简要报告：亚洲艾滋病毒感染者中的成人恶性肿瘤。

Brief Report: Malignancies in Adults Living With HIV in Asia.

机构信息

The Kirby Institute, UNSW, Sydney, NSW, Australia.

Taipei Veterans General Hospital, Taipei, Taiwan.

出版信息

J Acquir Immune Defic Syndr. 2019 Mar 1;80(3):301-307. doi: 10.1097/QAI.0000000000001918.

DOI:10.1097/QAI.0000000000001918

PMID:30531303

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6375805/

Abstract

BACKGROUND

Hematological malignancies have continued to be highly prevalent among people living with HIV (PLHIV). This study assessed the occurrence of, risk factors for, and outcomes of hematological and nonhematological malignancies in PLHIV in Asia.

METHODS

Incidence of malignancy after cohort enrollment was evaluated. Factors associated with development of hematological and nonhematological malignancy were analyzed using competing risk regression and survival time using Kaplan-Meier.

RESULTS

Of 7455 patients, 107 patients (1%) developed a malignancy: 34 (0.5%) hematological [0.08 per 100 person-years (/100PY)] and 73 (1%) nonhematological (0.17/100PY). Of the hematological malignancies, non-Hodgkin lymphoma was predominant (n = 26, 76%): immunoblastic (n = 6, 18%), Burkitt (n = 5, 15%), diffuse large B-cell (n = 5, 15%), and unspecified (n = 10, 30%). Others include central nervous system lymphoma (n = 7, 21%) and myelodysplastic syndrome (n = 1, 3%). Nonhematological malignancies were mostly Kaposi sarcoma (n = 12, 16%) and cervical cancer (n = 10, 14%). Risk factors for hematological malignancy included age >50 vs. ≤30 years [subhazard ratio (SHR) = 6.48, 95% confidence interval (CI): 1.79 to 23.43] and being from a high-income vs. a lower-middle-income country (SHR = 3.97, 95% CI: 1.45 to 10.84). Risk was reduced with CD4 351-500 cells/µL (SHR = 0.20, 95% CI: 0.05 to 0.74) and CD4 >500 cells/µL (SHR = 0.14, 95% CI: 0.04 to 0.78), compared to CD4 ≤200 cells/µL. Similar risk factors were seen for nonhematological malignancy, with prior AIDS diagnosis showing a weak association. Patients diagnosed with a hematological malignancy had shorter survival time compared to patients diagnosed with a nonhematological malignancy.

CONCLUSIONS

Nonhematological malignancies were common but non-Hodgkin lymphoma was more predominant in our cohort. PLHIV from high-income countries were more likely to be diagnosed, indicating a potential underdiagnosis of cancer in low-income settings.

摘要

背景

血液系统恶性肿瘤在 HIV 感染者（PLHIV）中仍高度流行。本研究评估了亚洲 PLHIV 中血液系统和非血液系统恶性肿瘤的发生、危险因素和结局。

方法

评估了队列入组后恶性肿瘤的发生情况。使用竞争风险回归分析和 Kaplan-Meier 分析评估与血液系统和非血液系统恶性肿瘤发生相关的因素。

结果

在 7455 名患者中，有 107 名（1%）患者发生恶性肿瘤：34 名（0.5%）血液系统恶性肿瘤（0.08/100 人年[100PY]）和 73 名（1%）非血液系统恶性肿瘤（0.17/100PY）。在血液系统恶性肿瘤中，非霍奇金淋巴瘤占主导地位（n=26，76%）：免疫母细胞性（n=6，18%）、伯基特（n=5，15%）、弥漫性大 B 细胞（n=5，15%）和未特指（n=10，30%）。其他包括中枢神经系统淋巴瘤（n=7，21%）和骨髓增生异常综合征（n=1，3%）。非血液系统恶性肿瘤主要为卡波西肉瘤（n=12，16%）和宫颈癌（n=10，14%）。血液系统恶性肿瘤的危险因素包括年龄＞50 岁与≤30 岁（亚危险比[SHR]=6.48，95%置信区间[CI]：1.79 至 23.43）和来自高收入与中低收入国家（SHR=3.97，95%CI：1.45 至 10.84）。与 CD4 细胞计数≤200 个/μL 相比，CD4 细胞计数为 351-500 个/μL（SHR=0.20，95%CI：0.05 至 0.74）和 CD4 细胞计数＞500 个/μL（SHR=0.14，95%CI：0.04 至 0.78）时风险降低。非血液系统恶性肿瘤也存在类似的危险因素，既往 AIDS 诊断与风险呈弱相关。与诊断为非血液系统恶性肿瘤的患者相比，诊断为血液系统恶性肿瘤的患者生存时间更短。