Piketty Christophe, Selinger-Leneman Hana, Grabar Sophie, Duvivier Claudine, Bonmarchand Manuela, Abramowitz Laurent, Costagliola Dominique, Mary-Krause Murielle
AP-HP, Department of Clinical Immunology, Georges Pompidou European Hospital, René Descartes University, Paris, France.
AIDS. 2008 Jun 19;22(10):1203-11. doi: 10.1097/QAD.0b013e3283023f78.
To describe the cases of anal cancer that appeared in the French Hospital Database on HIV between 1992 and 2004 and to study risk factors of anal cancer.
We examined the incidence rates of anal cancer between 1992 and 2004 and the risk associated among 86,322 HIV-infected patients included in the French Hospital Database on HIV.
We identified 132 cases of anal cancer, including 124 cases in men (94%), of whom 75% had sex with men. Median age at diagnosis was 42.8 years (interquartile range: 36.9-49.4). At diagnosis, 103 patients (78%) were receiving combination antiretroviral therapy for a median of 37.1 months (interquartile range: 4.5-59.8). Median survival after anal cancer diagnosis was 5 years. The respective overall incidence rates of anal cancer per 100,000 person-years between 1992 and March 1996, April 1996 to 1998 and between 1999 and 2004 were 11 (95% confidence interval, 4-17), 18 (95% confidence interval, 10-27) and 40 (95% confidence interval, 32-47). The risk of anal cancer was higher among men who have sex with men. After adjustment for age at inclusion in the study, as well as gender, the HIV transmission group, the nadir CD4 cell count and AIDS status, the incidence was higher in the years 1999-2004 than in between 1992 to March 1996 (hazard ratio, 2.5; 95% confidence interval, 1.2-5.3), with no change in the years 1999-2004.
The incidence of anal cancer has increased among HIV-infected patients in France since 1996. Although an ascertainment bias cannot be excluded, data indicate that combination antiretroviral therapy does not prevent anal cancer in these patients. This supports the urgent need for developing anal cancer screening programs for HIV-infected men who have sex with men.
描述1992年至2004年间法国医院艾滋病毒数据库中出现的肛门癌病例，并研究肛门癌的危险因素。
我们调查了1992年至2004年间肛门癌的发病率以及法国医院艾滋病毒数据库中86322名艾滋病毒感染患者的相关风险。
我们识别出132例肛门癌病例，其中男性124例（94%），其中75%与男性发生过性行为。诊断时的中位年龄为42.8岁（四分位间距：36.9 - 49.4）。诊断时，103例患者（78%）正在接受联合抗逆转录病毒治疗，中位治疗时间为37.1个月（四分位间距：4.5 - 59.8）。肛门癌诊断后的中位生存期为5年。1992年至1996年3月、1996年4月至1998年以及1999年至2004年间每10万人年的肛门癌总体发病率分别为11（95%置信区间，4 - 17）、18（95%置信区间，10 - 27）和40（95%置信区间，32 - 47）。与男性发生性行为的男性患肛门癌的风险更高。在对纳入研究时的年龄、性别、艾滋病毒传播组、最低CD4细胞计数和艾滋病状态进行调整后，1999 - 2004年的发病率高于1992年至1996年3月（风险比，2.5；95%置信区间，1.2 - 5.3），1999 - 2004年期间无变化。
自1996年以来，法国艾滋病毒感染患者中肛门癌的发病率有所上升。尽管不能排除确诊偏倚，但数据表明联合抗逆转录病毒治疗并不能预防这些患者患肛门癌。这支持了迫切需要为与男性发生性行为的艾滋病毒感染男性制定肛门癌筛查计划。
