瑞士HIV队列研究中高效抗逆转录病毒治疗前后非霍奇金淋巴瘤的发病率

Non-Hodgkin lymphoma incidence in the Swiss HIV Cohort Study before and after highly active antiretroviral therapy.

作者信息

Polesel Jerry, Clifford Gary M, Rickenbach Martin, Dal Maso Luigino, Battegay Manuel, Bouchardy Christine, Furrer Hansjakob, Hasse Barbara, Levi Fabio, Probst-Hensch Nicole M, Schmid Patrick, Franceschi Silvia

机构信息

Epidemiology and Biostatics Unit, Aviano Cancer Center, Aviano, Italy.

出版信息

AIDS. 2008 Jan 11;22(2):301-6. doi: 10.1097/QAD.0b013e3282f2705d.

DOI:10.1097/QAD.0b013e3282f2705d

PMID:18097233

Abstract

OBJECTIVE

To assess the long-term effect of HAART on non-Hodgkin lymphoma (NHL) incidence in people with HIV (PHIV).

DESIGN

Follow-up of the Swiss HIV Cohort Study (SHCS).

METHODS

Between 1984 and 2006, 12 959 PHIV contributed a total of 75 222 person-years (py), of which 36 787 were spent under HAART. Among these PHIV, 429 NHL cases were identified from the SHCS dataset and/or by record linkage with Swiss Cantonal Cancer Registries. Age- and gender-standardized incidence was calculated and Cox regression was used to estimate hazard ratios (HR).

RESULTS

NHL incidence reached 13.6 per 1000 py in 1993-1995 and declined to 1.8 in 2002-2006. HAART use was associated with a decline in NHL incidence [HR = 0.26; 95% confidence interval (CI), 0.20-0.33], and this decline was greater for primary brain lymphomas than other NHL. Among non-HAART users, being a man having sex with men, being 35 years of age or older, or, most notably, having low CD4 cell counts at study enrollment (HR = 12.26 for < 50 versus >or= 350 cells/microl; 95% CI, 8.31-18.07) were significant predictors of NHL onset. Among HAART users, only age was significantly associated with NHL risk. The HR for NHL declined steeply in the first months after HAART initiation (HR = 0.46; 95% CI, 0.27-0.77) and was 0.12 (95% CI, 0.05-0.25) 7 to10 years afterwards.

CONCLUSIONS

HAART greatly reduced the incidence of NHL in PHIV, and the influence of CD4 cell count on NHL risk. The beneficial effect remained strong up to 10 years after HAART initiation.

摘要

目的

评估高效抗逆转录病毒治疗（HAART）对感染人类免疫缺陷病毒（HIV）者（PHIV）非霍奇金淋巴瘤（NHL）发病率的长期影响。

设计

瑞士HIV队列研究（SHCS）的随访研究。

方法

在1984年至2006年期间，12959名PHIV贡献了总计75222人年（py），其中36787人年处于HAART治疗之下。在这些PHIV中，429例NHL病例从SHCS数据集和/或通过与瑞士各州癌症登记处的记录链接得以识别。计算年龄和性别标准化发病率，并使用Cox回归估计风险比（HR）。

结果

1993 - 1995年NHL发病率达到每1000人年13.6例，在2002 - 2006年降至1.8例。使用HAART与NHL发病率下降相关[HR = 0.26；95%置信区间（CI），0.20 - 0.33]，并且原发性脑淋巴瘤的下降幅度大于其他NHL。在未使用HAART者中，男男性行为者、年龄35岁及以上，或者最显著的是，研究入组时CD4细胞计数低（CD4细胞计数<50个/微升与≥350个/微升相比，HR = 12.26；95% CI，8.31 - 18.07）是NHL发病的显著预测因素。在使用HAART者中，只有年龄与NHL风险显著相关。HAART开始后的头几个月NHL的HR急剧下降（HR = 0.46；95% CI，0.27 - 0.77），7至10年后为0.12（95% CI，0.05 - 0.25）。