Biggar Robert J, Chaturvedi Anil K, Goedert James J, Engels Eric A
Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Room EPS 8014, Bethesda, MD 20852, USA.
J Natl Cancer Inst. 2007 Jun 20;99(12):962-72. doi: 10.1093/jnci/djm010. Epub 2007 Jun 12.
The incidence of Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer has been declining among persons with AIDS. We investigated the association between cancer risk and CD4 cell count among such persons.
Data from US AIDS registries were linked to local cancer registry data. Cancer incidence per 100,000 person-years was determined for the 4-27 months from the onset of AIDS from January 1, 1990, through December 31, 1995--before highly active antiretroviral therapy (HAART) became available--and from January 1, 1996, through December 31, 2002. The relationships between CD4 count at AIDS onset and cancer incidence were assessed by proportional hazards models.
Among 325,516 adults with AIDS, the incidence of Kaposi sarcoma was lower in 1996-2002 (334.6 cases per 100,000 person-years) than in 1990-1995 (1838.9 cases per 100,000 person-years), and the incidence of non-Hodgkin lymphoma followed a similar pattern (i.e., 390.1 cases per 100,000 person-years in 1996-2002 and 1066.2 cases per 100,000 person-years in 1990-1995). In 1996-2002, for each decline in CD4 cell count of 50 cells per microliter of blood, increased risks were found for Kaposi sarcoma (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.33 to 1.50), for central nervous system non-Hodgkin lymphoma subtypes (HR = 1.85, 95% CI = 1.58 to 2.16), and for non-central nervous system diffuse large B-cell lymphoma (HR = 1.12, 95% CI = 1.04 to 1.20) but not for non-central nervous system Burkitt lymphoma (HR = 0.93, 95% CI = 0.81 to 1.06). Cervical cancer incidence was higher in 1996-2002 (86.5 per 100,000 person-years) than in 1990-1995 (64.2 per 100,000 person-years), although not statistically significantly so (relative risk [RR] = 1.41, 95% CI = 0.81 to 2.46). After adjustment for age, race, and sex or mode of HIV exposure, the risks for Kaposi sarcoma (RR = 0.22, 95% CI = 0.20 to 0.24) and for non-Hodgkin lymphoma (RR = 0.40, 95% CI = 0.36 to 0.44) were lower in the period of 1996-2002 than in 1990-1995. Similar relationships of these cancers to CD4 count were observed for 1990-1995.
Both before and after HAART was available, CD4 count was strongly associated with risks for Kaposi sarcoma and non-Hodgkin lymphoma but not for cervical cancer and Burkitt lymphoma. The decreasing incidences of most AIDS-associated cancers in persons with AIDS during the 1990s are consistent with improving CD4 counts after HAART introduction in 1996.
艾滋病患者中卡波西肉瘤、非霍奇金淋巴瘤和宫颈癌的发病率一直在下降。我们调查了此类患者癌症风险与CD4细胞计数之间的关联。
将美国艾滋病登记处的数据与当地癌症登记处的数据相链接。确定了1990年1月1日至1995年12月31日（高效抗逆转录病毒治疗[HAART]出现之前）以及1996年1月1日至2002年12月31日艾滋病发病后4至27个月每10万人年的癌症发病率。通过比例风险模型评估艾滋病发病时的CD4计数与癌症发病率之间的关系。
在325516名成年艾滋病患者中，1996 - 2002年卡波西肉瘤的发病率（每10万人年334.6例）低于1990 - 1995年（每10万人年1838.9例），非霍奇金淋巴瘤的发病率也呈现类似模式（即1996 - 2002年为每10万人年390.1例，1990 - 1995年为每10万人年1066.2例）。1996 - 2002年，每微升血液中CD4细胞计数每下降50个细胞，卡波西肉瘤（风险比[HR]=1.40，95%置信区间[CI]=1.33至1.50）、中枢神经系统非霍奇金淋巴瘤亚型（HR = 1.85，95% CI = 1.58至2.16）以及非中枢神经系统弥漫性大B细胞淋巴瘤（HR = 1.12，95% CI = 1.04至1.20）的风险增加，但非中枢神经系统伯基特淋巴瘤的风险未增加（HR = 0.93，95% CI = 0.81至1.06）。1996 - 2002年宫颈癌发病率（每10万人年86.5例）高于1990 - 1995年（每10万人年64.2例），尽管差异无统计学意义（相对风险[RR]=1.41，95% CI = 0.81至2.46）。在对年龄、种族、性别或HIV暴露方式进行调整后，1996 - 2002年期间卡波西肉瘤（RR = 0.22，95% CI = 0.20至0.24）和非霍奇金淋巴瘤（RR = 0.40，95% CI = 0.36至0.44）的风险低于1990 - 1995年。1990 - 1995年也观察到这些癌症与CD4计数之间存在类似关系。
在HAART出现之前和之后，CD4计数均与卡波西肉瘤和非霍奇金淋巴瘤的风险密切相关，但与宫颈癌和伯基特淋巴瘤的风险无关。20世纪90年代艾滋病患者中大多数与艾滋病相关癌症发病率的下降与1996年引入HAART后CD4计数的改善一致。
