Grulich A E, Wan X, Law M G, Milliken S T, Lewis C R, Garsia R J, Gold J, Finlayson R J, Cooper D A, Kaldor J M
National Centre in HIV Epidemiology and Clinical Research, Sydney, New South Wales, Australia.
AIDS. 2000 Jan 28;14(2):133-40. doi: 10.1097/00002030-200001280-00008.
To identify risk factors for non-Hodgkin's lymphoma (NHL) in people with HIV infection.
Case-control study in Sydney, Australia.
Two hundred and nineteen patients with AIDS-related NHL were compared with 219 HIV-infected controls without NHL, matched for CD4 positive cell count and date of specimen collection. Data on demographic, infectious, treatment-related and immunological factors were abstracted by medical record review. The association between demographic factors, sexually transmissible diseases, HIV-related opportunistic infections, anti-viral therapy, duration of immune deficiency and indices of immune stimulation and risk of NHL were derived for these groups.
In a multivariate model, there were two independent groups of predictors of NHL risk. The first was duration of immunodeficiency, as measured by longer time since seroconversion (P for trend 0.008), and lower CD4 positive cell count 1 year prior to the time of NHL diagnosis (P for trend 0.009). The second predictor was B-cell stimulation, as indicated by higher serum globulin (a surrogate marker for serum immunoglobulin, P for trend 0.044) and HIV p24 antigenaemia [odds ratio (OR) for p24 positivity, 1.82; 95% confidence interval (CI), 1.15-2.88]. Indices of B-cell stimulation preceded the diagnosis of NHL by several years. Factors not related to NHL risk included clinical indices of Epstein-Barr virus infection and receipt of individual nucleoside analogue antiretroviral agents. Combination therapy with these agents was associated with a non-significant reduction in NHL risk (OR, 0.68; 95% CI, 0.39-1.18).
Markers of long-standing immune deficiency and B-cell stimulation were associated with an increased risk of developing NHL. Unless the strongest risk factor for NHL, immune deficiency, can be reversed, NHL is likely to become proportionately more important as a cause of morbidity and mortality in people with HIV infection.
确定HIV感染者中非霍奇金淋巴瘤（NHL）的危险因素。
在澳大利亚悉尼进行的病例对照研究。
将219例艾滋病相关NHL患者与219例未患NHL的HIV感染者进行对照，根据CD4阳性细胞计数和标本采集日期进行匹配。通过病历回顾提取有关人口统计学、感染、治疗相关和免疫学因素的数据。得出这些人群的人口统计学因素、性传播疾病、HIV相关机会性感染、抗病毒治疗、免疫缺陷持续时间和免疫刺激指标与NHL风险之间的关联。
在多变量模型中，有两组独立的NHL风险预测因素。第一组是免疫缺陷持续时间，以血清转化后较长时间衡量（趋势P值为0.008），以及NHL诊断前1年较低的CD4阳性细胞计数（趋势P值为0.009）。第二个预测因素是B细胞刺激，表现为较高的血清球蛋白（血清免疫球蛋白的替代标志物，趋势P值为0.044）和HIV p24抗原血症[p24阳性的比值比（OR）为1.82；95%置信区间（CI）为1.15 - 2.88]。B细胞刺激指标在NHL诊断前数年就已出现。与NHL风险无关的因素包括EB病毒感染的临床指标和接受单个核苷类似物抗逆转录病毒药物治疗。这些药物的联合治疗与NHL风险的非显著降低相关（OR为0.68；95%CI为0.39 - 1.18）。
长期免疫缺陷和B细胞刺激的标志物与发生NHL的风险增加相关。除非NHL最强的风险因素免疫缺陷能够得到逆转，否则NHL作为HIV感染者发病和死亡原因的重要性可能会相应增加。
