*Division of Research, Kaiser Permanente Northern California, Oakland, CA; †Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA; ‡Department of Infectious Diseases, Kaiser Permanente, San Leandro Medical Center, San Leandro, CA; §Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD; ‖Department of Internal Medicine, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA; ¶Department of Hematology-Oncology, San Francisco General Hospital, University of California San Francisco, San Francisco, CA.
J Acquir Immune Defic Syndr. 2014 Aug 15;66(5):495-502. doi: 10.1097/QAI.0000000000000202.
We investigated whether the reported lower incidence of prostate cancer in HIV-positive men is a result of confounding factors or reduced screening.
We conducted a cohort study of 17,424 HIV-positive and 182,799 HIV-negative men enrolled in Kaiser Permanente (KP). Subjects were followed from the first KP enrollment after January 01, 1996 for KP Northern California (KPNC) and January 01, 2000 for KP Southern California until the earliest of prostate cancer diagnosis, loss to follow-up, or December 31, 2007. Poisson regression was used to compare cancer rates by HIV status adjusting for age, race, smoking, alcohol/drug abuse, overweight/obesity, and diabetes. For the KPNC subset, we analyzed additional available data by HIV status on testosterone deficiency, and on prostate-specific antigen (PSA) tests as a proxy for cancer screening.
The prostate cancer incidence rate was 102/100,000 person-years in HIV-positive men (n = 74 cases) and 131/100,000 person-years in HIV-negative men (n = 1195 cases), with an adjusted rate ratio of 0.73 (95% confidence interval: 0.57 to 0.92; P = 0.008). The reduced risk among HIV-positive men was greater for higher-stage cancers, which are less likely to be biased by screening differences than lower-stage cancers. In the KPNC subset, more HIV-positive (90.8%) than HIV-negative men (86.2%) received a PSA test by age 55 (P < 0.001). Decreased risk for HIV-positive men remained when examined only among those with a previous PSA test, and with adjustment for testosterone deficiency (rate ratio = 0.55; 95% confidence interval: 0.39 to 0.80; P = 0.001).
Prostate cancer incidence rates are lower in HIV-positive compared with HIV-negative men, which is not explained by screening differences or the risk factors evaluated.
我们研究了 HIV 阳性男性中报告的前列腺癌发病率较低是否是由于混杂因素或筛查减少所致。
我们对 Kaiser Permanente（KP）中招募的 17424 名 HIV 阳性男性和 182799 名 HIV 阴性男性进行了队列研究。研究对象自 1996 年 1 月 1 日起，KP 北加利福尼亚（KPNC）首次加入 KP，2000 年 1 月 1 日起，KP 南加利福尼亚加入 KP，直至最早诊断出前列腺癌、随访丢失或 2007 年 12 月 31 日。采用泊松回归比较 HIV 阳性和 HIV 阴性男性的癌症发病率，调整年龄、种族、吸烟、饮酒/药物滥用、超重/肥胖和糖尿病等因素。对于 KPNC 亚组，我们还根据 HIV 状态分析了睾酮缺乏和前列腺特异性抗原（PSA）检测（作为癌症筛查的替代指标）的可用数据。
HIV 阳性男性（n = 74 例）的前列腺癌发病率为 102/100000 人年，HIV 阴性男性（n = 1195 例）的发病率为 131/100000 人年，调整后的发病率比为 0.73（95%置信区间：0.57 至 0.92；P = 0.008）。HIV 阳性男性的风险降低幅度更大，表明较高阶段的癌症不太可能受到筛查差异的影响，而较低阶段的癌症则更容易受到影响。在 KPNC 亚组中，更多的 HIV 阳性男性（90.8%）比 HIV 阴性男性（86.2%）在 55 岁时接受了 PSA 检测（P < 0.001）。仅对有过 PSA 检测的男性进行检查，并调整睾酮缺乏情况，HIV 阳性男性的风险降低仍然存在（发病率比 = 0.55；95%置信区间：0.39 至 0.80；P = 0.001）。
与 HIV 阴性男性相比，HIV 阳性男性的前列腺癌发病率较低，这不能用筛查差异或评估的危险因素来解释。
