Harvard Medical School, Boston, Massachusetts, USA.
University of Washington, Seattle, Washington, USA.
HIV Med. 2022 Jul;23(6):620-628. doi: 10.1111/hiv.13218. Epub 2021 Dec 23.
We assessed the incidence of extrahepatic cancer among people with HIV/HCV coinfection and the potential impact of direct-acting antivirals (DAAs) on extrahepatic cancer risk among people with HIV/HCV coinfection.
Our study cohort included adults who initiated HIV care at a CNICS site in the US during 1995-2017, excluding those with previous cancer and without HCV testing.
We used Cox regression to estimate hazard ratios for extrahepatic cancer incidence among patients with HIV/HCV coinfection compared with those with HIV monoinfection. Standardized morbidity ratio (SMR) weights were used to create a 'pseudopopulation' in which all patients were treated with antiretroviral therapy (ART), and to compare extrahepatic cancer incidence among patients with untreated HIV/HCV coinfection with the incidence that would have been observed if they had been successfully treated for HCV.
Of 18 422 adults, 1775 (10%) had HCV RNA and 10 899 (59%) were on ART at baseline. Incidence rates of any extrahepatic cancer among patients with HIV/HCV coinfection and HIV monoinfection were 1027 and 771 per 100 000 person-years, respectively. In SMR-weighted analyses, the risk of any extrahepatic cancer among patients with untreated HCV coinfection at baseline was similar to the risk if they had been successfully treated for HCV. Patients with untreated HCV coinfection at baseline had higher incidence of kidney, lung and inflammation-related cancers than if their HCV had been successfully treated, but these associations were not statistically significant.
We did not find evidence that treating HCV coinfection with DAAs would reduce the incidence of extrahepatic cancers among people with HIV receiving ART.
评估 HIV/HCV 合并感染人群的肝外癌症发病率，以及直接作用抗病毒药物（DAA）对 HIV/HCV 合并感染人群肝外癌症风险的潜在影响。
我们的研究队列包括在美国 CNICS 站点开始接受 HIV 护理的成年人，排除了既往癌症和未接受 HCV 检测的患者。
我们使用 Cox 回归估计与 HIV 单感染患者相比，HIV/HCV 合并感染患者的肝外癌症发病率的风险比。使用标准化发病比（SMR）权重创建一个“虚拟人群”，其中所有患者均接受抗逆转录病毒治疗（ART），并比较未经治疗的 HIV/HCV 合并感染患者的肝外癌症发病率与如果成功治疗 HCV 本应观察到的发病率。
在 18422 名成年人中，1775 名（10%）有 HCV RNA，10899 名（59%）在基线时接受 ART。HIV/HCV 合并感染和 HIV 单感染患者的任何肝外癌症的发生率分别为每 100000 人年 1027 例和 771 例。在 SMR 加权分析中，基线时未经治疗的 HCV 合并感染患者的任何肝外癌症风险与成功治疗 HCV 的风险相似。基线时未经治疗的 HCV 合并感染患者的肾脏、肺部和炎症相关癌症的发病率高于成功治疗 HCV 的患者，但这些关联无统计学意义。
我们没有发现证据表明用 DAA 治疗 HCV 合并感染会降低接受 ART 的 HIV 患者肝外癌症的发病率。
