Coghill Anna E, Pfeiffer Ruth M, Shiels Meredith S, Engels Eric A
Division of Cancer Epidemiology and Genetics, NCI, Rockville, Maryland.
Cancer Epidemiol Biomarkers Prev. 2017 Jul;26(7):1027-1033. doi: 10.1158/1055-9965.EPI-16-0964. Epub 2017 Jun 15.
Human immunodefieciency virus (HIV)-infected persons are living longer in the era of effective HIV treatment, resulting in an increasing cancer burden in this population. The combined effects of HIV and cancer on mortality are incompletely understood. We examined whether individuals with both HIV and cancer have excess mortality using data from the HIV/AIDS Cancer Match Study and the National Center for Health Statistics (1996-2010). We compared age, sex, and race-stratified mortality between people with and without HIV or one of the following cancers: lung, breast, prostate, colorectum, anus, Hodgkin lymphoma, or non-Hodgkin lymphoma. We utilized additive Poisson regression models that included terms for HIV, cancer, and an interaction for their combined effect on mortality. We report the number of excess deaths per 1,000 person-years for models with a significant interaction ( < 0.05). For all cancers examined except prostate cancer, at least one demographic subgroup of HIV-infected cancer patients experienced significant excess mortality. Excess mortality was most pronounced at younger ages (30-49 years), with large excesses for males with lung cancer (white race: 573 per 1,000 person-years; non-white: 503) and non-Hodgkin lymphoma (white: 236; non-white: 261), and for females with Hodgkin lymphoma (white: 216; non-white: 136) and breast cancer (non-white: 107). In the era of effective HIV treatment, overall mortality in patients with both HIV and cancer was significantly higher than expected on the basis of mortality rates for each disease separately. These results suggest that HIV may contribute to cancer progression and highlight the importance of improved cancer prevention and care for the U.S. HIV population. .
在有效的艾滋病治疗时代，感染人类免疫缺陷病毒（HIV）的人寿命延长，导致该人群的癌症负担日益加重。人们对HIV与癌症对死亡率的综合影响尚未完全了解。我们利用来自HIV/艾滋病癌症匹配研究和国家卫生统计中心（1996 - 2010年）的数据，研究了同时感染HIV和患癌症的个体是否有过高的死亡率。我们比较了感染HIV者与未感染HIV者，以及患以下癌症之一（肺癌、乳腺癌、前列腺癌、结直肠癌、肛门癌、霍奇金淋巴瘤或非霍奇金淋巴瘤）者按年龄、性别和种族分层的死亡率。我们使用了相加泊松回归模型，其中包括HIV、癌症的项以及它们对死亡率综合影响的交互项。对于具有显著交互作用（<0.05）的模型，我们报告每1000人年的额外死亡人数。除前列腺癌外，在所研究的所有癌症中，至少有一个感染HIV的癌症患者人口亚组经历了显著的过高死亡率。过高死亡率在较年轻年龄段（30 - 49岁）最为明显，肺癌男性（白人种族：每1000人年573例；非白人：503例）和非霍奇金淋巴瘤男性（白人：236例；非白人：261例），以及霍奇金淋巴瘤女性（白人：216例；非白人：136例）和乳腺癌女性（非白人：107例）的额外死亡率很高。在有效的HIV治疗时代，同时感染HIV和患癌症患者的总体死亡率显著高于根据每种疾病单独的死亡率所预期的水平。这些结果表明，HIV可能促进癌症进展，并凸显了改善美国HIV人群癌症预防和护理的重要性。
