Marcus Julia L, Leyden Wendy A, Chao Chun R, Horberg Michael A, Klein Daniel B, Quesenberry Charles P, Towner William J, Silverberg Michael J
aKaiser Permanente Northern California, Oakland, California bKaiser Permanente Southern California, Pasadena, California cKaiser Permanente Mid-Atlantic States, Rockville, Maryland dKaiser Permanente Northern California, Hayward eKaiser Permanente Southern California, Los Angeles, California, USA.
AIDS. 2017 Apr 24;31(7):989-993. doi: 10.1097/QAD.0000000000001434.
The objective is to clarify the role of immunodeficiency and pneumonia in elevated lung cancer risk among HIV-infected individuals.
Cohort study of HIV-infected and HIV-uninfected adults in a large integrated healthcare system in California during 1996-2011.
We used Poisson models to obtain rate ratios for lung cancer associated with HIV infection, overall and stratified by recent CD4 cells/μl (HIV-uninfected as reference group), with χ tests for trends across CD4 strata. Fully adjusted models included demographics, cancer risk factors (smoking, drug/alcohol abuse, overweight/obesity), and prior pneumonia.
Among 24 768 HIV-infected and 257 600 HIV-uninfected individuals, the lung cancer rate per 100 000 person-years was 66 (n = 80 events) for HIV-infected and 33 (n = 506 events) for HIV-uninfected individuals [rate ratio 2.0, 95% confidence interval (CI): 1.7-2.2]. Overall, HIV-infected individuals were at increased risk of lung cancer after adjustment for demographics and cancer risk factors (rate ratio 1.4, 95% CI: 1.1-1.7), but not after additional adjustment for pneumonia (rate ratio 1.2, 95% CI: 0.9-1.6). Lower CD4 cell counts were associated with higher risk of lung cancer in unadjusted and demographics-adjusted models (P < 0.001 for all), but this trend did not remain after adjustment for cancer risk factors and pneumonia. Compared with HIV-uninfected individuals, HIV-infected individuals with CD4 less than 200 cells/μl were not at increased risk of lung cancer in fully adjusted models.
The increased lung cancer risk among HIV patients is attributable to differences in demographics, risk factors such as smoking, and history of pneumonia. Immunodeficiency does not appear to have an independent effect on lung cancer risk.
旨在阐明免疫缺陷和肺炎在HIV感染者肺癌风险升高中的作用。
对1996年至2011年加利福尼亚州一个大型综合医疗系统中感染HIV和未感染HIV的成年人进行队列研究。
我们使用泊松模型来获取与HIV感染相关的肺癌发病率比，整体以及按近期每微升CD4细胞数分层（以未感染HIV者作为参照组），并通过χ检验分析CD4各层间的趋势。完全调整模型纳入了人口统计学因素、癌症风险因素（吸烟、药物/酒精滥用、超重/肥胖）以及既往肺炎史。
在24768例感染HIV者和257600例未感染HIV者中，每10万人年的肺癌发病率在感染HIV者中为66例（n = 80例事件），在未感染HIV者中为33例（n = 506例事件）[发病率比2.0，95%置信区间（CI）：1.7 - 2.2]。总体而言，在调整了人口统计学因素和癌症风险因素后，感染HIV者患肺癌的风险增加（发病率比1.4，95%CI：1.1 - 1.7），但在进一步调整肺炎因素后则不然（发病率比1.2，95%CI：0.9 - 1.6）。在未调整和调整了人口统计学因素的模型中，较低的CD4细胞计数与较高的肺癌风险相关（所有P < 0.001），但在调整了癌症风险因素和肺炎因素后，这一趋势不再存在。与未感染HIV者相比，在完全调整模型中，CD4细胞数低于200个/微升的感染HIV者患肺癌的风险并未增加。
HIV患者肺癌风险增加归因于人口统计学差异、吸烟等风险因素以及肺炎病史。免疫缺陷似乎对肺癌风险没有独立影响。
