Galli Laura, Spagnuolo Vincenzo, Salpietro Stefania, Gianotti Nicola, Cossarini Francesca, Lazzarin Adriano, Castagna Antonella
Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy.
Antivir Ther. 2012;17(3):447-58. doi: 10.3851/IMP1984. Epub 2011 Nov 18.
HAART has reduced mortality in HIV-infected patients; however, the risk of non-AIDS-related events has increased, including cancer. We compared mortality in HIV-infected patients with or without cancer with the general population in Italy.
Eligible patients were recorded in the San Raffaele Infectious Diseases Department database. The ratio of observed deaths to expected all-cause deaths (standardized mortality ratio [SMR]) was standardized for age and gender, and stratified by cancer occurrence or year of HIV infection (≤1998 or >1998). Expected all-cause deaths were obtained from the Istituto Superiore di Sanità (Rome, Italy; 2002 data).
Among 6,495 HIV-infected patients, contributing 75,171 person-years, the SMR was 6.0 (95% CI 5.7, 6.4); SMRs decreased as age increased. Mortality rates were significantly higher than the general population for patients with or without cancer (SMR=15.1 [95% CI 13.6, 16.7] and 4.8 [95% CI 4.5, 5.1], respectively). For patients with or without cancer, SMRs were higher in those aged <45 years than older patients. SMRs for patients with cancer were almost stable in those infected with HIV ≤1998 (15.3; 95% CI 13.7, 17.0) or >1998 (13.5; 95% CI 9.2, 19.1). Among patients with cancer diagnosed with HIV >1998, age-adjusted SMRs ranged from 216.0 (95% CI 43.4, 631.3) to 6.8 (95% CI 4.7, 9.7) in patients <30 years or ≥70 years, respectively.
Mortality in HIV-infected patients remains higher than the general population in Italy, with marked differences according to age, and cancer contributing to an increased excess of mortality.
高效抗逆转录病毒治疗（HAART）已降低了HIV感染患者的死亡率；然而，非艾滋病相关事件的风险有所增加，包括癌症。我们比较了意大利有或没有癌症的HIV感染患者与普通人群的死亡率。
符合条件的患者记录在圣拉斐尔传染病科数据库中。观察到的死亡人数与预期全因死亡人数之比（标准化死亡率[SMR]）按年龄和性别进行标准化，并按癌症发生情况或HIV感染年份（≤1998年或>1998年）进行分层。预期全因死亡人数来自意大利罗马的高等卫生研究院（2002年数据）。
在6495例HIV感染患者中，贡献了75171人年，SMR为6.0（95%CI 5.7，6.4）；SMR随着年龄的增加而降低。有或没有癌症的患者死亡率均显著高于普通人群（分别为SMR=15.1[95%CI 13.6，16.7]和4.8[95%CI 4.5，5.1]）。对于有或没有癌症的患者，年龄<45岁者的SMR高于老年患者。癌症患者中，HIV感染≤1998年者（15.3；95%CI 13.7，17.0）或>1998年者（13.5；95%CI 9.2，19.1）的SMR几乎稳定。在HIV感染>1998年时被诊断出癌症的患者中，年龄调整后的SMR在<30岁或≥70岁的患者中分别为216.0（95%CI 43.4，631.3）至6.8（95%CI 4.7，9.7）。
在意大利，HIV感染患者的死亡率仍然高于普通人群，根据年龄有显著差异，癌症导致死亡率额外增加。
