1998-2009 年台湾地区全国 HIV/AIDS 患者队列中的癌症发病率。
Cancer incidence in a Nationwide HIV/AIDS patient cohort in Taiwan in 1998-2009.
机构信息
*Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan; †Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; ‡School of Medicine, Mackay Medical College, New Taipei City, Taiwan; §Department and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; ‖Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan; ¶AIDS Malignancy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD; #Epidemiology Branch, Basic Science Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; **Kirby Institute, the University of New South Wales, Sydney, Australia; and ††Department of Microbiology and Institute of Medical Research, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
出版信息
J Acquir Immune Defic Syndr. 2014 Apr 1;65(4):463-72. doi: 10.1097/QAI.0000000000000065.
BACKGROUND
The aims of this study were to investigate the cancer incidence and risk in HIV/AIDS patients relative to the general population in Taiwan.
METHODS
Using Taiwan's National Health Insurance Research Database, 15,269 HIV/AIDS patients were identified between 1998 and 2009. Gender-specific incidence densities (IDs) of both AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC) after HIV infection were calculated. Age-, sex-, and period-adjusted standardized incidence rates (SIRs) were obtained using 1.8 million people from the general population as controls.
RESULTS
A total of 1117 male and 165 female HIV/AIDS patients were diagnosed with cancer. Non-Hodgkin lymphoma (n = 196; ID = 328.79/100,000 person-years) and cervical cancer (n = 50; ID = 712.08/100,000 person-years) were the most common ADCs, whereas liver cancer (n = 125; ID = 184.52/100,000 person-years) and colon cancer (n = 11; ID = 156.66/100,000 person-years) were the most common NADCs in males and females, respectively. Period-adjusted gender-specific ADC and NADC rates decreased from more than 1500 cases/100,000 person-years to less than 500 cases/100,000 person-years (P < 0.001 for trend). SIRs of ADCs and NADCs also decreased. However, relative to the general population, increased SIRs were still seen for most cancers, many of which had an infectious etiology. The highest SIRs in ADCs and NADCs were seen in Kaposi sarcoma [SIR = 298.0, 95% confidence interval (CI): 258.16 to 343.85] and anal cancer (SIR = 19.10, 95% CI: 12.80 to 27.50).
CONCLUSION
This study showed that although the cancer incidence rates have significantly decreased in the highly active antiretroviral therapy era, HIV/AIDS patients were still at increased risk of ADCs and most NADCs. Cancer screening, especially for infection-related NADCs, should therefore be promoted.
背景
本研究旨在调查台湾地区 HIV/AIDS 患者的癌症发病率和风险相对于一般人群的情况。
方法
利用台湾全民健康保险研究数据库，于 1998 年至 2009 年间确定了 15269 例 HIV/AIDS 患者。计算了 AIDS 定义癌症（ADC）和非 AIDS 定义癌症（NADC）在 HIV 感染后的性别特异性发病率密度（ID）。使用一般人群中的 180 万人作为对照，获得了年龄、性别和时期调整后的标准化发病率（SIR）。
结果
共有 1117 例男性和 165 例女性 HIV/AIDS 患者被诊断患有癌症。非霍奇金淋巴瘤（n = 196；ID = 328.79/100,000 人年）和宫颈癌（n = 50；ID = 712.08/100,000 人年）是最常见的 ADC，而肝癌（n = 125；ID = 184.52/100,000 人年）和结肠癌（n = 11；ID = 156.66/100,000 人年）是男性和女性中最常见的 NADCs。经时期调整的性别特异性 ADC 和 NADC 发生率从超过 1500 例/100,000 人年降至低于 500 例/100,000 人年（趋势 P < 0.001）。ADC 和 NADCs 的 SIR 也有所下降。然而，与一般人群相比，大多数癌症的 SIR 仍然较高，其中许多癌症具有传染性病因。ADC 和 NADCs 中 SIR 最高的是卡波西肉瘤[SIR = 298.0，95%置信区间（CI）：258.16 至 343.85]和肛门癌（SIR = 19.10，95%CI：12.80 至 27.50）。
结论
本研究表明，尽管在高效抗逆转录病毒治疗时代癌症发病率显著下降，但 HIV/AIDS 患者仍然面临 ADC 和大多数 NADCs 的风险增加。因此，应促进癌症筛查，特别是针对感染相关 NADCs 的筛查。
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