美国 HIV 感染者中的癌症负担。
Cancer burden in the HIV-infected population in the United States.
机构信息
Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852, USA.
出版信息
J Natl Cancer Inst. 2011 May 4;103(9):753-62. doi: 10.1093/jnci/djr076. Epub 2011 Apr 11.
BACKGROUND
Effective antiretroviral therapy has reduced the risk of AIDS and dramatically prolonged the survival of HIV-infected people in the United States. Consequently, an increasing number of HIV-infected people are at risk of non-AIDS-defining cancers that typically occur at older ages. We estimated the annual number of cancers in the HIV-infected population, both with and without AIDS, in the United States.
METHODS
Incidence rates for individual cancer types were obtained from the HIV/AIDS Cancer Match Study by linking 15 HIV and cancer registries in the United States. Estimated counts of the US HIV-infected and AIDS populations were obtained from Centers for Disease Control and Prevention surveillance data. We obtained estimated counts of AIDS-defining (ie, Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer) and non-AIDS-defining cancers in the US AIDS population during 1991-2005 by multiplying cancer incidence rates and AIDS population counts, stratified by year, age, sex, race and ethnicity, transmission category, and AIDS-relative time. We tested trends in counts and standardized incidence rates using linear regression models. We multiplied overall cancer rates and HIV-only (HIV infected, without AIDS) population counts, available from 34 US states during 2004-2007, to estimate cancers in the HIV-only population. All statistical tests were two-sided.
RESULTS
The US AIDS population expanded fourfold from 1991 to 2005 (96,179 to 413,080) largely because of an increase in the number of people aged 40 years or older. During 1991-2005, an estimated 79 656 cancers occurred in the AIDS population. From 1991-1995 to 2001-2005, the estimated number of AIDS-defining cancers decreased by greater than threefold (34,587 to 10,325 cancers; P(trend) < .001), whereas non-AIDS-defining cancers increased by approximately threefold (3193 to 10,059 cancers; P(trend) < .001). From 1991-1995 to 2001-2005, estimated counts increased for anal (206 to 1564 cancers), liver (116 to 583 cancers), prostate (87 to 759 cancers), and lung cancers (875 to 1882 cancers), and Hodgkin lymphoma (426 to 897 cancers). In the HIV-only population in 34 US states, an estimated 2191 non-AIDS-defining cancers occurred during 2004-2007, including 454 lung, 166 breast, and 154 anal cancers.
CONCLUSIONS
Over a 15-year period (1991-2005), increases in non-AIDS-defining cancers were mainly driven by growth and aging of the AIDS population. This growing burden requires targeted cancer prevention and treatment strategies.
背景
有效的抗逆转录病毒疗法降低了艾滋病的风险，并极大地延长了美国 HIV 感染者的生存时间。因此，越来越多的 HIV 感染者面临着非艾滋病定义的癌症的风险，这些癌症通常发生在年龄较大的时候。我们估计了美国 HIV 感染者（包括有和没有艾滋病的）中癌症的年发病数。
方法
通过将美国 15 个 HIV 和癌症登记处与 HIV/AIDS 癌症匹配研究相联系，获得了各种癌症类型的发病率。从疾病控制和预防中心的监测数据中获得了美国 HIV 感染者和艾滋病患者的估计人数。我们通过将癌症发病率乘以艾滋病患者人数，来获得美国艾滋病患者中艾滋病定义性癌症（即卡波济肉瘤、非霍奇金淋巴瘤和宫颈癌）和非艾滋病定义性癌症的估计发病数，这是在 1991-2005 年期间按年份、年龄、性别、种族和族裔、传播类别和艾滋病相对时间进行分层的。我们使用线性回归模型测试了发病率和标准化发病率的趋势。我们将美国 34 个州在 2004-2007 年期间的总体癌症发病率和 HIV 感染者（HIV 感染但没有艾滋病）的人数相乘，以估计 HIV 感染者中的癌症。所有的统计检验都是双侧的。
结果
美国的艾滋病患者人数从 1991 年到 2005 年增加了四倍（从 96179 人增加到 413080 人），这主要是由于 40 岁或以上的人数增加。在 1991-2005 年期间，估计有 79656 例癌症发生在艾滋病患者中。从 1991-1995 年到 2001-2005 年，艾滋病定义性癌症的估计数量减少了三倍以上（从 34587 例减少到 10325 例；趋势 P<0.001），而非艾滋病定义性癌症的数量增加了约三倍（从 3193 例增加到 10059 例；趋势 P<0.001）。从 1991-1995 年到 2001-2005 年，估计发病率增加的癌症包括肛门（206 例增加到 1564 例）、肝脏（116 例增加到 583 例）、前列腺（87 例增加到 759 例）和肺癌（875 例增加到 1882 例），以及霍奇金淋巴瘤（426 例增加到 897 例）。在 34 个美国州的 HIV 感染者中，2004-2007 年期间估计有 2191 例非艾滋病定义性癌症，包括 454 例肺癌、166 例乳腺癌和 154 例肛门癌。
结论
在 15 年期间（1991-2005 年），非艾滋病定义性癌症的增加主要是由于艾滋病患者人数的增长和老龄化。这种不断增加的负担需要有针对性的癌症预防和治疗策略。
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