Association between HIV and Survival after Cancer Diagnosis

描述（由申请人提供）：癌症是全球范围内越来越常见的HIV感染并发症，在撒哈拉以南非洲发现的HIV相关癌症的负担最高。有证据表明，艾滋病毒与艾滋病定义（ADC）和非艾滋病定义（NADC）癌症发病率增加之间存在关联。尽管艾滋病毒感染和癌症发病率之间的联系，艾滋病毒是否会影响受感染个体的癌症进展的问题尚未得到充分解决。人们对癌症诊断后的生存情况知之甚少，特别是在资源有限的情况下;有限的新数据确实表明艾滋病毒感染及其治疗的存在起着重要作用。这项研究的目的是探讨艾滋病毒及其治疗对癌症诊断后生存的作用。具体而言，我们将1）确定HIV血清状态与常见AIDS定义（卡波西肉瘤（KS）和宫颈癌）和非AIDS定义（乳腺癌和肺癌）癌症诊断后生存率之间的关系，2）检查HIV疾病严重程度、治疗和HIV阳性癌症患者生存率之间的关系。为了实现这些目标，我们将研究2005- 2010年乌干达唯一的癌症护理机构乌干达癌症研究所（UCI）的宫颈癌、KS癌、乳腺癌和肺癌病例（n= 7，488）。有关艾滋病毒血清状态、病毒载量、CD 4 T细胞计数和高效抗逆转录病毒治疗（HAART）的信息将从患者病历中获得。将对所有病例完成1年时的以下结局随访和完整研究随访：总死亡率、癌症特异性死亡率和癌症无进展生存期。乌干达的环境为艾滋病毒相关的恶性肿瘤研究提供了一个独特的机会;除了在UCI拥有世界一流的癌症护理设施外，乌干达的艾滋病毒感染率极高，癌症发病率也在上升。据我们所知，这项拟议的研究将是第一个调查艾滋病毒及其治疗与资源匮乏环境中艾滋病定义或非艾滋病定义癌症诊断后生存率的关联。拟议的研究将以具有成本效益的方式利用现存的医疗记录，我们预计这项研究的结果将提供对癌症患者中艾滋病毒病因的见解，可以在未来的研究中进行随访。 公共卫生相关性：项目相关性：有效的艾滋病毒治疗（HAART）延长了艾滋病毒阳性人群的预期寿命，因此，艾滋病毒阳性癌症患者的数量持续增加。因此，艾滋病毒感染对癌症诊断后生存率的影响是一个越来越相关的问题，对于艾滋病毒相关的恶性肿瘤，特别是在艾滋病毒流行地区，如东非，在很大程度上仍然没有答案。

DESCRIPTION (provided by applicant): Cancer is an increasingly common complication of HIV infection worldwide, with one of the highest burdens of HIV-associated cancer found in sub-Saharan Africa. Evidence exists for an association between HIV and increased incidence for both AIDS-defining (ADC) and non-AIDS-defining (NADC) cancers. Despite the link between HIV infection and cancer incidence, the question of whether HIV affects cancer progression in infected individuals has not been adequately addressed to date. Little is known about survival after a diagnosis of cancer, particularly in resource-limited settings; limited emerging data does suggest that the presence of HIV infection and its treatment play an important role. The goal of this research is to exmaine the role of HIV and its treatment on survival after a diagnosis of cancer. Specifically we will 1) determine the relationship between HIV serostatus and survival after diagnosis with common AIDS-defining (Kaposi's sarcoma (KS) and cervical) and non-AIDS-defining (breast and lung) cancers and 2) examine the relationship between HIV disease severity, its treatment, and survival in HIV- positive cancer patients. To accomplish these aims, we will study cases of cervical, KS, breast, and lung cancer presenting to the Uganda Cancer Institute (UCI), the sole cancer care facility in Uganda, from 2005- 2010 (n=7,488). Information on HIV serostatus, viral load, CD4 T-cell count, and highly active antiretroviral therapy (HAART) will be available from patient medical records. Follow up for the following outcomes at one year and for full study follow-up will be completed for all cases: overall mortality, cancer-specific mortality, and cancer progression-free survival. The setting of Uganda presents a unique opportunity for HIV-associated malignancy research; in addition to having a world class cancer care facility at UCI, Uganda experiences extremely high rates of HIV infection and increasing rates of cancer. To our knowledge, the proposed study will be the first to investigate the association of HIV and its treatment on survival after diagnosis with either AIDS-defining or non-AIDS defining cancers in a resource-poor setting. The proposed study will utilize extant medical records in a cost- efficient manner, and we anticipate that results from this study will provide insights into the etiology of HIV among cancer patients that can be followed up in future research. PUBLIC HEALTH RELEVANCE: Project Relevance: Effective HIV therapy (HAART) has prolonged the life expectancy of the HIV-positive population, and as a result, the number of HIV-positive individuals living with cancer has continued to increase. As such, the question of the effect of HIV infection on survival after a cancer diagnosis is an increasingly relevant one that remains largely unanswered for HIV-associated malignancies, particularly in HIV-endemic regions such as East Africa.