Jacobson L P, Yamashita T E, Detels R, Margolick J B, Chmiel J S, Kingsley L A, Melnick S, Muñoz A
Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205, USA.
J Acquir Immune Defic Syndr. 1999 Aug 1;21 Suppl 1:S34-41.
Effective HIV-1 therapies may directly or indirectly impact the development of AIDS-associated malignancies. Using data from the Multicenter AIDS Cohort Study, a longitudinal cohort study of the natural history of HIV-1 infection among homosexual men, the incidence rates of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL) over calendar time were determined for the 1813 HIV-1-seropositive men enrolled in 1984 through 1985. Poisson regression models were used to identify statistically significant temporal trends. Nested case control studies were used to assess whether recent cases of these malignancies represented treatment breakthroughs. The incidence of KS as a presenting AIDS illness significantly (p = .003) declined from 25.6 cases per 1000 person-years (95% confidence interval [CI], 21.8-29.9) in the early 1990s to an average incidence of 7.5 per 1000 person-years (95% CI, 3.4-16.7) in 1996 through 1997. In contrast, the incidence of NHL has continued to increase significantly (p < .001) at a rate of 21% per year since 1985, although a possible recent decrease is suggested. None of the recent KS cases and only 1 of 8 NHL cases had used the potent antiretroviral therapies, compared with >70 percent of the HIV-1-seropositive men who were free of malignancies and observed over the same time period. These results may be due to an indirect protection against developing KS by the boosting of the immune system by antiretroviral therapies. However, it is important to clarify the direct therapeutic effect on the pathogenic disease mechanism of human herpesvirus type 8 (HHV-8), the agent postulated to be important in the causal pathway of KS. The absence of a similar effect on NHL may be due to a lack of effect on its pathogenesis or because potent antiretroviral therapies need to be administered early in the disease process and the cases that have occurred represent outcomes following a long latency period. With additional follow-up, an impact on NHL may yet be observed.
有效的HIV-1疗法可能直接或间接影响与艾滋病相关的恶性肿瘤的发展。利用多中心艾滋病队列研究的数据，该研究是对同性恋男性中HIV-1感染自然史的纵向队列研究，确定了1984年至1985年入组的1813名HIV-1血清阳性男性中卡波西肉瘤（KS）和非霍奇金淋巴瘤（NHL）随时间的发病率。采用泊松回归模型来确定具有统计学意义的时间趋势。嵌套病例对照研究用于评估这些恶性肿瘤的近期病例是否代表治疗突破。作为首发艾滋病疾病的KS发病率从20世纪90年代初的每1000人年25.6例（95%置信区间[CI]，21.8 - 29.9）显著下降（p = 0.003）至1996年至1997年的平均每1000人年7.5例（95% CI，3.4 - 16.7）。相比之下，NHL的发病率自1985年以来以每年21%的速度持续显著上升（p < 0.001），尽管近期可能有下降趋势。近期的KS病例中无一例使用过强效抗逆转录病毒疗法，8例NHL病例中只有1例使用过，而同期未患恶性肿瘤的HIV-1血清阳性男性中超过70%使用过。这些结果可能是由于抗逆转录病毒疗法增强免疫系统从而对KS的发生起到间接保护作用。然而，明确其对人类疱疹病毒8型（HHV-8）致病机制的直接治疗效果很重要，HHV-8被认为在KS的病因途径中起重要作用。对NHL没有类似效果可能是由于对其发病机制没有影响，或者是因为强效抗逆转录病毒疗法需要在疾病过程早期使用，而发生的病例代表的是长期潜伏期后的结果。随着进一步随访，可能会观察到对NHL的影响。
