1999-2009 年意大利北部一个大区的 HIV 感染者与普通人群相比，艾滋病定义性癌症及病毒相关和非病毒相关非艾滋病定义性癌症的发病率。

Incidence of AIDS-defining cancers and virus-related and non-virus-related non-AIDS-defining cancers among HIV-infected patients compared with the general population in a large health district of Northern Italy, 1999-2009.

机构信息

University Division of Infectious and Tropical Diseases, University of Brescia, Brescia Spedali Civili General Hospital, Brescia, Italy.

出版信息

HIV Med. 2013 Sep;14(8):481-90. doi: 10.1111/hiv.12034. Epub 2013 Apr 7.

DOI:10.1111/hiv.12034

PMID:23560682

Abstract

OBJECTIVES

The aim of the study was to investigate the incidence of AIDS-defining cancers (ADCs) and virus-related and non-virus-related non-AIDS-defining cancers (NADCs) in HIV-infected patients compared with the general population, and to assess the risk factors associated with these malignancies.

METHODS

We performed a retrospective cohort study for the period from 1999 to 2009 of HIV-infected patients residing in the Local Health Authority of Brescia (northern Italy). Observed cancers in patients with HIV infection were compared with expected cancers in the population living in the same area using standardized incidence ratios (SIRs). Risk factors were assessed using Poisson regression analysis.

RESULTS

A total of 5090 HIV-infected patients were included in the study, with 32 390 person-years of follow-up. We recorded 416 tumours in 390 HIV-infected patients. Two hundred of these (48.1%) were ADCs, 138 (33.2%) were non-virus-related NADCs and 78 (18.7%) were virus-related NADCs. An increased risk (SIR = 4.2) of cancers overall was found in HIV-infected patients. A large excess of ADCs (SIR = 31.0) and virus-related NADCs (SIR = 12.3) was observed in HIV-infected patients, while the excess risk for non-virus-related NADCs was small (SIR = 1.6). The highest SIRs were observed for Kaposi sarcoma among ADCs and for Hodgkin lymphoma among virus-related NADCs. Conversely, among non-virus-related NADCs, SIRs for a broad range of malignancies were close to unity. In multivariate analysis, increasing age and CD4 cell count < 50 cells/μL were the only factors independently associated with all cancers.

CONCLUSIONS

Among HIV-infected people there was an excess of ADCs and also of NADCs, particularly those related to viral infections. Ageing and severe immunodeficiency were the strongest predictors.

摘要

目的

本研究旨在比较 HIV 感染者与普通人群中艾滋病定义性癌症（ADCs）和病毒相关及非病毒相关非艾滋病定义性癌症（NADCs）的发病率，并评估与这些恶性肿瘤相关的危险因素。

方法

我们对 1999 年至 2009 年期间居住在意大利布雷西亚地方卫生局（北部）的 HIV 感染者进行了回顾性队列研究。采用标准化发病率比（SIR）比较 HIV 感染者中的观察性癌症与同一地区人群中的预期癌症。采用泊松回归分析评估危险因素。

结果

共纳入 5090 例 HIV 感染者，随访 32390 人年。我们在 390 例 HIV 感染者中记录了 416 例肿瘤。其中 200 例（48.1%）为 ADC，138 例（33.2%）为非病毒相关 NADCs，78 例（18.7%）为病毒相关 NADCs。HIV 感染者的癌症总体风险增加（SIR=4.2）。HIV 感染者的 ADC （SIR=31.0）和病毒相关 NADCs（SIR=12.3）的发病率显著升高，而非病毒相关 NADCs 的超额风险较小（SIR=1.6）。在 ADC 中，卡波西肉瘤的 SIR 最高，在病毒相关 NADCs 中，霍奇金淋巴瘤的 SIR 最高。相反，在非病毒相关 NADCs 中，多种恶性肿瘤的 SIR 接近 1。在多变量分析中，年龄增长和 CD4 细胞计数＜50 个/μL 是与所有癌症相关的唯一独立因素。