Yanik Elizabeth L, Katki Hormuzd A, Engels Eric A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
AIDS. 2016 Jun 19;30(10):1663-8. doi: 10.1097/QAD.0000000000001077.
HIV-infected people and elderly people have higher cancer risk, but the combined effects of aging and HIV are not well described. We aimed to evaluate the magnitude of cancer risk in the HIV-infected elderly population.
We conducted a case-cohort study including a 5% sample of U.S. Medicare enrollees and all cancer cases aged at least 65 in linked cancer registries.
HIV was identified through Medicare claims. Among the HIV-infected, absolute cancer risk was calculated accounting for the competing risk of death. Associations between HIV and cancer were estimated with weighted Cox regression adjusting for demographic characteristics.
Among 469 954 people in the 5% sample, 0.08% had an HIV diagnosis. Overall, 825 776 cancer cases were identified in cancer registries. Over 5 years, 10.1% of the HIV-infected elderly developed cancer, the most common diagnoses comprising lung (5-year cumulative incidence=2.2%), prostate (2.7%, among men), and colorectal cancer (0.9%), and non-Hodgkin lymphoma (0.8%). HIV was strongly associated with incidence of Kaposi sarcoma [adjusted hazard ratio (aHR)=94.4, 95% confidence interval (95%CI)=54.6-163], anal cancer (aHR=34.2, 95%CI=23.9-49.0) and Hodgkin lymphoma (aHR=6.3, 95%CI=2.8-14.3). HIV was also associated with incidence of liver cancer, non-Hodgkin lymphoma and lung cancer (aHR=3.4, 2.6, and 1.6, respectively).
In the elderly, HIV infection is associated with higher risk for many cancers, although some associations were weaker than expected, perhaps reflecting effects of non-HIV pathways on cancer development. Due to the effects of HIV and aging, the HIV-infected elderly have a sizeable absolute risk, highlighting a need for cancer prevention.
艾滋病毒感染者和老年人患癌症的风险更高，但衰老和艾滋病毒的综合影响尚无充分描述。我们旨在评估艾滋病毒感染老年人群的癌症风险程度。
我们进行了一项病例队列研究，纳入了美国医疗保险参保者5%的样本以及关联癌症登记处中所有年龄至少65岁的癌症病例。
通过医疗保险理赔记录识别艾滋病毒。在艾滋病毒感染者中，计算考虑死亡竞争风险后的绝对癌症风险。采用加权Cox回归评估艾滋病毒与癌症之间的关联，并对人口统计学特征进行校正。
在5%的样本中的469954人里，0.08%被诊断为感染艾滋病毒。总体而言，癌症登记处共识别出825776例癌症病例。在5年期间，10.1%的艾滋病毒感染老年人患上癌症，最常见的诊断包括肺癌（5年累积发病率=2.2%）、前列腺癌（男性为2.7%）、结直肠癌（0.9%）和非霍奇金淋巴瘤（0.8%）。艾滋病毒与卡波西肉瘤的发病率密切相关[校正风险比（aHR）=94.4，95%置信区间（95%CI）=54.6 - 163]、肛门癌（aHR=34.2，95%CI=23.9 - 49.0）和霍奇金淋巴瘤（aHR=6.3，95%CI=2.8 - 14.3）。艾滋病毒还与肝癌、非霍奇金淋巴瘤和肺癌的发病率相关（aHR分别为3.4、2.6和1.6）。
在老年人中，艾滋病毒感染与多种癌症的较高风险相关，尽管有些关联比预期弱，这可能反映了非艾滋病毒途径对癌症发展的影响。由于艾滋病毒和衰老的影响，艾滋病毒感染老年人有相当大的绝对风险，凸显了癌症预防的必要性。
