艾滋病毒感染者退伍军人中病毒抑制与艾滋病定义和非艾滋病定义癌症发病率降低的相关性：一项前瞻性队列研究。
Association of Viral Suppression With Lower AIDS-Defining and Non-AIDS-Defining Cancer Incidence in HIV-Infected Veterans: A Prospective Cohort Study.
机构信息
Stanford Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California (L.S.P.).
Veterans Affairs Connecticut Healthcare System, West Haven, and Yale School of Medicine, New Haven, Connecticut (J.P.T., A.C.J.).
出版信息
Ann Intern Med. 2018 Jul 17;169(2):87-96. doi: 10.7326/M16-2094. Epub 2018 Jun 12.
BACKGROUND
Viral suppression is a primary marker of HIV treatment success. Persons with HIV are at increased risk for AIDS-defining cancer (ADC) and several types of non-AIDS-defining cancer (NADC), some of which are caused by oncogenic viruses.
OBJECTIVE
To determine whether viral suppression is associated with decreased cancer risk.
DESIGN
Prospective cohort.
SETTING
Department of Veterans Affairs.
PARTICIPANTS
HIV-positive veterans (n = 42 441) and demographically matched uninfected veterans (n = 104 712) from 1999 to 2015.
MEASUREMENTS
Standardized cancer incidence rates and Poisson regression rate ratios (RRs; HIV-positive vs. uninfected persons) by viral suppression status (unsuppressed: person-time with HIV RNA levels ≥500 copies/mL; early suppression: initial 2 years with HIV RNA levels <500 copies/mL; long-term suppression: person-time after early suppression with HIV RNA levels <500 copies/mL).
RESULTS
Cancer incidence for HIV-positive versus uninfected persons was highest for unsuppressed persons (RR, 2.35 [95% CI, 2.19 to 2.51]), lower among persons with early suppression (RR, 1.99 [CI, 1.87 to 2.12]), and lowest among persons with long-term suppression (RR, 1.52 [CI, 1.44 to 1.61]). This trend was strongest for ADC (unsuppressed: RR, 22.73 [CI, 19.01 to 27.19]; early suppression: RR, 9.48 [CI, 7.78 to 11.55]; long-term suppression: RR, 2.22 [CI, 1.69 to 2.93]), much weaker for NADC caused by viruses (unsuppressed: RR, 3.82 [CI, 3.24 to 4.49]; early suppression: RR, 3.42 [CI, 2.95 to 3.97]; long-term suppression: RR, 3.17 [CI, 2.78 to 3.62]), and absent for NADC not caused by viruses.
LIMITATION
Lower viral suppression thresholds, duration of long-term suppression, and effects of CD4+ and CD8+ T-cell counts were not thoroughly evaluated.
CONCLUSION
Antiretroviral therapy resulting in long-term viral suppression may contribute to cancer prevention, to a greater degree for ADC than for NADC. Patients with long-term viral suppression still had excess cancer risk.
PRIMARY FUNDING SOURCE
National Cancer Institute and National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.
背景
病毒抑制是 HIV 治疗成功的主要标志。HIV 感染者患艾滋病定义性癌症（ADC）和几种非艾滋病定义性癌症（NADC）的风险增加，其中一些癌症是由致癌病毒引起的。
目的
确定病毒抑制是否与降低癌症风险有关。
设计
前瞻性队列研究。
地点
退伍军人事务部。
参与者
1999 年至 2015 年间，HIV 阳性退伍军人（n=42441）和匹配的未感染退伍军人（n=104712）。
测量
标准化癌症发病率和泊松回归率比（RR；HIV 阳性与未感染人群）按病毒抑制状态（未抑制：HIV RNA 水平≥500 拷贝/mL 的个体时间；早期抑制：HIV RNA 水平<500 拷贝/mL 的最初 2 年；长期抑制：早期抑制后 HIV RNA 水平<500 拷贝/mL 的个体时间）。
结果
与未感染人群相比，HIV 阳性人群的癌症发病率最高（未抑制人群 RR，2.35 [95%CI，2.19 至 2.51]），早期抑制人群 RR（1.99 [CI，1.87 至 2.12]）较低，长期抑制人群 RR（1.52 [CI，1.44 至 1.61]）最低。这种趋势在 ADC（未抑制：RR，22.73 [CI，19.01 至 27.19]；早期抑制：RR，9.48 [CI，7.78 至 11.55]；长期抑制：RR，2.22 [CI，1.69 至 2.93]）中最强，在病毒引起的 NADC 中较弱（未抑制：RR，3.82 [CI，3.24 至 4.49]；早期抑制：RR，3.42 [CI，2.95 至 3.97]；长期抑制：RR，3.17 [CI，2.78 至 3.62]），在非病毒引起的 NADC 中不存在。
局限性
未彻底评估较低的病毒抑制阈值、长期抑制的持续时间以及 CD4+和 CD8+T 细胞计数的影响。
结论
导致长期病毒抑制的抗逆转录病毒疗法可能有助于预防癌症，对 ADC 的作用大于对 NADC 的作用。长期病毒抑制的患者仍然存在癌症风险增加。
主要资金来源
美国国立卫生研究院国家癌症研究所和国家酒精滥用和酒精中毒研究所。
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