Cancer risk in the swiss HIV cohort study: Associations with immunodeficiency, smoking, and highly active antiretroviral therapy
Cancer risk in the swiss HIV cohort study: Associations with immunodeficiency, smoking, and highly active antiretroviral therapy
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DOI：
10.1093/jnci/dji072
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发表时间：
2005-03-16
影响因子：
10.3
通讯作者：
Franceschi, S
中科院分区：
文献类型：
--
作者：
Clifford, GM;Polesel, J;Franceschi, S
背景：人类免疫缺陷病毒(HIV)感染者患多种癌症的风险增加，但吸烟、静脉用药、高效抗逆转录病毒治疗(HAART)等行为危险因素对癌症风险的影响尚不清楚。方法：患者记录在瑞士HIV队列研究和瑞士州癌症登记之间建立联系。对7,304名感染艾滋病毒的人进行了28836人年的跟踪调查，评估了观察到的和预期的癌症发病率。与普通人群相比，癌症的相对风险通过估计癌症登记、性别、年龄和时期标准化发病率比(SIRS)来确定。结果：感染HIV的卡波西肉瘤(KS)患者(SIR=192，95%可信区间[CI]=170~217)和非霍奇金淋巴瘤患者(SIR=76.4，95%CI=66.5~87.4)SIRS明显升高。肛门癌(SIR=33.4，95%CI=10.5~78.6)、霍奇金淋巴瘤(SIR=17.3，95%CI=10.2~27.4)、宫颈癌(SIR=8.0，95%CI=2.9~17.4)、肝癌(SIR=7.0，95%CI=2.2~16.5)、嘴唇、口腔和咽部(SIR 4.1，95%CI=2.1~7.4)；气管、肺和支气管(SIR 3.2，95%CI=1.7~5.4)；皮肤，非黑色素瘤(SIR=3.2，95%CI=2.2~4.5)。在HAART使用者中，KS(SIR=25.3，95%CI=10.8~50.1)和非霍奇金淋巴瘤(SIR=24.2，95%CI=15.0~37.1)的SIR低于非使用者(KS SIR=239，95%CI 211~270；非霍奇金淋巴瘤SIR=99.3，95%CI 85.8~114)。然而，在HAART使用者中，霍奇金淋巴瘤的SIR(尽管不是绝对数字)(SIR=36.2，95%CI=16.4~68.9)与KS和非霍奇金淋巴瘤的SIR相当。对于宫颈癌或定义为非获得性免疫缺陷综合征的癌症，HAART对SIRS没有明显影响。非吸烟者中未发现肺癌、唇癌、口癌或咽癌。结论：在HIV感染者中，使用HAART可以预防大多数KS和非霍奇金淋巴瘤的额外风险，但不能预防霍奇金淋巴瘤和其他非获得性免疫缺陷综合征定义的癌症。在非吸烟者中没有观察到唇癌、口癌、咽癌或肺癌。
Background: Persons infected with human immunodeficiency virus (HIV) have an increased risk for several cancers, but the influences of behavioral risk factors, such as smoking and intravenous drug use, and highly active antiretroviral therapy (HAART) on cancer risk are not clear. Methods: Patient records were linked between the Swiss HIV Cohort Study and Swiss cantonal cancer registries. Observed and expected numbers of incident cancers were assessed in 7304 persons infected with HIV followed for 28836 person-years. Relative risks for cancer compared with those for the general population were determined by estimating cancer registry-, sex-, age-, and period-standardized incidence ratios (SIRs). Results: Highly elevated SIRs were confirmed in persons infected with HIV for Kaposi sarcoma (KS) (SIR = 192, 95% confidence interval [CI] = 170 to 217) and non-Hodgkin lymphoma (SIR = 76.4, 95% CI = 66.5 to 87.4). Statistically significantly elevated SIRs were also observed for anal cancer (SIR = 33.4, 95% CI = 10.5 to 78.6); Hodgkin lymphoma (SIR = 17.3, 95% Cl = 10.2 to 27.4); cancers of the cervix (SIR = 8.0, 95% Cl = 2.9 to 17.4); liver (SIR = 7.0, 95% Cl = 2.2 to 16.5); lip, mouth, and pharynx (SIR 4.1, 95% CI = 2.1 to 7.4); trachea, lung, and bronchus (SIR 3.2, 95% Cl = 1.7 to 5.4); and skin, non-melanomatous (SIR = 3.2, 95% Cl = 2.2 to 4.5). In HAART users, SIRs for KS (SIR = 25.3, 95% Cl = 10.8 to 50.1) and non-Hodgkin lymphoma (SIR = 24.2, 95% Cl = 15.0 to 37.1) were lower than those for nonusers (KS SIR = 239, 95% CI 211 to 270; non-Hodgkin lymphoma SIR = 99.3, 95% CI 85.8 to 114). Among HAART users, however, the SIR (although not absolute numbers) for Hodgkin lymphoma (SIR =36.2,95% CI= 16.4 to 68.9) was comparable to that for KS and non-Hodgkin lymphoma. No clear impact of HAART on SIRs emerged for cervical cancer or non-acquired immunodeficiency syndrome-defining cancers. Cancers of the lung, lip, mouth, or pharynx were not observed among nonsmokers. Conclusion: In persons infected with HIV, HAART use may prevent most excess risk of KS and non-Hodgkin lymphoma, but not that of Hodgkin lymphoma and other non-acquired immunodeficiency syndrome-defining cancers. No cancers of the lip, mouth, pharynx, or lung were observed in nonsmokers.