The changing pattern of Kaposi sarcoma in patients with HIV, 1994-2003
The changing pattern of Kaposi sarcoma in patients with HIV, 1994-2003
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DOI：
10.1002/cncr.20309
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发表时间：
2004-06-12
期刊：
影响因子：
6.2
通讯作者：
Lundgren, JD
中科院分区：
文献类型：
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作者：
Mocroft, A;Kirk, O;Lundgren, JD
背景高效抗逆转录病毒疗法（HAART）的引入从根本上改变了人类免疫缺陷病毒（HIV）感染的临床过程。本研究的目的是评估引入HAART后欧洲HIV患者Kaposi肉瘤（KS）发病率的变化，并确定HAART患者发生KS的相关因素。采用Poisson回归分析评价HAART患者KS的发生率和与该恶性肿瘤发生相关的因素。在目前的研究中检查的患者是9803名HIV感染者中的一员，他们参加了EuroSIDA研究，这是一项泛欧多中心研究。1994年至2003年，KS发病率估计每年下降39%（95%置信区间[CI]，35-43%; P < 0.0001）。在前瞻性随访期间，由于KS而诊断为获得性免疫缺陷综合征（AIDS）的比例范围为4.1%至7.5%，该数字随时间推移无显著变化（P = 0.97）。在前瞻性随访期间，4014例患者开始接受HAART治疗;其中41例随后被诊断为KS（1.0%）。多变量分析校正后，发现当前CD 4计数较高的患者KS发生率降低（发病率比[IRR]，0.60; 95%CI，0.53-0.68; P < 0.0001），以及那些自HAART开始以来时间较长的患者（IRR，0.77; 95% CI，0.60-0.98; P = 0.037）。相比之下，男同性恋者KS的发病率显著增加（IRR，2.12; 95%CI，1.00-4.54; P = 0.050）。目前艾滋病毒感染者中KS的发病率低于1994年报告的发病率的10%;根据KS诊断作出的艾滋病诊断的比例仍然接近6%。大多数在接受HAART治疗时发生KS的患者开始治疗时CD 4细胞计数较低，并在HAART开始后6个月内发生KS。在同性恋男性中，KS的发病率继续增加，而在CD 4计数较高的患者中，KS的发病率大大降低。(C)2004年美国癌症协会。
BACKGROUND. The introduction of highly active antiretroviral therapy (HAART) has radically changed the clinical course of human immunodeficiency virus (HIV) infection. The goals of the current study were to assess the change in the incidence of Kaposi sarcoma (KS) among European patients with HIV since the introduction of HAART and to identify the factors associated with the development of KS among patients receiving HAART.METHODS. The incidence of KS and the factors associated with the development of this malignancy in patients receiving HAART were evaluated using Poisson regression. Patients examined in the current study were among the 9803 individuals with HIV who were enrolled in the EuroSIDA study, a pan-European multicenter investigation.RESULTS. There was an estimated annual reduction of 39% (95% confidence interval [CI], 35-43%; P < 0.0001) in the incidence of KS between 1994 and 2003. The proportion of acquired immunodeficiency syndrome (AIDS) diagnoses made due to KS during prospective follow-up ranged from 4.1% to 7.5%, and there was no significant change over time in this figure (P = 0.97). Four thousand fourteen patients began receiving HAART during prospective follow-up; 41 of these 4014 were subsequently diagnosed with KS (1.0%). After adjustment in multivariate analyses, patients with higher current CD4 counts were found to have a decreased incidence of KS (incidence rate ratio [IRR], 0.60; 95% CI, 0.53-0.68; P < 0.0001), as were those for whom more time had elapsed since the initiation of HAART (IRR, 0.77; 95% CI, 0.60-0.98; P = 0.037). In contrast, homosexual men were found to have a significantly increased incidence of KS (IRR, 2.12; 95% CI, 1.00-4.54; P = 0.050).CONCLUSIONS. The current incidence of KS among patients with HIV is less than 10% of the incidence reported in 1994; the proportion of AIDS diagnoses made on the basis of KS diagnoses remains near 6%. Most individuals who developed KS while receiving HAART began treatment with low CD4 cell counts and developed KS within 6 months of the initiation of HAART. There continues to be an increased incidence of KS among homosexual men and a greatly reduced incidence of KS among patients with higher CD4 counts. (C) 2004 American Cancer Society.