Veterans Affairs North Texas Healthcare System, University of Texas Southwestern Medical Center, Dallas, Texas.
Stanford University School of Medicine, Palo Alto, California.
AIDS. 2021 Feb 2;35(2):325-334. doi: 10.1097/QAD.0000000000002748.
To determine whether statin exposure is associated with decreased cancer and mortality risk among persons with HIV (PWH) and uninfected persons. Statins appear to have immunomodulatory and anti-inflammatory effects and may reduce cancer risk, particularly among PWH as they experience chronic inflammation and immune activation.
Propensity score-matched cohort of statin-exposed and unexposed patients from 2002 to 2017 in the Veterans Aging Cohort Study (VACS), a large cohort with cancer registry linkage and detailed pharmacy data.
We calculated Cox regression hazard ratios (HRs) and 95% confidence intervals (CI) associated with statin use for all cancers, microbial cancers (associated with bacterial or oncovirus coinfection), nonmicrobial cancers, and mortality.
:The propensity score-matched sample (N = 47 940) included 23 970 statin initiators (31% PWH). Incident cancers were diagnosed in 1160 PWH and 2116 uninfected patients. Death was reported in 1667 (7.0%) statin-exposed, and 2215 (9.2%) unexposed patients. Statin use was associated with 24% decreased risk of microbial-associated cancers (hazard ratio 0.76; 95% CI 0.69-0.85), but was not associated with nonmicrobial cancer risk (hazard ratio 1.00; 95% CI 0.92-1.09). Statin use was associated with 33% lower risk of death overall (hazard ratio 0.67; 95% CI 0.63-0.72). Results were similar in analyses stratified by HIV status, except for non-Hodgkin lymphoma where statin use was associated with reduced risk (hazard ratio 0.56; 95% CI 0.38-0.83) for PWH, but not for uninfected (P interaction = 0.012).
In both PWH and uninfected, statin exposure was associated with lower risk of microbial, but not nonmicrobial cancer incidence, and with decreased mortality.
确定他汀类药物暴露是否与艾滋病毒感染者（PWH）和未感染者的癌症和死亡风险降低相关。他汀类药物似乎具有免疫调节和抗炎作用，并且可以降低癌症风险，尤其是在 PWH 中，因为他们经历慢性炎症和免疫激活。
来自退伍军人老龄化队列研究（VACS）的 2002 年至 2017 年期间接受他汀类药物治疗和未接受他汀类药物治疗的患者的倾向评分匹配队列，这是一个具有癌症登记链接和详细药房数据的大型队列。
我们计算了与他汀类药物使用相关的所有癌症、微生物癌症（与细菌或致癌病毒合并感染相关）、非微生物癌症和死亡率的 Cox 回归风险比（HR）和 95%置信区间（CI）。
倾向评分匹配的样本（N=47940）包括 23970 名他汀类药物起始者（31%为 PWH）。在 1160 名 PWH 和 2116 名未感染者中诊断出了癌症。在 1667 名（7.0%）接受他汀类药物治疗的患者和 2215 名（9.2%）未接受他汀类药物治疗的患者中报告了死亡。他汀类药物治疗与微生物相关癌症风险降低 24%相关（风险比 0.76；95%CI 0.69-0.85），但与非微生物癌症风险无关（风险比 1.00；95%CI 0.92-1.09）。他汀类药物治疗与总体死亡率降低 33%相关（风险比 0.67；95%CI 0.63-0.72）。在按 HIV 状态分层的分析中，结果相似，除了非霍奇金淋巴瘤，在 PWH 中，他汀类药物治疗与风险降低相关（风险比 0.56；95%CI 0.38-0.83），但在未感染者中无此关联（P 交互作用=0.012）。
在 PWH 和未感染者中，他汀类药物暴露与微生物癌症风险降低相关，而非非微生物癌症风险，并且与死亡率降低相关。
