McGinnis Kathleen A, Fultz Shawn L, Skanderson Melissa, Conigliaro Joseph, Bryant Kendall, Justice Amy C
Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
J Clin Oncol. 2006 Nov 1;24(31):5005-9. doi: 10.1200/JCO.2006.05.7984.
To explore the relationship of HIV, hepatitis C (HCV), and alcohol abuse/dependence to risk for hepatocellular carcinoma and non-Hodgkin's lymphoma (NHL).
Male veterans (n = 14,018) with a first HIV diagnosis in the Veterans Affairs Healthcare System from October 1997 to September 2004; and 28,036 age-, race-, sex-, and location-matched HIV-negative veterans were identified. We examined the incidence of hepatocellular carcinoma and NHL and presence of HCV and alcohol abuse/dependence using International Classification of Diseases, ninth revision (ICD-9-CM) codes. HIV-positive to HIV-negative incident rate ratios (IRRs) and 95% CIs for the occurrence of hepatocellular carcinoma and NHL were calculated using Poisson regression models.
HIV-positive veterans were at greater risk for hepatocellular carcinoma than HIV-negative veterans (IRR = 1.68; 95% CI, 1.02 to 2.77). After adjusting for HCV infection and alcohol abuse/dependence, HIV status was not independently associated with hepatocellular cancer (IRR = 0.96; 95% CI, 0.56 to 1.63). HIV-positive veterans had 9.71 times (95% CI, 6.99 to 13.49) greater risk of NHL than HIV-negative veterans. After adjusting for HCV and alcohol abuse/dependence, the IRR for NHL comparing HIV-positive with HIV-negative veterans is similar (IRR = 10.03, 95% CI, 7.19 to 13.97).
HIV-positive veterans have a higher relative incidence of hepatocellular carcinoma and NHL than HIV-negative veterans. For hepatocellular carcinoma, this association appears to be largely explained by the higher prevalence of HCV and alcohol abuse/dependence. Efforts to decrease hepatocellular carcinoma among persons with HIV should focus primarily on detecting and treating HCV and reducing heavy alcohol use.
探讨人类免疫缺陷病毒（HIV）、丙型肝炎（HCV）以及酒精滥用/依赖与肝细胞癌和非霍奇金淋巴瘤（NHL）风险之间的关系。
确定了1997年10月至2004年9月在退伍军人事务医疗系统中首次被诊断为HIV的男性退伍军人（共14,018例），以及28,036例年龄、种族、性别和地点匹配的HIV阴性退伍军人。我们使用国际疾病分类第九版（ICD-9-CM）编码检查肝细胞癌和NHL的发病率以及HCV和酒精滥用/依赖的情况。采用泊松回归模型计算HIV阳性与HIV阴性患者肝细胞癌和NHL发生的发病率比（IRR）及95%置信区间（CI）。
HIV阳性退伍军人患肝细胞癌的风险高于HIV阴性退伍军人（IRR = 1.68；95% CI，1.02至2.77）。在对HCV感染和酒精滥用/依赖进行校正后，HIV状态与肝细胞癌无独立相关性（IRR = 0.96；95% CI，0.56至1.63）。HIV阳性退伍军人患NHL的风险是HIV阴性退伍军人的9.71倍（95% CI，6.99至13.49）。在对HCV和酒精滥用/依赖进行校正后，HIV阳性与HIV阴性退伍军人NHL的IRR相似（IRR = 10.03，95% CI，7.19至13.97）。
HIV阳性退伍军人肝细胞癌和NHL的相对发病率高于HIV阴性退伍军人。对于肝细胞癌，这种关联似乎主要由HCV和酒精滥用/依赖的较高患病率所解释。降低HIV感染者肝细胞癌发病率的努力应主要集中在检测和治疗HCV以及减少大量饮酒上。
