目前免疫缺陷程度与非获得性免疫缺陷综合征定义性恶性肿瘤之间的关系。

Relationship between current level of immunodeficiency and non-acquired immunodeficiency syndrome-defining malignancies.

机构信息

University College London Medical School, London, UK.

出版信息

Cancer. 2010 Nov 15;116(22):5306-15. doi: 10.1002/cncr.25311.

DOI:10.1002/cncr.25311

PMID:20661911

Abstract

BACKGROUND

In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency syndrome (AIDS)-defining malignancies account for more morbidity and mortality in human immunodeficiency virus-infected patients than AIDS-defining malignancies. However, conflicting data have been reported on the relationship between immunodeficiency and the development of some non-AIDS-defining malignancies.

METHODS

A total of 14,453 patients from the prospective, multinational EuroSIDA cohort were included. Malignancies were classified as virus-related, non-virus-related epithelial, and other. The incidence of non-AIDS-defining malignancies was calculated stratified by current CD4 count. Poisson regression was used to investigate factors associated with the development of non-AIDS-defining malignancies.

RESULTS

A total of 356 non-AIDS-defining malignancies occurred, with an incidence rate of 4.3 per 1000 person years of follow-up (95% confidence interval [CI], 3.8-4.7); 172 (48.3%) were virus-related, 135 (37.9%) were non-virus-related epithelial, and 49 (13.7%) were classified as other. Anal (69 cases), lung (31 cases), and melanoma (13 cases), respectively, were the most common non-AIDS-defining malignancies within each group. After adjustment, current CD4 was associated with virus-related non-AIDS-defining malignancies (incidence rate ratio [IRR], 0.81 per doubling; 95% CI, 0.75-0.88; P < .0001) and non-virus-related epithelial non-AIDS-defining malignancies (IRR, 0.84; 95% CI, 0.75-0.95; P = .004), but not with other non-AIDS-defining malignancies (IRR, 1.04; 95% CI, 0.83-1.31; P = .73). Current CD4 count was also associated with anal cancer (IRR, 0.86; 95% CI, 0.75-0.99; P = .03), Hodgkin lymphoma (n = 52; IRR, 0.83; 95% CI, 0.73-0.95; P = .005), and lung cancer (IRR, 0.76; 95% CI, 0.64-0.90; P = .0002).

CONCLUSIONS

A low current CD4 count was associated with an increased incidence of certain non-AIDS-defining malignancies. Starting cART earlier to reduce the proportion of patients with a low CD4 count may decrease the rate of developing many common non-AIDS-related malignancies. A randomized trial to explore this strategy is urgently needed.

摘要

背景

在联合抗逆转录病毒疗法（cART）时代，非获得性免疫缺陷综合征（AIDS）定义的恶性肿瘤在感染人类免疫缺陷病毒（HIV）的患者中的发病率和死亡率高于 AIDS 定义的恶性肿瘤。然而，关于免疫缺陷与某些非 AIDS 定义的恶性肿瘤的发展之间的关系，已有相互矛盾的数据报告。

方法

共纳入了来自前瞻性、多中心 EuroSIDA 队列的 14453 名患者。恶性肿瘤分为病毒相关、非病毒相关上皮和其他。根据当前 CD4 计数对非 AIDS 定义的恶性肿瘤的发生率进行分层。使用泊松回归分析与非 AIDS 定义的恶性肿瘤发展相关的因素。

结果

共发生 356 例非 AIDS 定义的恶性肿瘤，发病率为每 1000 人年随访 4.3 例（95%置信区间 [CI]，3.8-4.7）；172 例（48.3%）为病毒相关，135 例（37.9%）为非病毒相关上皮，49 例（13.7%）为其他。分析（69 例）、肺（31 例）和黑色素瘤（13 例）分别是每种组中最常见的非 AIDS 定义的恶性肿瘤。调整后，当前 CD4 与病毒相关的非 AIDS 定义的恶性肿瘤（发病率比 [IRR]，每增加一倍 0.81；95%CI，0.75-0.88；P<0.0001）和非病毒相关上皮非 AIDS 定义的恶性肿瘤（IRR，0.84；95%CI，0.75-0.95；P=0.004）相关，但与其他非 AIDS 定义的恶性肿瘤（IRR，1.04；95%CI，0.83-1.31；P=0.73）无关。当前 CD4 计数也与肛门癌（IRR，0.86；95%CI，0.75-0.99；P=0.03）、霍奇金淋巴瘤（n=52；IRR，0.83；95%CI，0.73-0.95；P=0.005）和肺癌（IRR，0.76；95%CI，0.64-0.90；P=0.0002）相关。