加拿大安大略省艾滋病毒感染者癌症负担，1997-2020 年：基于行政健康数据的回顾性人群队列研究。
The burden of cancer among people living with HIV in Ontario, Canada, 1997-2020: a retrospective population-based cohort study using administrative health data.
机构信息
Division of Epidemiology Toronto (Nicolau, Brooks, Cotterchio, Gillis, Burchell, Dalla Lana School of Public Health, University of Toronto; ICES Central (Antoniou, Moineddin, Kendall, Burchell); Unity Health Toronto (Antoniou, Lindsay, Burchell), St Michael's Hospital; Department of Family and Community Medicine (Moineddin, Burchell), University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Cooper), Ottawa, Ont.; Ontario Health (Cancer Care Ontario) (Cotterchio), Toronto, Ont.; Department of Medicine (Gillis), School of Population and Public Health, University of British Columbia, Vancouver, BC; Bruyère Research Institute (Kendall); ICES uOttawa (Kendall); Department of Family Medicine (Kendall), University of Ottawa; Institut du Savoir Montfort (Kendall); Clinical Epidemiology Program (Kendall), Ottawa Hospital Research Institute, Ottawa, Ont.; Ontario HIV Treatment Network (Kroch), Toronto, Ont.; CIHR Canadian HIV Trials Network - Chronic Pain and HIV Working Group (Price); British Columbia Centre for Excellence in HIV/AIDS (Salters), Vancouver, BC; Department of Pathology and Molecular Medicine (Smieja), McMaster University (Smieja), Hamilton, Ont.
出版信息
CMAJ Open. 2022 Jul 19;10(3):E666-E674. doi: 10.9778/cmajo.20220012. Print 2022 Jul-Sep.
BACKGROUND
With combination antiretroviral therapy (ART) and increased longevity, cancer is a leading cause of morbidity among people with HIV. We characterized trends in cancer burden among people with HIV in Ontario, Canada, between 1997 and 2020.
METHODS
We conducted a population-based, retrospective cohort study of adults with HIV using linked administrative health databases from Jan. 1, 1997, to Nov. 1, 2020. We grouped cancers as infection-related AIDS-defining cancers (ADCs), infection-related non-ADCs (NADCs) and infection-unrelated cancers. We calculated age-standardized incidence rates per 100 000 person-years with 95% confidence intervals (CIs) using direct standardization, stratified by calendar period and sex. We also calculated limited-duration prevalence.
RESULTS
Among 19 403 adults living with HIV (79% males), 1275 incident cancers were diagnosed. From 1997-2000 to 2016- 2020, we saw a decrease in the incidence of all cancers (1113.9 [95% CI 657.7-1765.6] to 683.5 [95% CI 613.4-759.4] per 100 000 person-years), ADCs (403.1 [95% CI 194.2-739.0] to 103.8 [95% CI 79.2-133.6] per 100 000 person-years) and infection-related NADCs (196.6 [95% CI 37.9-591.9] to 121.9 [95% CI 94.3-154.9] per 100 000 person-years). The incidence of infection-unrelated cancers was stable at 451.0 per 100 000 person-years (95% CI 410.3-494.7). The incidence of cancer among females increased over time but was similar to that of males in 2016-2020.
INTERPRETATION
Over a 24-year period, the incidence of cancer decreased overall, largely driven by a considerable decrease in the incidence of ADC, whereas the incidence of infection-unrelated cancer remained unchanged and contributed to the greatest burden of cancer. These findings could reflect combination ART-mediated changes in infectious comorbidity and increased life expectancy; targeted cancer screening and prevention strategies are needed.
背景
随着联合抗逆转录病毒疗法（ART）的应用和寿命的延长，癌症已成为艾滋病毒感染者发病的主要原因。本研究旨在描述 1997 年至 2020 年间安大略省艾滋病毒感染者癌症负担的趋势。
方法
我们对 1997 年 1 月 1 日至 2020 年 11 月 1 日期间通过链接的行政健康数据库进行了一项基于人群的回顾性队列研究，研究对象为艾滋病毒感染者。我们将癌症分为感染相关艾滋病定义性癌症（ADCs）、感染相关非艾滋病定义性癌症（NADCs）和感染无关癌症。我们采用直接标准化法计算了每 100000 人年的年龄标准化发病率及其 95%置信区间（CI），并按日历时间和性别分层。我们还计算了有限期限的患病率。
结果
在 19403 名成年艾滋病毒感染者（79%为男性）中，诊断出 1275 例癌症新发病例。从 1997-2000 年至 2016-2020 年，所有癌症（1113.9[95%CI 657.7-1765.6]至 683.5[95%CI 613.4-759.4]）、ADCs（403.1[95%CI 194.2-739.0]至 103.8[95%CI 79.2-133.6]）和感染相关 NADCs（196.6[95%CI 37.9-591.9]至 121.9[95%CI 94.3-154.9]）的发病率均有所下降。感染无关癌症的发病率保持稳定，为 451.0[95%CI 410.3-494.7]。女性癌症的发病率随时间推移而增加，但在 2016-2020 年与男性相似。
结论
在 24 年期间，癌症的发病率总体下降，主要是由于 ADC 发病率的显著下降所致，而感染无关癌症的发病率保持不变，是癌症负担最大的原因。这些发现可能反映了联合抗逆转录病毒疗法介导的传染性合并症和预期寿命的变化；需要制定有针对性的癌症筛查和预防策略。
Zotero 插件