Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , Georgia.
Cerner Corporation , Vienna, Virginia.
Open Forum Infect Dis. 2014 May 27;1(1):ofu012. doi: 10.1093/ofid/ofu012. eCollection 2014 Mar.
Little is known about survival and factors associated with mortality after cancer diagnosis among persons infected with human immunodeficiency virus (HIV).
Using Poisson regression, we analyzed incidence rates of acquired immune deficiency syndrome (AIDS)-defining cancers (ADC), non-AIDS-defining infection-related cancers (NADCI), and non-AIDS-defining noninfection-related cancers (NADCNI) among HIV Outpatient Study participants seen at least twice from 1996-2010. All-cause mortality within each cancer category and by calendar period (1996-2000, 2001-2005, 2006-2010) were examined using Kaplan-Meier survival methods and log-rank tests. We identified risk factors for all-cause mortality using multivariable Cox proportional hazard models.
Among 8350 patients, 627 were diagnosed with 664 cancers. Over the 3 time periods, the age- and sex-adjusted incidence rates for ADC and NADCNI declined (both P < .001) and for NADCI did not change (P = .13). Five-year survival differed by cancer category (ADC, 54.5%; NADCI, 65.8%; NADCNI, 65.9%; P = .018), as did median CD4 cell count (107, 241, and 420 cells/mm(3); P < .001) and median log10 viral load (4.1, 2.3, and 2.0 copies/mL; P < .001) at cancer diagnosis, respectively. Factors independently associated with increased mortality for ADC were lower nadir CD4 cell count (hazard ratio [HR] = 3.02; 95% confidence interval [CI], 1.39-6.59) and detectable viral load (≥400 copies/mL; HR = 1.72 [95% CI, 1.01-2.94]) and for NADCNI, age (HR = 1.50 [95% CI, 1.16-1.94]), non-Hispanic black race (HR = 1.92 [95% CI, 1.15-3.24]), lower nadir CD4 cell count (HR = 1.77 [95% CI, 1.07-2.94]), detectable viral load (HR = 1.96 [95% CI, 1.18-3.24]), and current or prior tobacco use (HR = 3.18 [95% CI, 1.77-5.74]).
Since 1996, ADC and NADCNI incidence rates have declined. Survival after cancer diagnosis has increased with concomitant increases in CD4 cell count in recent years. Advances in HIV therapy, including early initiation of combination antiretroviral therapy, may help reduce mortality risk among HIV-infected persons with cancer.
人们对艾滋病毒（HIV）感染者癌症诊断后的生存情况和与死亡率相关的因素知之甚少。
我们使用泊松回归分析了 1996 年至 2010 年间至少两次就诊的 HIV 门诊研究参与者中获得性免疫缺陷综合征（AIDS）定义性癌症（ADC）、非 AIDS 定义性感染相关癌症（NADCI）和非 AIDS 定义性非感染相关癌症（NADCNI）的发病率。使用 Kaplan-Meier 生存方法和对数秩检验，检查每个癌症类别的全因死亡率和按日历期（1996-2000 年、2001-2005 年、2006-2010 年）。我们使用多变量 Cox 比例风险模型确定全因死亡率的危险因素。
在 8350 名患者中，有 627 名被诊断患有 664 种癌症。在 3 个时期，ADC 和 NADCNI 的年龄和性别调整发病率均下降（均 P <.001），而 NADCI 没有变化（P =.13）。不同癌症类别的 5 年生存率不同（ADC，54.5%；NADCI，65.8%；NADCNI，65.9%；P =.018），中位 CD4 细胞计数（107、241 和 420 个细胞/mm3；P <.001）和中位 log10 病毒载量（4.1、2.3 和 2.0 拷贝/mL；P <.001）也不同，分别在癌症诊断时。ADC 死亡率增加的独立危险因素是较低的最低 CD4 细胞计数（危险比 [HR] = 3.02；95%置信区间 [CI]，1.39-6.59）和可检测的病毒载量（≥400 拷贝/mL；HR = 1.72 [95% CI，1.01-2.94]），而 NADCNI 的危险因素是年龄（HR = 1.50 [95% CI，1.16-1.94]）、非西班牙裔黑人种族（HR = 1.92 [95% CI，1.15-3.24]）、较低的最低 CD4 细胞计数（HR = 1.77 [95% CI，1.07-2.94]）、可检测的病毒载量（HR = 1.96 [95% CI，1.18-3.24]）以及当前或既往吸烟（HR = 3.18 [95% CI，1.77-5.74]）。
自 1996 年以来，ADC 和 NADCNI 的发病率有所下降。近年来，随着 CD4 细胞计数的增加，癌症诊断后的生存率有所提高。艾滋病毒治疗的进展，包括早期开始联合抗逆转录病毒治疗，可能有助于降低艾滋病毒感染者癌症的死亡率。
