Division of Infectious Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9113, USA.
Curr HIV/AIDS Rep. 2013 Sep;10(3):207-16. doi: 10.1007/s11904-013-0166-8.
In the highly active antiretroviral therapy (HAART) era, the incidence of non-AIDS-defining cancers (NADC) has increased and contributes to a growing proportion of mortality in the aging HIV-infected population. The underlying pathogenic mechanisms of increased cancer risk are incompletely understood. Potential contributors include oncogenic effects of the HIV virus, immunosuppression, chronic inflammation and immune activation, exposure to HAART, higher rates of oncogenic viral coinfections and traditional cancer risk factors. HIV-infected patients often present with NADC at younger ages with more aggressive or advanced stage disease. However, when standard cancer therapy is given, treatment outcomes appear similar to the non-HIV population. These facts highlight the importance of clinicians' maintaining a high index of suspicion, performing age-appropriate screening, and optimizing cancer therapy. Development of novel strategies for screening, prevention, and treatment of NADC will be required to reverse these epidemiologic trends and improve the survival of HIV-infected patients.
在高效抗逆转录病毒治疗 (HAART) 时代，非艾滋病定义性癌症 (NADC) 的发病率增加，并导致老龄化 HIV 感染人群的死亡率不断上升。癌症风险增加的潜在发病机制尚不完全清楚。潜在的致病因素包括 HIV 病毒的致癌作用、免疫抑制、慢性炎症和免疫激活、HAART 暴露、致癌性病毒合并感染的发生率较高以及传统的癌症危险因素。HIV 感染者常因 NADC 在较年轻时发病，且疾病更具侵袭性或处于晚期。然而，当给予标准癌症治疗时，治疗效果似乎与非 HIV 人群相似。这些事实强调了临床医生保持高度怀疑、进行适龄筛查和优化癌症治疗的重要性。需要制定新的筛查、预防和治疗 NADC 的策略，以扭转这些流行病学趋势并提高 HIV 感染者的生存率。
