Hodgkin lymphoma and immunodeficiency in persons with HIV/AIDS
Hodgkin lymphoma and immunodeficiency in persons with HIV/AIDS
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DOI：
10.1182/blood-2006-05-024109
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发表时间：
2006-12-01
期刊：
影响因子：
20.3
通讯作者：
Engels, Eric A.
中科院分区：
文献类型：
--
作者：
Biggar, Robert J.;Jaffe, Elaine S.;Engels, Eric A.
在HIV/AIDS（PWHA）患者中，霍奇金淋巴瘤（HL）的风险增加。然而，自从引入高效抗逆转录病毒治疗（HAART）以来，PWHA中的HL发病率意外增加。我们将1980年至2002年的全国艾滋病毒/艾滋病和癌症登记数据联系起来。在艾滋病发病时通过CD 4 T淋巴细胞计数评估免疫力。计算艾滋病发病后4至27个月的HL年发病率。在对317428名艾滋病患者（PWAS）进行的477368人年（py's）随访期间，发生了173例HL病例（36.2/105 py's）。1996年至2002年的发病率明显高于以前。CD 4细胞/μ L为150 - 199的PWA的发病率为53.7/10（5）py，而CD 4细胞/μ L低于50的PWA的发病率为20.7/10（5）py（P趋势= 0.002）。对于每种HL亚型，发病率随着CD 4计数的下降而下降，但结节硬化比混合细胞性更急剧下降，从而增加了PWA中观察到的混合细胞性HL的比例。我们得出结论，重度免疫抑制的HL发病率低于中度免疫抑制，HAART相关的CD 4计数改善可能解释了自1996年以来观察到的PWHS中HL发病率增加。随着免疫抑制的加重，结节性硬化性HL变得罕见，这解释了PWA中混合细胞型HL的比例较高。发病机制的影响进行了讨论。
In persons with HIV/AIDS (PWHAs), Hodgkin lymphoma (HL) risk is increased. However, HL incidence in PWHAs has unexpectedly increased since highly active antiretroviral therapy (HAART) was introduced. We linked nationwide HIV/AIDS and cancer registry data from 1980 through 2002. Immunity was assessed by CD4 T-lymphocyte counts at AIDS onset. Annual HL incidence rates were calculated for 4 through 27 months after AIDS onset. During 477 368 person years (py's) of follow-up in 317 428 persons with AIDS (PWAS), 173 HL cases occurred (36.2 per 105 py's). Incidence was significantly higher in 1996 to 2002 than earlier. Incidence in PWAs with 150 to 199 CD4 cells/mu L was 53.7 per 10(5) py's, whereas in PWAs with fewer than 50 CD4 cells/mu L, it was 20.7 per 10(5) py's (P-trend = .002). For each HL subtype, incidence decreased with declining CD4 counts, but nodular sclerosing decreased more precipitously than mixed cellularity, thereby increasing the proportion of mixed cellularity HL seen in PWAs. We conclude that HL incidence is lower with severe immunosuppression than with moderate immunosuppression, and HAART-related improvements in CD4 counts likely explain the increasing HL incidence in PWHAS observed since 1996. With more severe immunosuppression, nodular sclerosing HL becomes infrequent, explaining the higher proportion of mixed cellularity HL found in PWAs. Pathogenesis implications are discussed.