HIV 感染对结直肠肿瘤的影响：亚洲患者的前瞻性结肠镜研究。

Impact of HIV infection on colorectal tumors: a prospective colonoscopic study of Asian patients.

机构信息

*AIDS Clinical Center and †Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan; ‡Center for AIDS Research, Kumamoto University, Kumamoto, Japan; §Research and Informatics, International Clinical Research Center Research Institute, and ‖Pathology Division of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan; and ¶The Research Center for Hepatitis and Immunology, Department of Gastroenterology and Hepatology, and #Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.

出版信息

J Acquir Immune Defic Syndr. 2014 Mar 1;65(3):312-7. doi: 10.1097/QAI.0000000000000016.

DOI:10.1097/QAI.0000000000000016

PMID:24525468

Abstract

BACKGROUND

Non-AIDS defining cancer has recently become a major problem in HIV-infected patients. Little has been reported on whether HIV infection is a risk factor for colorectal adenoma, especially in Asians.

METHODS

The study was conducted under a prospective cross-sectional design and included all adults who underwent colonoscopy. Subjects were matched by age and sex to compare the prevalence of colorectal adenoma, adenocarcinoma, polyps, and other tumors. Detailed risk factors were assessed, including lifestyle habits, medications, comorbidities, gastrointestinal symptom rating scale, HIV-associated factors, and human papillomavirus infection. To evaluate the effects of HIV infection on adenoma, the odds ratio (OR) was estimated by multivariate logistic regression.

RESULTS

A total of 177 HIV-infected patients and 177 controls were selected for analysis. No significant difference was noted in the prevalence of adenoma (n = 29 vs. 40, P = 0.14). Multivariate analysis adjusted by baseline demographics and risk factors showed that HIV is not associated with increased risk of adenoma (adjusted OR = 0.66, P = 0.16). Kaposi's sarcoma was more common in HIV-infected patients (n = 6 vs. 0, P = 0.03). Among HIV-infected patients, advanced age was an independent and significant risk factor for adenoma (adjusted OR = 2.28, P < 0.01). CD4 count, HIV-RNA, history of antiretroviral treatment, and oncogenic human papillomavirus infection were not risk factors for adenoma.

CONCLUSIONS

HIV infection was not identified as risk for adenoma in Asian patients. However, advanced age was independently associated with increased risk of adenoma. HIV-infected patients should not miss screening opportunity for colorectal adenoma and other gastrointestinal malignancies.

摘要

背景

非艾滋病定义的癌症最近成为 HIV 感染患者的一个主要问题。关于 HIV 感染是否是结直肠腺瘤的危险因素，特别是在亚洲人群中，相关报道较少。

方法

本研究采用前瞻性横断面设计，纳入所有接受结肠镜检查的成年人。通过年龄和性别匹配，比较结直肠腺瘤、腺癌、息肉和其他肿瘤的患病率。评估详细的危险因素，包括生活方式习惯、药物、合并症、胃肠道症状评分量表、与 HIV 相关的因素和人乳头瘤病毒感染。为了评估 HIV 感染对腺瘤的影响，通过多变量逻辑回归估计比值比（OR）。

结果

共选择了 177 例 HIV 感染患者和 177 例对照进行分析。两组腺瘤的患病率（29 例 vs. 40 例，P = 0.14）无显著差异。经基线人口统计学和危险因素调整的多变量分析显示，HIV 与腺瘤风险增加无关（调整后的 OR = 0.66，P = 0.16）。Kaposi 肉瘤在 HIV 感染患者中更为常见（6 例 vs. 0 例，P = 0.03）。在 HIV 感染患者中，年龄较大是腺瘤的独立和显著危险因素（调整后的 OR = 2.28，P < 0.01）。CD4 计数、HIV-RNA、抗逆转录病毒治疗史和致癌型人乳头瘤病毒感染不是腺瘤的危险因素。