Mbulaiteye Sam M, Biggar Robert J, Goedert James J, Engels Eric A
Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute/NIH, Bethesda, MD 20852, USA.
J Acquir Immune Defic Syndr. 2003 Apr 15;32(5):527-33. doi: 10.1097/00126334-200304150-00010.
People with AIDS have an elevated risk for cancer. We studied the relationship between cancer risk and AIDS-related immunosuppression as measured by CD4 count at AIDS onset.
We linked records from AIDS and cancer registries in 11 US regions (1990-1996). We studied 82,217 (86.6%) adults who had a CD4 count measured at AIDS onset and survived into the follow-up period. We calculated standardized incidence ratios (SIRs) for AIDS-defining (Kaposi sarcoma [KS], non-Hodgkin lymphoma [NHL] and cervical cancer) as well as non-AIDS-defining cancers in the 2 years after AIDS onset. For each cancer, the change in SIRs across CD4 counts (0-49 cells/mm3, 50-99 cells/mm3, 100-199 cells/mm3, and > or =200 cells/mm3) was modeled using Poisson regression.
The SIRs for KS, NHL, and cervical cancer were 258, 78, and 8.8, respectively. For each fall of 100 CD4 cells/mm3, RRs were 1.36 (95% CI: 1.29-1.43) for KS and 1.48 (95% CI: 1.37-1.59) for NHL. Among NHL subtypes, the association with lower CD4 counts was strongest for immunoblastic lymphoma (RR =1.64, 95% CI: 1.37-1.96, per decline of 100 CD4 cells/mm3) and central nervous system lymphoma (RR = 2.29, 95% CI: 1.95-2.69). The SIR for cervical cancer did not vary with CD4 count (p =.74). For non-AIDS-defining cancers (overall SIR = 2.1), neither the combined risk nor the risk of specific types was associated with declining CD4 counts.
SKS and NHL risk increased with level of immunosuppression at AIDS onset. Risks for other cancers, including cervical cancer, were unrelated to CD4 counts. Elevated risks for non-AIDS cancers may be a result of lifestyle factors.
艾滋病患者患癌症的风险升高。我们研究了癌症风险与艾滋病相关免疫抑制之间的关系，该免疫抑制通过艾滋病发病时的CD4细胞计数来衡量。
我们将美国11个地区（1990 - 1996年）艾滋病和癌症登记处的记录进行了关联。我们研究了82217名（86.6%）在艾滋病发病时进行了CD4细胞计数且存活至随访期的成年人。我们计算了艾滋病发病后2年内艾滋病定义性癌症（卡波西肉瘤[KS]、非霍奇金淋巴瘤[NHL]和宫颈癌）以及非艾滋病定义性癌症的标准化发病比（SIRs）。对于每种癌症，使用泊松回归对CD4细胞计数（0 - 49个细胞/mm³、50 - 99个细胞/mm³、100 - 199个细胞/mm³和≥200个细胞/mm³）范围内SIRs的变化进行建模。
KS、NHL和宫颈癌的SIRs分别为258、78和8.8。CD4细胞计数每下降100个细胞/mm³，KS的相对风险（RR）为1.36（95%置信区间：1.29 - 1.43），NHL的RR为1.48（95%置信区间：1.37 - 1.59）。在NHL亚型中，免疫母细胞性淋巴瘤（RR = 1.64，95%置信区间：1.37 - 1.96，CD4细胞计数每下降100个细胞/mm³）和中枢神经系统淋巴瘤（RR = 2.29，95%置信区间：1.95 - 2.69）与较低CD4细胞计数的关联最强。宫颈癌的SIRs不随CD4细胞计数变化（p = 0.74）。对于非艾滋病定义性癌症（总体SIR = 2.1），综合风险和特定类型的风险均与CD4细胞计数下降无关。
艾滋病发病时KS和NHL的风险随免疫抑制程度增加。其他癌症，包括宫颈癌的风险与CD4细胞计数无关。非艾滋病相关癌症风险升高可能是生活方式因素所致。
