Makinson Alain, Park Lesley S, Stone Kimberly, Tate Janet, Rodriguez-Barradas Maria C, Brown Sheldon T, Wadia Roxanne, Crothers Kristina, Bedimo Roger, Goetz Matthew Bidwell, Shebl Fatma, Reynes Jacques, Moing Vincent Le, Sigel Keith M
University Hospital Montpellier, Institut National de Science et de Recherche Médicale U1175 and University of Montpellier, Montpellier, France.
Stanford University School of Medicine, Stanford, California, USA.
Open Forum Infect Dis. 2021 Jul 19;8(8):ofab389. doi: 10.1093/ofid/ofab389. eCollection 2021 Aug.
We ascertained incidence of opportunistic infections (OIs) in people with human immunodeficiency virus (PWH) with cancer undergoing chemotherapy with non-human immunodeficiency virus (HIV) comparators.
We identified 2106 PWH and 2981 uninfected Veterans with cancer who received at least 1 dose of chemotherapy between 1996 and 2017 from the Veterans Aging Cohort Study. We ascertained incident OIs within 6 months of chemotherapy amongst zoster, cytomegalovirus, tuberculosis, esophagitis, pneumonia (PCP), toxoplasmosis, Cryptococcosis, atypical infection, bacteremia, histoplasmosis, coccidioidomycosis, or progressive multifocal leukoencephalopathy. We used Poisson methods to calculate OI incidence rates by HIV status, stratifying for hematological and nonhematological tumors. We compared OI rates by HIV status, using inverse probability weights of HIV status, further adjusting for PCP prophylaxis.
We confirmed 106 OIs in 101 persons. Adjusted OI incidence rate ratios (IRRs) indicated higher risk in PWH for all cancers (IRR, 4.8; 95% confidence interval [CI], 2.8-8.2), hematological cancers (IRR, 8.2; 95% CI, 2.4-27.3), and nonhematological cancers (IRR, 3.9; 95% CI, 2.1-7.2). Incidence rate ratios were not significantly higher in those with CD4 >200 cells/mm and viral load <500 copies/mL (IRR, 1.8; 95% CI, 0.9-3.2). All PCP cases (n = 11) occurred in PWH, with 2 microbiologically unconfirmed cases among 1467 PWH with nonhematological cancers, no PCP prophylaxis, and CD4 counts >200/mm.
Veterans with HIV undergoing chemotherapy had higher rates of OIs than uninfected Veterans, particularly those with hematological cancers, but not in PWH with HIV controlled disease. Our study does not support systematic PCP prophylaxis in solid tumors in PWH with HIV controlled disease.
我们确定了感染人类免疫缺陷病毒（HIV）的癌症患者在接受化疗时机会性感染（OI）的发生率，并与未感染HIV的患者进行了比较。
我们从退伍军人老龄化队列研究中识别出2106例感染HIV的癌症患者和2981例未感染HIV的退伍军人癌症患者，他们在1996年至2017年期间接受了至少一剂化疗。我们确定了化疗后6个月内带状疱疹、巨细胞病毒、结核病、食管炎、肺炎（肺孢子菌肺炎）、弓形虫病、隐球菌病、非典型感染、菌血症、组织胞浆菌病、球孢子菌病或进行性多灶性白质脑病等机会性感染的发生率。我们使用泊松方法按HIV感染状况计算机会性感染发生率，并对血液系统和非血液系统肿瘤进行分层。我们通过HIV感染状况比较机会性感染发生率，使用HIV感染状况的逆概率权重，并进一步调整肺孢子菌肺炎预防措施。
我们确认了101例患者发生了106次机会性感染。调整后的机会性感染发生率比（IRR）表明，所有癌症患者（IRR，4.8；95%置信区间[CI]，2.8 - 8.2）、血液系统癌症患者（IRR，8.2；95%CI，2.4 - 27.3）和非血液系统癌症患者（IRR，3.9；95%CI，2.1 - 7.2）中，感染HIV的患者发生机会性感染的风险更高。CD4>200个细胞/mm且病毒载量<500拷贝/mL的患者，其发生率比没有显著升高（IRR，1.8；95%CI，0.9 - 3.2）。所有肺孢子菌肺炎病例（n = 11）均发生在感染HIV的患者中，在1467例患有非血液系统癌症、未接受肺孢子菌肺炎预防措施且CD4计数>200/mm的感染HIV患者中，有2例微生物学确诊病例。
接受化疗的感染HIV的退伍军人比未感染的退伍军人发生机会性感染的比率更高，尤其是那些患有血液系统癌症的患者，但在疾病得到控制的感染HIV患者中并非如此。我们的研究不支持对疾病得到控制的感染HIV的实体瘤患者进行系统性肺孢子菌肺炎预防。
