Lurain Kathryn, Yarchoan Robert, Ramaswami Ramya
1 HIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
Am Soc Clin Oncol Educ Book. 2019 Jan;39:36-40. doi: 10.1200/EDBK_100017. Epub 2019 May 17.
Because of tremendous advances in HIV care, the survival of many people living with HIV (PLWH) now approaches that of the general population. This has led to a shift in the types of malignancies diagnosed among PLWH from AIDS-defining cancers during the height of the HIV epidemic toward more non-AIDS-defining cancers and age-related incidental cancers in the last 2 decades. Despite these trends, positive cancer outcomes still lag behind patients without HIV, and many PLWH never receive appropriate cancer therapy. We explore the reasons for the epidemiologic shift that has been observed, as well as the factors that influence treatment disparities. Furthermore, several studies have demonstrated similar cancer survival rates when PLWH and certain cancers receive the same treatment as those who are HIV-negative. Among possible solutions to improve cancer outcomes include increasing the inclusion of PLWH in clinical trials, using guidelines specific for the treatment of HIV-associated malignancies, and incorporating a multidisciplinary approach to cancer management in PLWH.
由于艾滋病护理取得了巨大进展，许多艾滋病毒感染者（PLWH）的生存期现已接近普通人群。这导致了艾滋病毒感染者中诊断出的恶性肿瘤类型发生了转变，从艾滋病毒流行高峰期的艾滋病相关定义癌症，转向过去20年中更多的非艾滋病相关定义癌症和与年龄相关的偶发性癌症。尽管有这些趋势，但癌症的积极治疗结果仍落后于未感染艾滋病毒的患者，许多艾滋病毒感染者从未接受过适当的癌症治疗。我们探讨了已观察到的流行病学转变的原因，以及影响治疗差距的因素。此外，几项研究表明，当艾滋病毒感染者和某些癌症患者接受与艾滋病毒阴性患者相同的治疗时，癌症生存率相似。改善癌症治疗结果的可能解决方案包括增加艾滋病毒感染者参与临床试验的比例，使用针对艾滋病毒相关恶性肿瘤治疗的特定指南，以及对艾滋病毒感染者采用多学科方法进行癌症管理。
