Division of Infectious Diseases, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
AIDS. 2011 Mar 13;25(5):691-700. doi: 10.1097/QAD.0b013e3283437f77.
To evaluate survival and predictors of mortality after cancer diagnosis among HIV-infected persons receiving combination antiretroviral therapy (cART).
Multisite cohort study.
We examined all-cause mortality among HIV-infected patients treated with cART in routine care at eight US sites and diagnosed with cancer between 1996 and 2009, and predictors of mortality using Cox proportional hazards regression models. Non-AIDS-defining cancers (NADCs) were classified as related and unrelated to viral coinfections.
Out of 20 677 persons in the Centers for AIDS Research Network of Integrated Clinical Systems cohort, 650 cART-treated individuals developed invasive cancer. Of these, 305 died during 1480 person-years of follow-up; crude mortality rate was 20.6 per 100 person-years [95% confidence interval (CI) 18.4, 23.1] and overall 2-year survival was 58% (95% CI 54, 62). Highest mortality was seen in primary central nervous system non-Hodgkin's lymphoma, liver, and lung cancer with rates of 90.6, 84.3, and 68.1 per 100 person-years, respectively. Adjusted hazard of death was higher among those who were older and had stage IV cancer. Adjusted hazard of death was lower among those with higher CD4 cell counts at cancer diagnosis, who achieved HIV-RNA suppression (≤400 copies/ml) on cART, received any cancer treatment, and had AIDS-defining cancer or infection-related NADCs compared to infection-unrelated NADCs.
Independent predictors of mortality after cancer diagnosis among HIV-infected persons include poor immune status, failure to suppress HIV-RNA on cART, cancer stage, and lack of cancer treatment. Modification of these factors with improved strategies for the prevention and treatment of HIV and HIV-associated malignancies are needed.
评估接受联合抗逆转录病毒疗法（cART）的 HIV 感染者癌症诊断后的生存情况及其死亡预测因素。
多地点队列研究。
我们研究了在 8 个美国地点接受常规 cART 治疗且在 1996 年至 2009 年间被诊断患有癌症的 HIV 感染者的全因死亡率，并使用 Cox 比例风险回归模型来评估死亡率的预测因素。非艾滋病定义性癌症（NADC）分为与病毒合并感染相关和不相关两类。
在 AIDS 研究网络综合临床系统队列中，共有 20677 名接受 cART 治疗的患者，其中 650 名患者发生侵袭性癌症。在这 650 名患者中，有 305 人在 1480 人年的随访期间死亡；粗死亡率为 20.6/100 人年（95%可信区间 [CI] 18.4，23.1），总体 2 年生存率为 58%（95%CI 54，62）。原发性中枢神经系统非霍奇金淋巴瘤、肝癌和肺癌的死亡率最高，分别为 90.6、84.3 和 68.1/100 人年。年龄较大且处于癌症 IV 期的患者死亡风险更高。在癌症诊断时 CD4 细胞计数较高、cART 达到 HIV-RNA 抑制（≤400 拷贝/ml）、接受任何癌症治疗以及患有艾滋病定义性癌症或与感染相关的 NADC 而非感染不相关的 NADC 的患者，其死亡风险较低。
HIV 感染者癌症诊断后死亡的独立预测因素包括免疫状态差、cART 抑制 HIV-RNA 失败、癌症分期和缺乏癌症治疗。需要通过改进预防和治疗 HIV 及与 HIV 相关恶性肿瘤的策略来改变这些因素。
