AIDS-Related cancer and severity of immunosuppression in persons with AIDS
AIDS-Related cancer and severity of immunosuppression in persons with AIDS
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DOI：
10.1093/jnci/djm010
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发表时间：
2007-06-20
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影响因子：
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通讯作者：
Engels, Eric A.
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文献类型：
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作者：
Biggar, Robert J.;Chaturvedi, Anil K.;Engels, Eric A.
背景艾滋病患者中卡波西肉瘤、非霍奇金淋巴瘤和宫颈癌的发病率一直在下降。我们调查了这些人的癌症风险与 CD4 细胞计数之间的关联。方法将美国艾滋病登记处的数据与当地癌症登记数据联系起来。每100000人每年的癌症发病率是从1990年1月1日到1995年12月31日（在高效抗逆转录病毒疗法（HAART）可用之前）艾滋病发病后的4-27个月内以及从1996年1月1日到2002年12月31日确定的。通过比例风险评估艾滋病发病时的CD4计数与癌症发病率之间的关系结果 在 325516 名成年艾滋病患者中，1996-2002 年卡波西肉瘤的发病率（每 10 万人年 334.6 例）低于 1990-1995 年（每 10 万人年 1838.9 例），非霍奇金淋巴瘤的发病率也遵循类似的模式（即， 1996-2002年每10万人年有390.1例，1990-1995年每10万人年有1066.2例。 1996-2002 年，每微升血液中 CD4 细胞计数每下降 50 个细胞，卡波西肉瘤（风险比 [HR] = 1.40，95% 置信区间 [CI] = 1.33 至 1.50）和中枢神经系统非霍奇金淋巴瘤亚型（HR = 1.85，95% Cl 1.58 至 1.50）的风险就会增加。 2.16），并且适用于非中枢神经系统弥漫性大 B 细胞淋巴瘤（HR = 1.12，95% Cl 1.04 至 1.20），但不适用于非中枢神经系统 Burkitt 淋巴瘤（HR = 0.93，95% Cl = 0.81 至 1.06）。 1996-2002 年的宫颈癌发病率（每 10 万人年 86.5 例）高于 1990-1995 年（每 10 万人年 64.2 例），尽管没有统计学意义（相对风险 [RR] = 1.41，95% CI = 0.81 至 2.46）。调整年龄、种族、性别或 HIV 暴露方式后，1996 年至 2002 年期间卡波西肉瘤（RR = 0.22，95% Cl = 0.20 至 0.24）和非霍奇金淋巴瘤（RR = 0.40，95% Cl = 0.36 至 0.44）的风险低于 1996 年至 2002 年期间的风险。 1990-1995。 1990-1995 年观察到这些癌症与 CD4 计数的类似关系。 结论 在 HAART 出现之前和之后，CD4 计数与卡波西肉瘤和非霍奇金淋巴瘤的风险密切相关，但与宫颈癌和伯基特淋巴瘤的风险无关。 20 世纪 90 年代，艾滋病患者中大多数与艾滋病相关的癌症发病率下降，这与 1996 年引入 HAART 后 CD4 计数的改善是一致的。
Background The incidence of Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer has been declining among persons with AIDS. We investigated the association between cancer risk and CD4 cell count among such persons.Methods Data from US AIDS registries were linked to local cancer registry data. Cancer incidence per 100000 person-years was determined for the 4-27 months from the onset of AIDS from January 1, 1990, through December 31, 1995-before highly active antiretroviral therapy (HAART) became available-and from January 1, 1996, through December 31, 2002. The relationships between CD4 count at AIDS onset and cancer incidence were assessed by proportional hazards models.Results Among 325516 adults with AIDS, the incidence of Kaposi sarcoma was lower in 1996-2002 (334.6 cases per 100000 person-years) than in 1990-1995 (1838.9 cases per 100000 person-years), and the incidence of non-Hodgkin lymphoma followed a similar pattern (i.e., 390.1 cases per 100000 person-years in 1996-2002 and 1066.2 cases per 100000 person-years in 1990-1995). In 1996-2002, for each decline in CD4 cell count of 50 cells per microliter of blood, increased risks were found for Kaposi sarcoma (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.33 to 1.50), for central nervous system non-Hodgkin lymphoma subtypes (HR = 1.85, 95% Cl 1.58 to 2.16), and for non-central nervous system diffuse large B-cell lymphoma (HR = 1.12, 95% Cl 1.04 to 1.20) but not for non-central nervous system Burkitt lymphoma (HR = 0.93, 95% Cl = 0.81 to 1.06). Cervical cancer incidence was higher in 1996-2002 (86.5 per 100000 person-years) than in 1990-1995 (64.2 per 100000 person-years), although not statistically significantly so (relative risk [RR] = 1.41, 95% CI = 0.81 to 2.46). After adjustment for age, race, and sex or mode of HIV exposure, the risks for Kaposi sarcoma (RR = 0.22, 95% Cl = 0.20 to 0.24) and for non-Hodgkin lymphoma (RR = 0.40, 95% Cl = 0.36 to 0.44) were lower in the period of 1996-2002 than in 1990-1995. Similar relationships of these cancers to CD4 count were observed for 1990-1995.Conclusions Both before and after HAART was available, CD4 count was strongly associated with risks for Kaposi sarcoma and non-Hodgkin lymphoma but not for cervical cancer and Burkitt lymphoma. The decreasing incidences of most AIDS-associated cancers in persons with AIDS during the 1990s are consistent with improving CD4 counts after HAART introduction in 1996.