AIDS. 2021 Apr 1;35(5):747-757. doi: 10.1097/QAD.0000000000002791.
It is unknown if the carcinogenic effect of smoking is influenced by CD4+ cell count and viral load in persons living with HIV.
RESPOND participants with known smoking status were included. Poisson regression adjusting for baseline confounders investigated the interaction between current CD4+/viral load strata [good (CD4+ cell count ≥500 cells/μl and viral load <200 copies/ml], poor [CD4+ cell count ≤350 cells/μl and viral load >200 copies/ml] and intermediate [all other combinations]), smoking status and all cancers, non-AIDS defining cancers (NADCs), smoking-related cancers (SRCs) and infection-related cancers (IRCs).
Out of 19 602 persons, 41.3% were never smokers, 44.4% current and 14.4% previous smokers at baseline. CD4+/viral load strata were poor in 3.4%, intermediate in 44.8% and good in 51.8%. There were 513 incident cancers; incidence rate 6.9/1000 person-years of follow-up (PYFU) [95% confidence interval (95% CI) 6.3-7.5]. Current smokers had higher incidence of all cancer (adjusted incidence rate ratio 1.45; 1.17-1.79), NADC (1.65; 1.31-2.09), SRC (2.21; 1.53-3.20) and IRC (1.38; 0.97-1.96) vs. never smokers. Those with poor CD4+/viral load had increased incidence of all cancer (5.36; 95% CI 3.71-7.75), NADC (3.14; 1.92-5.14), SRC (1.82; 0.76-4.41) and IRC (10.21; 6.06-17.20) vs. those with good CD4+/viral load. There was no evidence that the association between smoking and cancer subtypes differed depending on the CD4+/viral load strata (P > 0.1, test for interaction).
In the large RESPOND consortium, the impact of smoking on cancer was clear and reducing smoking rates should remain a priority. The association between current immune deficiency, virological control and cancer was similar for never smokers, current smokers and previous smokers suggesting similar carcinogenic effects of smoking regardless of CD4+ cell count and viral load.
目前尚不清楚 CD4+ 细胞计数和病毒载量是否会影响 HIV 感染者的吸烟致癌作用。
纳入已知吸烟状况的 RESPOND 参与者。使用泊松回归调整基线混杂因素，调查了当前 CD4+/病毒载量分层[良好（CD4+ 细胞计数≥500 个/μl 和病毒载量<200 拷贝/ml）、差（CD4+ 细胞计数≤350 个/μl 和病毒载量>200 拷贝/ml）和中等（所有其他组合）]、吸烟状况与所有癌症、非艾滋病定义癌症（NADC）、与吸烟相关癌症（SRC）和与感染相关癌症（IRC）之间的交互作用。
在 19602 人中，41.3%为从不吸烟者，44.4%为当前吸烟者，14.4%为既往吸烟者。CD4+/病毒载量分层差占 3.4%，中等占 44.8%，良好占 51.8%。共有 513 例新发癌症；发病率为 6.9/1000 人年随访（PYFU）[95%置信区间（95%CI）6.3-7.5]。与从不吸烟者相比，当前吸烟者的所有癌症（校正发病率比 1.45；1.17-1.79）、NADC（1.65；1.31-2.09）、SRC（2.21；1.53-3.20）和 IRC（1.38；0.97-1.96）发病率更高。CD4+/病毒载量差的患者所有癌症（5.36；95%CI 3.71-7.75）、NADC（3.14；1.92-5.14）、SRC（1.82；0.76-4.41）和 IRC（10.21；6.06-17.20）的发病率均高于 CD4+/病毒载量良好的患者。没有证据表明吸烟与癌症亚型之间的关联因 CD4+/病毒载量分层而异（P>0.1，交互作用检验）。
在大型 RESPOND 研究联盟中，吸烟对癌症的影响是明确的，降低吸烟率仍应是当务之急。当前免疫缺陷、病毒学控制与癌症之间的关联在从未吸烟者、当前吸烟者和既往吸烟者中相似，这表明无论 CD4+ 细胞计数和病毒载量如何，吸烟的致癌作用相似。
