Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
Nat Rev Urol. 2024 Jun;21(6):373-383. doi: 10.1038/s41585-023-00846-8. Epub 2024 Jan 18.
The number of people living with HIV infection has been increasing globally. Administration of antiretroviral therapy is effective in controlling the infection for most patients and, as a consequence, people living with HIV (PLWH) now often have a long life expectancy. However, their risk of developing cancer - most notably virus-related cancers - has been increasing. To date, few studies have assessed the risk of genitourinary cancers in PLWH, and robust scientific data on their treatment-related outcomes are lacking. Previous studies have noted that PLWH are at a reduced risk of prostate cancer; however, low adoption and/or availability of prostate cancer screening among these patients might be confounding the validity of this finding. In genitourinary cancers, advanced stage at diagnosis and reduced cancer-specific mortality have been reported in PLWH. These data likely reflect, at least in part, the inequity of health care access for PLWH. Notably, systemic chemotherapy and/or radiotherapy could decrease total CD4 cell counts, which could, therefore, increase the risk of morbidity and mortality from cancer treatments in PLWH. Immune checkpoint inhibitors have become the therapeutic backbone for many advanced malignancies in the general population; however, most studies validating their efficacy have excluded PLWH owing to concerns of severe adverse effects from immune checkpoint inhibitors themselves and/or related to their immunosuppressed status. To our knowledge, no genitourinary cancer survivorship programme exists that specifically caters to the needs of PLWH. By including PLWH in ongoing cancer trials, we can gain invaluable insights that will help to improve cancer care specifically for PLWH.
全球范围内，感染艾滋病毒的人数一直在增加。抗逆转录病毒疗法的应用在控制大多数患者的感染方面非常有效，因此，艾滋病毒感染者（PLWH）现在的预期寿命通常很长。然而，他们罹患癌症的风险——尤其是与病毒相关的癌症——一直在增加。迄今为止，很少有研究评估艾滋病毒感染者发生泌尿系统癌症的风险，并且缺乏有关其治疗相关结果的可靠科学数据。先前的研究指出，艾滋病毒感染者罹患前列腺癌的风险较低；然而，这些患者中前列腺癌筛查的采用率和/或可及性较低，可能会影响这一发现的有效性。在泌尿系统癌症中，艾滋病毒感染者的诊断时分期较晚和癌症特异性死亡率降低的情况已有报道。这些数据可能至少部分反映了艾滋病毒感染者获得医疗保健的机会不平等。值得注意的是，全身化疗和/或放疗可能会降低总 CD4 细胞计数，从而增加艾滋病毒感染者接受癌症治疗的发病率和死亡率。免疫检查点抑制剂已成为普通人群中许多晚期恶性肿瘤的治疗基础；然而，由于担心免疫检查点抑制剂本身以及与免疫抑制状态相关的严重不良反应，大多数验证其疗效的研究都排除了艾滋病毒感染者。据我们所知，目前还没有专门针对艾滋病毒感染者需求的泌尿系统癌症生存者计划。通过将艾滋病毒感染者纳入正在进行的癌症试验，我们可以获得宝贵的见解，这将有助于专门为艾滋病毒感染者改善癌症护理。
