Grupo de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, Madrid, Spain.
CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
J Cancer Res Clin Oncol. 2023 Dec;149(20):18161-18171. doi: 10.1007/s00432-023-05500-9. Epub 2023 Nov 26.
Our aim was to describe non-AIDS-defining cancer (NADC) mortality among people living with HIV (PLWH), to compare it with that of the general population, and to assess potential risk factors.
We included antiretroviral-naive PLWH from the multicentre CoRIS cohort (2004-2021). We estimated mortality rates and standardised mortality ratios (SMRs). We used cause-specific Cox models to identify risk factors.
Among 17,978 PLWH, NADC caused 21% of all deaths observed during the follow-up. Mortality rate due to NADC was 1.58 (95%CI 1.36, 1.83) × 1000 person-years and lung and liver were the most frequent cancer-related causes of death. PLWH had 79% excess NADC mortality risk compared to the general population with the highest SMR found for Hodgkin lymphoma, anal and liver cancers. The SMRs decreased with age and were the highest in age groups under 50 years. The most important prognostic factor was low CD4 count, followed by smoking, viral hepatitis and HIV transmission through heterosexual contact or injection drug use.
Non-AIDS cancers are an important cause of death among PLWH. The excess mortality related to certain malignancies and the association with immunodeficiency, smoking, and coinfections highlights the need for early detection and treatment of cancer in this population.
本研究旨在描述艾滋病毒（HIV）感染者（PLWH）中与艾滋病无关的癌症（NADC）的死亡率，将其与一般人群进行比较，并评估潜在的危险因素。
我们纳入了来自多中心 CoRIS 队列（2004-2021 年）的初治抗逆转录病毒治疗的 PLWH。我们估计了死亡率和标准化死亡率比（SMR）。我们使用基于死因的 Cox 模型来确定危险因素。
在 17978 名 PLWH 中，NADC 导致了随访期间观察到的所有死亡的 21%。NADC 导致的死亡率为 1.58（95%CI 1.36，1.83）×1000 人年，肺和肝是最常见的癌症相关死因。与一般人群相比，PLWH 的 NADC 死亡风险高出 79%，其中霍奇金淋巴瘤、肛门癌和肝癌的 SMR 最高。SMR 随年龄降低，在 50 岁以下年龄组中最高。最重要的预后因素是低 CD4 计数，其次是吸烟、病毒性肝炎以及异性性接触或注射毒品传播的 HIV。
非艾滋病癌症是 PLWH 死亡的一个重要原因。某些恶性肿瘤相关的死亡率过高，以及与免疫缺陷、吸烟和合并感染的关联，强调了在该人群中早期发现和治疗癌症的必要性。
