Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA.
Curr Opin Oncol. 2012 Sep;24(5):506-16. doi: 10.1097/CCO.0b013e328355e131.
Combination antiretroviral therapy (ART) has turned HIV infection into a complex chronic disease. This article documents cancer risk among HIV-infected persons, reviews immune system effects of HIV infection in relation to cancer risk, discusses implications for cancer prevention, and suggests future research directions.
There has been a shift in the cancer spectrum from AIDS-defining cancers (ADC) to non-ADC, although the burden of ADC remains high. Although a high prevalence of non-HIV cancer risk factors among HIV-infected persons contributes to cancer risk, substantial evidence has accumulated in favor of an independent association between HIV-induced immunodeficiency and elevated risk of many specific cancer types, most of viral cause, although further work is needed to disentangle immunodeficiency and smoking effects for lung cancer, and immunodeficiency and hepatitis virus effects for liver cancer. Relationships between cancer risk and two other immune system hallmarks of HIV infection, chronic inflammation, and immune dysfunction/senescence, remain poorly understood.
Early, sustained ART is a crucial component of cancer prevention. Continued epidemiologic monitoring is needed to detect possible effects on cancer risk of specific ART classes or medications, long-term exposure to systemic inflammation or immune dysfunction, or earlier or more effective ART.
联合抗逆转录病毒疗法（ART）已将 HIV 感染转变为一种复杂的慢性疾病。本文记录了 HIV 感染者的癌症风险，综述了 HIV 感染对癌症风险的免疫系统影响，讨论了癌症预防的意义，并提出了未来的研究方向。
HIV 感染者的癌症谱已从艾滋病定义性癌症（ADC）转变为非 ADC，尽管 ADC 的负担仍然很高。尽管 HIV 感染者中存在大量非 HIV 癌症风险因素导致癌症风险增加，但大量证据表明，HIV 引起的免疫缺陷与多种特定癌症类型的风险升高之间存在独立关联，这些癌症大多数由病毒引起，尽管仍需要进一步的研究来理清肺癌中免疫缺陷和吸烟的作用，以及肝癌中免疫缺陷和肝炎病毒的作用。癌症风险与 HIV 感染的另外两个免疫系统特征（慢性炎症和免疫功能障碍/衰老）之间的关系仍知之甚少。
早期、持续的 ART 是癌症预防的重要组成部分。需要继续进行流行病学监测，以检测特定的 ART 类别或药物、长期暴露于全身炎症或免疫功能障碍、或更早或更有效的 ART 对癌症风险的可能影响。
