Cancers attributable to infections among adults with HIV in the United States.
Cancers attributable to infections among adults with HIV in the United States.
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DOI：
10.1097/qad.0000000000000808
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发表时间：
2015-10-23
期刊：
影响因子：
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通讯作者：
Plummer M
中科院分区：
文献类型：
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作者：
de Martel C;Shiels MS;Franceschi S;Simard EP;Vignat J;Hall HI;Engels EA;Plummer M
艾滋病毒感染者患传染性癌症的风险增加。我们估计了2008年美国艾滋病毒感染者因感染而造成的癌症负担。根据艾滋病毒/艾滋病登记处和癌症登记处之间的记录联系，估计了与感染相关的癌症部位的发病率。2008年，该比率被用于估计美国确诊的艾滋病毒感染者人数，以获得癌症病例的数量。根据癌症病例中的感染率估计特定部位归因分数（AF）和相应的95%置信区间（CI）。感染患病率数据来自病例系列的文献综述。在估计的6200例新发癌症病例中（95%CI：6000-6500），2500例（95%CI：2400-2700）可归因于感染（AF= 40%，95%CI：39-42）。最重要的感染是卡波西肉瘤疱疹病毒、EB病毒和人乳头瘤病毒，它们共同导致了2200例新发癌症病例（95%CI：2100-2400），主要是卡波西肉瘤、淋巴瘤和肛门生殖器癌。HIV感染者中AF在20-29岁年龄组中最高（69%，95%CI：65-72）。由于卡波西肉瘤和肛门癌的高发病率，男男性行为者是HIV传播组中AF最高的人群（48%，95%CI：46-50）。艾滋病毒感染者中因感染而患癌症的比例很高，这表明有特别的机会预防这些癌症，即，避免、发现和早期治疗癌症相关感染，以及普遍早期发现和不间断地治疗艾滋病毒感染，以避免免疫抑制。
HIV-infected people are at increased risk of cancers of infectious origin. We estimated the burden of cancer attributable to infections among HIV-infected people in the United States in 2008. Incidence rates for cancer sites associated with infections were estimated from record linkage between HIV/AIDS registries and cancer registries. Rates were applied to estimates of the population living with diagnosed HIV in the United States in 2008 to obtain the number of incident cancer cases. Site-specific attributable fractions (AF) and corresponding 95% confidence intervals (CI) were estimated from infection prevalence among cancer cases. Infection prevalence data were derived from literature review of case series. Of an estimated 6200 incident cancer cases (95%CI: 6000–6500), 2500 (95%CI: 2400–2700) were attributable to infection (AF=40%, 95%CI: 39–42). The most important infections were Kaposi sarcoma herpes virus, Epstein-Barr virus, and human papillomavirus, which together were responsible for 2200 new cancer cases (95%CI: 2100–2400), mainly Kaposi sarcoma, lymphomas, and ano-genital cancers. The AF in HIV-infected people was highest in the age group 20–29 years (69%, 95%CI: 65–72). Men who have sex with men were the HIV transmission group with the highest AF (48%, 95%CI: 46–50), due to the high incidence of both Kaposi sarcoma and anal cancer. The very high fraction of cancer attributable to infection in HIV-infected people points to special opportunities to prevent these cancers, i.e., avoidance, detection, and early treatment of cancer-associated infections and universal early detection and uninterrupted treatment of HIV infection to avoid immunosuppression.