Risk of Anal Cancer in HIV-Infected and HIV-Uninfected Individuals in North America
Risk of Anal Cancer in HIV-Infected and HIV-Uninfected Individuals in North America
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DOI：
10.1093/cid/cir1012
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发表时间：
2012-04-01
影响因子：
11.8
通讯作者：
Dubrow, Robert
中科院分区：
文献类型：
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作者：
Silverberg, Michael J.;Lau, Bryan;Dubrow, Robert
背景资料。肛门癌是影响感染人类免疫缺陷病毒(HIV)个体的最常见癌症之一，尽管很少有人单独评估男男性行为者(MSM)、其他男性和女性的发病率。关于日历趋势，也有相互矛盾的数据。在1996年至2007年间，一项涉及北美13个队列的研究中，我们比较了34189名HIV感染者(男同性恋者55%，其他男性19%，女性26%)和114260名非HIV感染者(90%男性)的肛门癌发病率。在男性中，感染艾滋病毒的男男性同性恋者的未调整肛门癌发病率为每10万人年131例，其他感染艾滋病毒的男性为46例，未感染艾滋病毒的男性为2例，与未感染艾滋病毒的男性相比，经人口统计学调整的比率(RR)为80.3(95%可信区间，42.7%-151.1)，其他感染艾滋病毒的男性为26.7%(95%可信区间，11.5%-61.7%)。感染艾滋病毒的妇女的肛门癌发病率为30/10万人年，未感染艾滋病毒的妇女没有观察到病例。在多变量Poisson回归模型中，在HIV感染者中，MSM的风险高于其他男性(RR，3.3；95%CI，1.8-6.0)，但与女性相比没有差异(RR，1.0；95%CI，0.5-2.2)。与2000-2003年相比，HIV感染者在1996-1999年和2004-2007年的调整RR分别为0.5(95%CI，0.3~0.9)和0.9(95%CI，0.6~1.2)。与未感染艾滋病毒的人相比，感染艾滋病毒的MSM、其他男性和女性的肛门癌发病率要高得多，这表明需要普遍的预防努力。在早期抗逆转录病毒治疗时代之后，发病率有所上升，然后趋于平稳。
Background. Anal cancer is one of the most common cancers affecting individuals infected with human immunodeficiency virus (HIV), although few have evaluated rates separately for men who have sex with men (MSM), other men, and women. There are also conflicting data regarding calendar trends.Methods. In a study involving 13 cohorts from North America with follow-up between 1996 and 2007, we compared anal cancer incidence rates among 34 189 HIV-infected (55% MSM, 19% other men, 26% women) and 114 260 HIV-uninfected individuals (90% men).Results. Among men, the unadjusted anal cancer incidence rates per 100 000 person-years were 131 for HIV-infected MSM, 46 for other HIV-infected men, and 2 for HIV-uninfected men, corresponding to demographically adjusted rate ratios (RRs) of 80.3 (95% confidence interval [CI], 42.7-151.1) for HIV-infected MSM and 26.7 ( 95% CI, 11.5-61.7) for other HIV-infected men compared with HIV-uninfected men. HIV-infected women had an anal cancer rate of 30/100 000 person-years, and no cases were observed for HIV-uninfected women. In a multivariable Poisson regression model, among HIV-infected individuals, the risk was higher for MSM compared with other men (RR, 3.3; 95% CI, 1.8-6.0), but no difference was observed comparing women with other men ( RR, 1.0; 95% CI, 0.5-2.2). In comparison with the period 2000-2003, HIV-infected individuals had an adjusted RR of 0.5 (95% CI,.3-.9) in 1996-1999 and 0.9 (95% CI,.6-1.2) in 2004-2007.Conclusions. Anal cancer rates were substantially higher for HIV-infected MSM, other men, and women compared with HIV-uninfected individuals, suggesting a need for universal prevention efforts. Rates increased after the early antiretroviral therapy era and then plateaued.