% lower risk of death overall (HR 0.67; 95% CI 0.63–0.72). Results were similar in analyses stratified by HIV status, except for non-Hodgkin lymphoma where statin use was associated with reduced risk (HR 0.56; 95% CI 0.38–0.83) for PWH, but not for uninfected (p-interaction = 0.012). In both PWH and uninfected, statin exposure was associated with lower risk of microbial, but not non-microbial cancer incidence, and with decreased mortality.