Vaccher Emanuela, Serraino Diego, Carbone Antonino, De Paoli Paolo
Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy.
Division of Medical Oncology, Unit of Epidemiology and Biostatistics, Division of Pathology, Scientific Directorate, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
Oncologist. 2014 Aug;19(8):860-7. doi: 10.1634/theoncologist.2014-0024. Epub 2014 Jun 26.
The impact of highly active antiretroviral therapies (HAART) on the risk of non-AIDS-defining cancers (NADCs) and the role of biological and clinical factors in their pathogenesis are debated issues. The purpose of this review is to examine the epidemiology, etiology, and not-yet-defined pathogenic characteristics of NADCs and discuss topics such as treatment strategies, comorbidity, and multidrug interactions. Four types of NADCs that deserve special attention are examined: anal cancer, Hodgkin lymphoma (HL), hepatocellular carcinoma, and lung cancer.
The PubMed database and the Cochrane Library were searched by focusing on NADCs and on the association among NADCs, HAART, aging, and/or chronic inflammation. All articles were reviewed to identify those reporting variables of interest.
NADC incidence is twofold higher in patients with HIV/AIDS than in the corresponding general population, and this elevated risk persists despite the use of HAART. The mechanisms that HIV may use to promote the development of NADCs are presently unclear; immunological mechanisms, either immunodeficiency and/or immunoactivation, may play a role.
Recent clinical studies have suggested that equivalent antineoplastic treatment is feasible and outcome can be similar in HIV-infected patients on HAART compared with uninfected patients for the treatment of HL and anal and lung cancers. However, patients with advanced HIV disease and/or aging-related comorbidities are likely to experience worse outcomes and have poorer tolerance of therapy compared with those with less advanced HIV disease.
高效抗逆转录病毒疗法（HAART）对非艾滋病定义性癌症（NADC）风险的影响以及生物学和临床因素在其发病机制中的作用是存在争议的问题。本综述的目的是研究NADC的流行病学、病因以及尚未明确的致病特征，并讨论治疗策略、合并症和多药相互作用等主题。文中对四类值得特别关注的NADC进行了研究：肛门癌、霍奇金淋巴瘤（HL）、肝细胞癌和肺癌。
通过聚焦NADC以及NADC、HAART、衰老和/或慢性炎症之间的关联，检索了PubMed数据库和Cochrane图书馆。对所有文章进行了综述，以确定那些报告感兴趣变量的文章。
HIV/AIDS患者中NADC的发病率比相应的普通人群高出两倍，尽管使用了HAART，这种升高的风险仍然存在。目前尚不清楚HIV促进NADC发生发展可能采用的机制；免疫机制，无论是免疫缺陷和/或免疫激活，可能都发挥了作用。
最近的临床研究表明，对于HL、肛门癌和肺癌的治疗，与未感染患者相比，接受HAART的HIV感染患者进行等效的抗肿瘤治疗是可行的，且结果可能相似。然而，与HIV疾病程度较轻的患者相比，HIV疾病晚期和/或患有与年龄相关合并症的患者可能预后更差，对治疗的耐受性也更差。
