Cornejo-Juárez P, Cavildo-Jerónimo D, Volkow-Fernández P
Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22 Col. Sección XVI, Del. Tlalpan, 14000, Mexico City, CDMX, Mexico.
AIDS Res Ther. 2018 Oct 27;15(1):16. doi: 10.1186/s12981-018-0202-2.
Non-AIDS defining cancers (NADCs) have been an increasing cause of morbidity and mortality in patients with HIV. There is no data on the spectrum of NADCs in Mexico. We describe the type of neoplasms, clinical characteristics, and outcomes of HIV-infected patients with NADCs.
We conducted a retrospective study of all patients with confirmed diagnosis of NADC attending the HIV/AIDS clinic at the National Cancer Institute in Mexico City (a tertiary-care center for adult patients with cancer) from January 1990 to December 2016.
From 1126 HIV-positive individuals seen at the institute since 1990, 127 (11.3%) were diagnosed with NADCs; seven patients developed two NADCs during their follow-up. At diagnosis of NADC median age was 43.7 ± 10.9 years; 101 (79.5%) were male; median CD4 was 273 cells/mm, 70 patients had a CD4 count of > 200 cells/mm, 73 had undetectable HIV viral load and 82 had taken combined antiretroviral therapy (cART) for more than 1 year. The most frequent NADCs were in men, Hodgkin lymphoma (34.3%) followed by anal cancer (15.7%), whereas in women, were vulvo-vaginal cancers associated to human papilloma virus (HPV) (51.8%), followed by breast cancer (25.9%). The main risk factor associated with death was cancer progression or relapse (OR, 28.2, 2.5-317.1; p = 0.007).
HL- and HPV-related neoplasms are the commonest NADC in a cancer referral hospital from a middle-income country with universal access to cART since year 2005. Screening for early anogenital lesions should be emphasized in patients with HIV. It is essential to establish multidisciplinary groups involving Hemato-oncologists, Oncologists, Gynecologists, and HIV Specialists in the treatment of these patients.
非艾滋病定义性癌症（NADC）已成为艾滋病患者发病和死亡的一个日益重要的原因。墨西哥尚无关于NADC谱的数据。我们描述了NADC的肿瘤类型、临床特征以及感染艾滋病毒患者的治疗结果。
我们对1990年1月至2016年12月期间在墨西哥城国家癌症研究所（一家成年癌症患者三级护理中心）的艾滋病毒/艾滋病诊所确诊为NADC的所有患者进行了回顾性研究。
自1990年以来在该研究所就诊的1126例艾滋病毒阳性个体中，127例（11.3%）被诊断为NADC；7例患者在随访期间发生了两种NADC。NADC诊断时的中位年龄为43.7±10.9岁；101例（79.5%）为男性；中位CD4为273个细胞/mm，70例患者的CD4计数>200个细胞/mm，73例患者的艾滋病毒病毒载量检测不到，82例患者接受联合抗逆转录病毒治疗（cART）超过1年。男性中最常见的NADC是霍奇金淋巴瘤（34.3%），其次是肛门癌（15.7%），而女性中则是与人乳头瘤病毒（HPV）相关的外阴阴道癌（51.8%），其次是乳腺癌（25.9%）。与死亡相关的主要危险因素是癌症进展或复发（OR，28.2，2.5 - 317.1；p = 0.007）。
自2005年以来，在一个普遍可获得cART的中等收入国家的癌症转诊医院中，HL和HPV相关肿瘤是最常见的NADC。应强调对艾滋病毒患者进行早期肛门生殖器病变筛查。在这些患者的治疗中，建立由血液肿瘤学家、肿瘤学家、妇科医生和艾滋病毒专家组成的多学科团队至关重要。
